Food Fight: Us versus the Norovirus

In August, three hundred high school students showed up at the University of Maryland College Park campus for a conference on medicine and health care. They got a dramatic lesson in both after a hundred of them were struck with a sudden bout of food poisoning and had to be treated at area hospitals. Food poisoning. Stomach flu. Viral gastroenteritis. These are common names for those all too common events in which groups of people are felled by the unforgiving symptoms of nausea, vomiting, and diarrhea. These kinds of outbreaks often are associated with cruise ships, conferences, summer camps, nursing homes, company picnics, and other organized gatherings that feature a variety of prepared foods and salads. Lurking somewhere among the vacationers and conventioneers is an uninvited guest: the norovirus. This is the virus that seems to have hit the students at the University of Maryland. Noroviruses—previously called Norwalk-like viruses or Caliciviruses—cause sudden infections of the gastrointestinal tract a day or so after being exposed to them. The result is sudden vomiting, watery diarrhea and cramps, and sometimes a low-grade fever. The awful symptoms last a day or two, and dehydration is usually the biggest personal danger from these infections. Still, it's enough to ruin a cruise or a conference. But there's also a social danger to these viral assaults. Infected individuals can shed the virus for up to two weeks after first becoming ill. That means the virus can be spread from person-to-person, or from one person to food and drink. It's the "Typhoid Mary" syndrome in which one individual manages to infect many others through poor hygiene, improper food handling or lingering illness.

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The best way to guard against this virus is through old-fashioned, low-tech hand washing. The hands that prepare foods should be clean, as should the countertops and containers where foods are prepared and stored. That's the best guard against a virus that is so contagious just 10 tiny viral particles may be enough to start an infection and send you hopping from bed to bathroom and back again. The University of Maryland incident was hardly unique. In January, the University of North Carolina had a small norovirus outbreak among its students. In February, fifty-three members of a Vermont swim club became ill from norovirus contamination of the pool water. (That outbreak may have been started by a leaky diaper.) In 2002, the Centers for Disease Control and Prevention (CDC) investigated twenty-one cruise ships after outbreaks of gastroenteritis. Nine of the shipboard outbreaks were due to norovirus. In Ohio, health officials are still trying to analyze an outbreak of gastroenteritis that affected over a thousand people at a resort at the end of August. Noroviruses may be one of the microbial culprits. How does one virus cause so many problems for so many people? Well, the norovirus is a hardy beast. It can survive freezing, heating to 140 degrees, and typical levels of chlorine in drinking water. No wonder it's such a common source of food poisoning. Not only are these viruses hardy, but there appears to be many different strains, or types, of noroviruses loose in the world. As with flu and cold viruses, we develop some short-term immunity to one strain, but remain vulnerable to other strains. According to a 1999 estimate of U.S. deaths from gastroenteritis, noroviruses kill approximately 310 people each year. Most of these deaths are probably due to severe dehydration and other underlying illnesses. The noroviruses are not major killers, but they do represent a significant source of annual morbidity and economic loss. The CDC estimates that

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noroviruses cause about 23 million cases of acute gastroenteritis in the U.S. each year. In fact, fifty percent of all foodborne outbreaks may involve noroviruses. That adds up to a lot missed school, missed work, and doctors’ bills. Scientists are working to better understand how these viruses cause illness and manage to spread so quickly from person to person. There is even some very preliminary work being done on vaccines against them. But until a vaccine or a preventive pill comes along we're going to have to rely on clean hands, clean countertops and good luck.

For more information about noroviruses and gastroenteritis, visit www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm.

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