Cleaning Protocols to Prevent the Spread of Norovirus

(Editor’s Note: This is an online-only article attributed to the February/March 2018 issue.)

In November of 2015, the North Carolina Division of Public Health was notified that approximately 44 people attending a company Thanksgiving lunch became ill with moderate to serious intestinal disease and diarrhea. Within hours of the notification, the department set up a website asking lunch attendees—those sick and those that did not get sick—what food and drink they consumed at the event.

Of the 80 people asked to complete the survey, 73 percent did so. Of those who reported they got sick, the following was revealed:

• Most became ill within 13 hours of the lunch;
• 93 percent said they experienced moderate to severe diarrhea;
• 91 percent reported abdominal pain; of these, most reported vomiting; and
• Nearly half of the people that became sick had eaten turkey and stuffing, which were served together.

It was becoming clear to public health officials that this was a classic case of norovirus. The virus normally comes on quickly with precisely these types of symptoms, often the result of eating specific food. Follow-up tests of those that became ill proved this to be the case. They then turned their focus to the commercial caterer that prepared the lunch.

The caterer had a “permitted” kitchen that has passed inspection by public health officials, but this time the meal was cooked in the home of the caterer. Once the meal was prepared, it was delivered to the party setting by car in stages—with the turkey and stuffing left unattended in warming pans or at ambient temperatures for up to eight hours before serving.

Health officials blamed the outbreak squarely on the caterer for not following proper safety procedures: using an “unpermitted” kitchen, leaving food unattended for a prolonged period, and for failure to monitor the temperature of the food products before consumption. All of these contributed to the growth of pathogens that can cause norovirus.

But that’s not the end of the story. Many of the people experienced vomiting while they were sick. Over the next 24 to 48 hours, almost as many family members of those that became ill at the lunch also came down with norovirus. While it was clear the commercial caterer was responsible for the original outbreak, why did so many family members also become sick?

A Closer Look at Norovirus

Before answering this question, let’s review some of the statistics regarding norovirus in the U.S. According to the CDC, some of the key facts include:

• There are about 20 million cases of norovirus each year in the U.S., with most of them happening on land, not on cruise ships (which is where many people assume the majority of norovirus cases occur);
• Norovirus contributes to approximately 70,000 hospitalizations each year and about 800 deaths;
• While people can get norovirus at any time of the year, it is most common in the winter;
• Most outbreaks occur in food service settings like restaurants; and
• Unlike other types of airborne pathogens that may die within hours after landing on a surface, norovirus pathogens can live up to two weeks.

But here is another important fact about norovirus. While it can spread through close personal contact with an infected person or the fecal-oral route similar to other illnesses, it is very often spread when someone vomits. This is why norovirus is commonly referred to as “the vomiting disease.” The vomiting is often forceful, called “aerosolized vomit” that can land on surfaces as much as 25 feet away.

If someone touches the droplets of this aerosolized vomit on a counter, a door handle, or a light switch, and then swallows it, there is a very good chance they will come down with the disease. This explains why so many family members at the Thanksgiving lunch later became ill.

Norovirus Spill Kits

It is very likely that few if any of the people that became ill at the Thanksgiving lunch were aware of how norovirus can spread to others. In addition, they likely were not aware of what cleaning protocols are necessary to help mitigate the spread of the disease.