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Norovirus (cont.)

Is It Possible to Prevent a Norovirus Infection?

The best method for prevention of norovirus infection is frequent hand washing and excellent hygiene, although hand sanitizers and washing are not absolutely effective. 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 clothes. Because 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.

Carefully wash fruits and vegetables before preparing and eating them. Cook oysters and other shellfish thoroughly before eating them. Noroviruses are relatively resistant and can survive temperatures as high as 140 F and quick steaming processes that are often used for cooking shellfish.

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.

There is currently no vaccine for norovirus, although at least one company has a vaccine preparation undergoing clinical trials; this may help in the future to prevent many of the 3 million to 5 million deaths per year worldwide due to diarrhea. 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 reinfected with norovirus.

Because of the recent norovirus outbreaks on the Crown Princess cruise ship (Oct. 2014), 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).

REFERENCES:

Khan, Zartash Zafar. "Norwalk Virus." Medscape.com. Jan. 11, 2012. <http://emedicine.medscape.com/article/224225-overview>.

Mattison, K., A. Shukla, A. Cook, F. Pollari, R. Friendship, D. Kelton, et al. "Human noroviruses in swine and cattle." Emerg Infect Dis 13.8 Aug. 2007 <http://wwwnc.cdc.gov/eid/article/13/8/07-0005>.

United States. Centers for Disease Control and Prevention. "Cruise Ship Travel." July 1, 2011. <http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-6-conveyance-and-transportation-issues/cruise-ship-travel.htm>.

United States. Centers for Disease Control and Prevention. "Norovirus." Dec. 10, 2015. <http://www.cdc.gov/norovirus/>.

United States. Centers for Disease Control and Prevention. "Travelers' Health: Chapter 3: Infectious Diseases Related to Travel." Aug. 1, 2013. <http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/norovirus>.


Medically Reviewed by a Doctor on 1/7/2016

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