We do not endorse non-Cleveland Clinic products or services. It can last for weeks on a counter, on an elevator button or even on a doorknob. Most people get it either through direct contact with someone who has it, or from touching a surface that has been contaminated with the virus. Symptoms, which include nausea, stomach pain, vomiting and diarrhea, will usually begin to appear within a day or two and then will last for about two to three days.
Some people who catch norovirus can remain contagious for days or even weeks afterwards. The average person will catch norovirus about 5 times in his or her lifetime.
Food and water can get contaminated with norovirus in many ways, including when:. Norovirus is the leading cause of illness and outbreaks from contaminated food in the United States.
Most of these outbreaks occur in food service settings like restaurants. Infected food workers are frequently the source of outbreaks, often by touching ready-to-eat foods, such as raw fruits and vegetables, with their bare hands before serving them. However, any food served raw or handled after being cooked can become contaminated with norovirus.
Recreational or drinking water can get contaminated with norovirus and make you sick or contaminate your food. This can happen:. For more information on healthy water and how water can get contaminated, visit www. Surfaces can get contaminated with norovirus in many ways, including when:. View larger image image icon. Skip directly to site content Skip directly to page options Skip directly to A-Z link.
Presumptive secondary infections are not shown. No other recent common food exposures were reported by the staff. All staff members working on 13 May attended the luncheon. Four presumptive secondary cases were identified. The auto dealer reported the outbreak to the sandwich shop, which failed to relay the report to the health department as required by law. Fortunately, the dealer also contacted the health department directly.
Environmental health staff were dispatched to the sandwich shop to review relevant operations. No recent gastrointestinal illness within previous 2 weeks was reported by food handlers or restaurant managers. No other patrons had complained. The restaurant was cited for 2 violations defined by environmental health staff as critical: presence of potentially hazardous food not maintained at proper hot or cold holding temperatures and presence of open beverages on the food preparation table.
When staff at the auto dealership were interviewed, we learned of an incident that occurred approximately 15 minutes before the luncheon began. The child's mother left the mess for employee A, who attempted to clean up with dry paper towels. No gloves or disinfectants were used, but employee A reported subsequently washing her hands with soap and water. Meanwhile, employee B had gone to pick up the food for the meeting.
Immediately after cleaning the restroom, employee A opened the door for employee B when the latter returned with the food. Employee A was the first to take one of the unwrapped sandwiches off the platter. Four of 5 female cases reported eating a sandwich, as did 6 of 7 male cases. All 5 female employees working that day became ill; all reported use of the restroom after the diarrheal incident.
No leftover food or food containers were available for testing. Stool specimens from 2 employees and the toddler—who was located through auto sales records—were positive for norovirus genotype GII. C with indistinguishable sequences. According to the mother, the child had been ill for 1 day before the visit to the auto dealership. Although the dealership diaper-changing station had allegedly been routinely cleaned twice by a professional janitorial service, using quaternary ammonium disinfectants, we observed corporeal brown matter inside and underneath the changing station Figure 2.
Swabs of the changing station were positive for norovirus genotype GII , although the samples did not amplify in region C or D, rendering sequencing impossible. Photograph of underneath the diaper changing station involved in this outbreak, which had allegedly been cleaned twice by janitorial staff. This level of soiling was consistently viewed in public restroom diaper-changing stations. To assess the background prevalence of norovirus on diaper-changing stations in Washington County, we tested a convenience sample of 14 diaper-changing stations in various restroom locations 1 restaurant, 3 parks, 3 grocery stores, 1 gas station, 2 shopping malls, 1 aquatic center, 2 libraries, and 1 public health clinic.
Fourteen of 14 dispensers for disposable bed liners were empty. We did not detect norovirus on any of the diaper changing stations tested other than the one at the auto dealership. The manufacturer's printed recommendations for cleaning brand X diaper-changing stations included cleaning with a detergent followed by sanitizing with a disinfectant—neither of which were specified.
When contacted, the manufacturer suggested the use of quaternary ammonium compounds. They discouraged the use of chlorine bleach, which might damage the changing station components.
The restaurant in question had historically done poorly on routine inspections, and the initial reports were consistent with a commonplace foodborne norovirus outbreak.
The absence of any food item significantly associated with illness is not uncommon and can reflect multiple items being contaminated or a lack of statistical power. It would have been easy and common to blame the outbreak on unidentified food handlers at the sandwich shop. Fortunately, 2 employees mentioned the incident involving the customer's ill child during interviews, which suggested another scenario. The identification of matching genogroup virus in the child's specimen and on the diaper-changing station confirmed that the child was the source of the outbreak, not the luncheon food.
The female employees were likely exposed to contaminated surfaces in and around their restroom, and induced sufficient contamination of the wider environment, including uncovered sandwiches and shared-contact surfaces, to expose many of the male employees. We could not assess whether other visitors to the dealership that afternoon became ill, but one might suspect that they did.
A diaper-changing station would seem a perfect fomes for the transmission of gastrointestinal disease. By design, they are routinely contaminated with fecal material. Thorough disinfection between uses rarely occurs, and often even routine janitorial service may be inadequate.
Aboard cruise ships—notorious for frequent and persistent norovirus outbreaks [ 7 ]—a rigorous investigation of public bathrooms found the diaper-changing station to be the worst cleaned surface [ 8 ].
There are no universal cleaning guidelines for diaper-changing stations. The manufacturer of the brand X device at the auto dealership recommended the use of disinfectants that are probably ineffective against norovirus. The use of disposable bed liners is highly recommended, but our small survey suggests that they often unavailable.
This outbreak underscores the importance of environmental cleaning in the control of norovirus transmission.
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