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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The key to prevention is to not physically contact (ingest) any norovirus. In many situations, this may not be possible, but individuals can decrease the chance of contact by several methods. The best method is frequent hand washing and excellent hygiene, although hand sanitizers and washing are not absolutely effective. Wash fruits and vegetables, and drink only fluids from noncontaminated sources (chemically treated, appropriately bottled, or boiled fluids). Avoid contact with any vomit or feces from ill individuals; discard the material in a toilet and clean any clothing and areas that may have come in contact with the material. Hot water and soap can help clean cloths. Because the norovirus has been reported to survive on surfaces up to four weeks at room temperature, disinfection is recommended with commercial products or a solution of ½ cup of bleach to 1 gallon of water. Norovirus is killed at temperatures above 140 F, so steaming or boiling (usual minimal time is one minute) can kill the virus.

Because of the potentially long (about two to four weeks) environmental survival of the virus at room temperature, often an area in which an outbreak occurs will need to be disinfected. Repopulating an area with uninfected people without disinfecting the area may produce another outbreak. Consequently, areas (for example, dorms, barracks, cafeterias, and cruise ships) should be disinfected after a norovirus outbreak to prevent further infections.

Although research is ongoing to produce a vaccine to norovirus, currently there is none available. Further, there are many different strains of the virus, which makes vaccine development difficult. Even the body's immune defense mechanisms have difficulty producing effective immune responses to norovirus. In addition, the infection is short-lived and usually self-limiting so some investigators suggest the body does not produce good immune responses to this infection. Although all of the reasons are not understood in detail, it is clear that most individuals can be repeatedly infected with norovirus.

Because of the recent norovirus outbreaks on the Crown Princess cruise ship (Feb. 2012), the following guide, developed by the CDC, is provided to help prevent norovirus and other infections on cruise ships:

Precautions for Cruise Ship Travelers (as per the CDC)

Before Travel

• Consult health care and dental providers before cruise travel.
• Consider additional insurance for overseas health care and medical evacuation.
• Carry prescription medications in their original containers, with a copy of the prescription and accompanying physician's letter.
• Defer travel while acutely ill.

During Travel

• Wash hands frequently, using soap and water or an alcohol-based cleaner.
• Follow safe food and water precautions when eating off the ship at ports of call.
• Use personal protective measures during port visits in malaria- or dengue-endemic areas.
• Use sun protection and maintain good fluid intake.
• Avoid excessive alcohol consumption.
• Avoid contact with ill people.
• If sexually active, practice safe sex.

Other investigators suggest hand sanitizers have little effect on viruses but suggest disinfectants such as Lysol or bleach solutions should be used to decontaminate most surfaces. If a cruise ship becomes contaminated with norovirus (or other pathogens), the cruise is usually disrupted while the ship is decontaminated (usually a two- to three-day process).

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