Norovirus outbreak resident survival guide
Norovirus is one of the extremely contagious viruses leading to 50% of the gastroenteritis outbreaks worldwide. An outbreak of norovirus is defined as an occurrence of 2 or more similar illnesses resulting from a common exposure that is either suspected or laboratory-confirmed to be caused by norovirus.
Prevention of Norovirus Outbreak
❑ If you are sick before starting your cruise, consider alternative cruising options.
On the Cruise
❑ Wash hands with soap and running water for 20 seconds.
❑ Avoid touching your face.
Food and water precautions
❑ Avoid eating raw fruits and vegetables unless they are washed and peeled by yourself.
Isolation of infected people
❑ If you see someone getting sick, move away from the area and report to the cruise staff.
Disinfection of the environment
❑ Clean contaminated surfaces to remove organic loads.
PPM: Parts Per Million
Inquire about exposure to settings prone to outbreaks:
❑ Health care settings
|Laboratory tests can be done||Laboratory tests cannot be done|
|❑ Collect samples||❑ Assess The Kaplan criteria|
❑ Whole stool sample
❑ Vomitus sample
❑ Environmental samples:
❑ Mean duration of illness is 12-60 hours.
❑ Mean incubation period is 24-48 hours.
❑ Enzyme immunoassays (RIDASCREEN)
|Are all 4 criteria present?|
|Norovirus negative||Norovirus positive||Yes||No|
❑ Treat as acute gastroenteritis
❑ Treat the acute gastroenteritis
Norovirus outbreak is highly likely
Norovirus outbreak is less likely but cannot be ruled out
❑ Implement measures to contain the outbreak
RT-PCR: Reverse Transcription Polymerase Chain Reaction
Initial Management of Acute Gastroenteritis
Shown below is an algorithm summarizing the approach to initial management of acute gastroenteritis.
❑ Assess the volume status
† Some dehydration = At least two signs, including at least one key sign (*) are present.
|No dehydration||Some dehydration||Severe dehydration|
❑ Start ORT at a volume of 50-100 mL/kg
❑ Start altered diet
❑ Reassess the patient's status every 4 hours
CBC: Complete Blood Count; ORT: Oral replacement therapy
- Consider an outbreak of norovirus when norovirus is positive in stool or vomitus specimens from 2 or more patients are found to be positive for norovirus by RT-PCR, EIA or electron microcopy.
- Do not obtain serum samples for routine norovirus detection.
- Do not use hand sanitizers as a substitute for washing hands with soap and water.
- Patel MM, Hall AJ, Vinjé J, Parashar UD (2009). "Noroviruses: a comprehensive review". J Clin Virol. 44 (1): 1–8. doi:10.1016/j.jcv.2008.10.009. PMID 19084472.
- "CDC - Norovirus - Reporting and Surveillance for Norovirus". Retrieved 10 February 2014.
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (2011). "Updated norovirus outbreak management and disease prevention guidelines". MMWR Recomm Rep. 60 (RR-3): 1–18. PMID 21368741.
- "http://www.epa.gov/oppad001/list_g_norovirus.pdf" (PDF). Retrieved 10 February 2014. External link in