Norovirus: Coast to Coast and Across the Ponds

Often categorized as a denizen of day care facilities, cruise ships and hotels, Norovirus has been working hard this year to remind us that it can disrupt lives wherever groups of people live, work or play.

Norovirus is a highly infectious virus, with a short incubation period and long staying power after a person's symptoms have disappeared. It is a gastrointestinal virus, causing a sudden onset of nausea, vomiting and diarrhea. The illness is self-limiting, with acute symptoms lasting 1-5 days. But a recovering victim can continue to carry shed infectious virus particles in the stool for a month or more.

One of Norovirus' strengths is its ability to survive in an infectious state on dry surfaces for prolonged periods of time. Bathroom fixtures, stair rails, eating utensils – all items subject to contamination by a symptomatic victim – are just a few places where Norovirus may lie in wait to infect an unsuspecting target. 

Recently, Norovirus outbreaks have been in the news in the United States, Australia, New Zealand, and the United Kingdom. The virus struck the campus of Georgetown University (Washington, DC) last week, sickening more than 170 students. And it is also the prime suspect in an outbreak of gastroenteritis that felled 30 or more students at the University of Southern California within the last few days.

As inconvenient and uncomfortable as those outbreaks were for the students, the illnesses were not life-threatening. Norovirus has caused more serious disruptions in the last couple of months by infecting patients and staff of hospitals and nursing homes in the UK, Australia and New Zealand.

New Zealand

Dunedin Hospital in New Zealand struggled to contain an outbreak of Norovirus last August, which began in one ward and ended in the hospital suspending scheduled surgery and closing its doors temporarily to visitors and to new admissions.  By the time the three-week long outbreak was over, 170 hospital patients and staff members had been infected, 2,300 out-patient appointments and procedures had been cancelled or rescheduled, and opposition members of Parliament were calling for an investigation into the hospital's handling of the outbreak.

Not content with wrecking havoc in a hospital, Norovirus also hit a New Zealand rest home – Leighton House Rest Home, in Gisborne – early in September. Eleven residents of the home suffered classic symptoms, including vomiting and diarrhea. The outbreak was contained quickly, after staff instituted a virtual lock-down routine. Patients were confined to their rooms, and all visitors were prohibited. 

Australia

Sydney, and its surrounding areas, suffered a series of norovirus outbreaks beginning in July.  During August, more than 30 rest homes, hospitals, child care centers and nursing homes were forced into lock-down to contain the outbreaks. The experience at the Mayflower Aged Care Facility in Westmead illustrates the difficulties that the staff of these facilities must confront. The rest home declared a lock-down on a Thursday, after 18 residents fell ill. By the next day, the number of cases of acute gastroenteritis had risen to 48 – just shy of one-third of the 146 residents of the Mayflower. 

During the Australian winter months of July - September, several additional institutions faced the same problem:

• Wodonga Hospital: 2 patients and 10 staff ill; one ward closed; 17 operations cancelled
  
• Tamworth Hospital: unspecified number of patients ill; one ward quarantined from visitors
  
• Holbrook Hospital: 17 patients and staff ill; access restricted to emergency cases only
  

The Holbrook outbreak began at the end of September. There's no reason to believe that it will be the last one of the year.

United Kingdom

The UK also has experienced its share of Norovirus outbreaks this year. Here are just a couple of examples:

• Countess of Chester Hospital: 10 patients and 2 staff ill; one ward closed to visitors
  
• Midland area hospitals: 2 hospitals affected; 124 patients ill; 15 wards closed; all non-emergency surgery deferred for 48 hours
  

Regardless of the venue of an outbreak, its scope or its severity, there are only a few reliable ways to cope with Norovirus.

• Contain the spread of an outbreak by preventing healthy individuals from coming into contact with the acutely ill victims.
  
• Confine individuals with active symptoms to their homes or rooms. Encourage sick workers to stay at home.
  
• Clean and disinfect all clothing, bedding, utensils, surfaces and other items that may have become contaminated as a result of vomiting or diarrhea.
  
• Conscienciously practice good personal hygiene habits at all times, including frequent and thorough hand-washing, especially when caring for a person who is suffering from symptoms of Norovirus.
  

By paying attention to these simple principles, we can all do our part to reduce the incidence and spread of Norovirus outbreaks.