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Contact CDCEnglish and Spanish International Travel
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What are noroviruses? Noroviruses are members of a group of viruses called caliciviruses also known previously as “Norwalk-like viruses.” Infection with norovirus affects the stomach and intestines, causing an illness called gastroenteritis, or “stomach flu.” This “stomach flu” is not related to the flu (or influenza), which is a respiratory illness caused by influenza virus. In addition, noroviruses are not related to bacteria and parasites that can cause gastrointestinal illnesses. Norovirus is not a “new” virus, but interest in it is growing as more is learned about how frequently noroviruses cause illness in people (see Why is norovirus infection important for food handlers?). What are the symptoms of infection with norovirus? Norovirus infection causes gastroenteritis, which is an inflammation of the stomach and the small and large intestines. The symptoms of gastroenteritis are nausea, vomiting, and/or diarrhea accompanied by abdominal cramps. Some people also complain of headache, fever/chills, and muscle aches. Symptoms usually last for 1 or 2 days. However, during that brief period, people can feel very ill and vomit, often violently and without warning, many times a day. Symptoms usually begin 24 to 48 hours after ingestion of the virus, but can appear as early as 12 hours after exposure (see How is norovirus spread?). There is no evidence that sick persons can become long-term carriers of the virus, but the virus can be in the stool and vomit of infected persons, from the day they start to feel ill to as long as 2 weeks after they feel better. Other infectious and non-infectious agents can cause symptoms similar to those of norovirus gastroenteritis; people who have these symptoms and have questions about the cause of their illness should consult a physician.
Noroviruses are found in the stool or vomit of infected people. People can become infected with the virus in several ways, including:
Food and drinks can very easily become contaminated with norovirus because the virus is so small and because it probably takes fewer than 100 norovirus particles to make a person sick. Food can be contaminated either by direct contact with contaminated hands or work surfaces that are contaminated with stool or vomit, or by tiny droplets from nearby vomit that can travel through air to land on food. Although the virus cannot multiply outside of human bodies, once on food or in water, it can cause illness. Some foods can be contaminated with norovirus before being delivered to a restaurant or store. Several outbreaks have been caused by the consumption of oysters harvested from contaminated waters. Other produce such as salads and frozen fruit may also be contaminated at source.
Why is norovirus infection important for food handlers? People working with food who are sick with norovirus gastroenteritis are a particular risk to others, because they handle the food and drink many other people will consume. Since the virus is so small, a sick food handler can easily – without meaning to – contaminate the food he or she is handling. Many of those eating the contaminated food may become ill, causing an outbreak. Outbreaks of norovirus gastroenteritis have taken place in restaurants, cruise ships, nursing homes, hospitals, schools, banquet halls, summer camps, and family dinners – in other words, places where often people have consumed water and/or food prepared or handled by others. It is estimated that as many as half of all food-related outbreaks of illness may be caused by norovirus. In many of these cases, sick food handlers were thought to be implicated. Can norovirus gastroenteritis be treated? Most people
recover completely within 1 to 2 days, with no long-term complications
of norovirus illness. However, persons who are unable to drink enough
liquids to replace those lost with vomiting and/or diarrhea may become
dehydrated and require special medical attention. These people include
young children, the elderly, and persons of any age unable to care for
themselves. What can I do to prevent norovirus gastroenteritis? Many local and state health departments require that food handlers and preparers with gastroenteritis not work until 2 or 3 days after they feel better. In addition, because the virus continues to be present in the stool for as long as 2 to 3 weeks after the person feels better, strict hand washing after using the bathroom and before handling food items is important in preventing the spread of this virus. Food handlers who were recently sick can be given different duties in the restaurant so that they do not have to handle food (for example, working the cash register or hostessing). People who are sick with norovirus illness can often vomit violently, without warning, and the vomit is infectious; therefore, any surfaces near the vomit should be promptly cleaned and disinfected with bleach solution and then rinsed. Furthermore, food items that may have become contaminated with norovirus should be thrown out. Linens (including clothes, towels, tablecloths, napkins) soiled to any extent with vomit or stool should be promptly washed at high temperature. Oysters should be obtained from reputable sources and appropriate documentation kept. Washing raw vegetables thoroughly before eating and appropriate disposal of sewage and soiled diapers also help to reduce the spread of norovirus and prevent illness. In small home-based catering businesses or family owned or operated restaurants, sick children and infants in diapers should be excluded from food preparation areas. How is norovirus gastroenteritis diagnosed? In special cases, when there is an outbreak of gastroenteritis there is a need to identify norovirus as the cause of the illness. In these cases, norovirus can often be found in stool samples of infected persons by using special tests. Sometimes blood tests looking for antibodies against norovirus are also performed, when the stool tests are inconclusive or were not done. Food handlers will often be asked for a stool sample or even a blood sample to help investigate the cause of an outbreak. Can a person have norovirus gastroenteritis more than once? Yes, a person can be infected with norovirus more than once in their lifetime. One reason is that there are many different types of noroviruses, and being infected with one type most likely does not prevent infection from another type later. This lack of cross-protection after natural infection is a major reason why it is difficult to develop a vaccine against norovirus.
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page was last reviewed on August 3, 2006
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