Norovirus — the importance of infection prevention and enhanced cleaning and disinfection
By Glenys Harrington, Consultant, Infection Control, Diversey
Friday, 01 November, 2019
Norovirus causes 685 million cases of acute gastroenteritis worldwide. Every year norovirus is estimated to cost $60 billion worldwide due to healthcare costs and lost productivity.1
Norovirus is a highly infectious disease which usually presents with an acute onset of diarrhoea, abdominal cramps, nausea and vomiting in both adults and children. Norovirus transmission is spread from person to person (close personal contact with an infected person), by the faecal–oral route (ingesting contaminated food or water) and through contact with contaminated surfaces (touching contaminated surfaces and then putting your unwashed hands in your mouth).
New research suggests there is a probable association between recent vomiting as a source of airborne norovirus and outbreaks in hospitals.2
Norovirus can persist on environmental surfaces for days to weeks.
Most Norovirus-associated gastroenteritis outbreaks occur where individuals are in close proximity, such as healthcare facilities, aged-care facilities, schools and childcare centres, restaurants and catered events, and therefore can affect the most vulnerable in the community. The very young, the elderly and the immunocompromised are at greater risk for severe symptoms and complications.
Noroviruses are the most common cause of viral gastrointestinal outbreaks on cruise ships, with the most common mode of transmission being person to person. Due to the close living quarters and shared dining areas, as well as large passenger turnovers, controlling norovirus outbreaks on cruise ships can be difficult. Norovirus can be brought on board ships when they dock and, as it persists on surfaces, outbreaks on consecutive cruises can occur.
Since there are many different types of noroviruses, people can get infected many times during their lifetime. Studies of elderly persons have shown that norovirus infection may lead to an increased duration of diarrhoea, and excretion (shedding) of the virus may continue for 10 days or longer.3
Norovirus can spread rapidly through confined populations because of the ease of its transmission, in that it only requires a very low infective dose. It takes as few as 18 viral particles to make another person sick. They are most contagious when sick with vomiting and diarrhoea, but may also infect others before their symptoms begin and after they feel better. Because symptoms come on suddenly, an infected person who vomits in a public place may expose many people.
Currently, there is no specific treatment for norovirus infection. Norovirus infection cannot be treated with antibiotics because it is a viral (not a bacterial) infection and there are currently no vaccines or antivirals available.
Critical to prevention and control of norovirus outbreaks are standard and contact precautions (inclusive of scrupulous hand hygiene) in addition to enhanced cleaning and disinfection of environmental surfaces to interrupt norovirus spread. Surfaces that should be cleaned and disinfected include frequently touched areas/items and hard surfaces such as toilets, faucets, hand/bed railings, phones, door handles, light switches and equipment.
Diversey One-Step Accelerated Hydrogen Peroxide Oxivir® Tb Wipes have activity against norovirus (feline calicivirus as surrogate) with a 1-minute contact time and are suitable for cleaning and disinfecting during outbreaks of norovirus.
- Centers for Disease Control and Prevention (CDC), Norovirus, Worldwide. https://www.cdc.gov/norovirus/trends-outbreaks/worldwide.html. Accessed 29/10/2019.
- Alsved M et al. Sources of Airborne Norovirus in Hospital Outbreaks. Clin Infect Dis 2019, June 29.
- Cardemil C V et al. Norovirus Infection in Older Adults Epidemiology, Risk Factors, and Opportunities for Prevention. Infect Dis Clin N Am 31 (2017) 839–870.
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