1. The Norvirus Wayne H. Williams, Ph.D. student Walden University
Hello my name is Wayne H. Williams, I am a doctoral student at Walden University. This presentation will cover the following: the pathogen, the reservoir, the method of transmission, the host of this disease, and a summary showing how public health measures are aimed at each of these steps. In addition, I will look at the role of epidemiologic surveillance, quarantine, contact tracing, immunization, prophylaxis, and public health regulations as it applies the norvirus
Wayne H. Williams, Ph.D. student
Walden University
14 November 2010

2. What is the Norovirus Advice
Salmon, L. (2008, January 04). Daviel -The Natural Health Care Company. Retrieved November 01, 2010, from What is the Norovirus Advice :
Leah Salmon (2008) provides her unique view on the norovirus, and simple natural home remedies that can be use in the prevention and treatment of the norovirus.

3. TERMINAL LEARNING OBJECTIVE
An historical overview and background of The Norvirus
The Norwalk virus was named after Norwalk, Ohio, where an outbreak of acute gasttoenteristis occurred among children at an elementary school in November In 1972, immune electron microscopy on saved stool samples identified the virus, which was called Norwalk virus, and was initially grouped as "Small Round-Structured Viruses". Numerous outbreaks with similar symptoms have been reported since. The cloning and sequencing of the Norwalk virus genome showed that these viruses have a genomic organization consistent with viruses belonging to the family Calicviridae.

4. ENABLING LEARNING OBJECTIVES
Norovirus Gastroenteritis
Food-borne Illness/Outbreak
Epidemiology
Virology
Surveillance
Transmission
Morbidity and Mortality
Control and Prevention

5. Norovirus Gastroenteritis
This presentation will cover the following aspects of the norovirus: food-borne Illness, epidemiology, virology, surveillance, transmission, morbidity and mortality, control and prevention, and a summary showing how public health measures are aimed at each of these steps.
“Norovirus (NoV) is the leading cause of nonbacterial, acute gastroenteritis among adults and is responsible for numerous outbreaks worldwide. The virus is frequently associated with contaminated food, causing >50% of all food-related outbreaks. (John Nordgren et al., 2010).”
“The Noroviruses are a group of related, single-stranded RNA, nonenveloped viruses that cause acute gastroenteritis in humans. Norovirus was recently approved as the official genus name for the group of viruses provisionally described as “Norwalk- like viruses” (NLV). This group of viruses has also referred to as caliciviruses (because of their virus family name) and as small round structured viruses, or SRSVs (because of their morphologic features). Another genus of the calicivirus family that can cause gastroenteritis in humans is Sapovirus, formerly described as “Sapporo- like virus” (SLV) and sometimes referred to as classic or typical calicivirus (CDC 2006).”

6. Food-borne Illness/Outbreak
The CDC estimates that 76 million foodborne illness, or food poisoning, cases occur in the United States every year, which means that one in four Americans contracts a foodborne illness annually after eating foods contaminated with such pathogens as E. coli O157:H7, Salmonella, Hepatitis A, Campylobacter, Shigella, Norovirus, and Listeria.
Foodborne Illness. (2010). Retrieved November 01, 2010, from Norovirus:
Foodborne Illness (2010) informs the reader that the norovirus “are estimated to cause 23 million cases of acute gastroenteritis.” In the United States, the nororvirus is the primary cause of gastroenteritis, and is responsible the majority of food-borne related illnesses than any other “bacteria and parasites.” When comparing viruses the nororvirus is second to ordinary cold, and the virus presents difficult challenge to contain the transmission process with standard hygienic procedures. (Foodborne, 2010, p. 1)

7. Food-borne Illness/ Outbreak
“Food-borne outbreaks reported to the Centers of Disease Control and Prevention (CDC), United States, 1991–2000. B) Norovirus (NoV)-confirmed foodborne outbreaks reported to CDC, United States, 1991–2000. REVB, Respiratory and Enteric Branch, CDC; RT-PCR, reverse transcription–polymerase chain reaction. Percentage value above bars represents proportion of all foodborne outbreaks reported to CDC that were laboratory-confirmed to be due to NoV by REVB and by some state public health laboratories” (CDC, 2004)
CDC. (2004, December 27). Retrieved November 08, 2010, from Norovirus and Foodborne Disease, United States, 1991–2000:

8. Epidemiology Incidence/Prevalence Geographic distribution
Temporal distribution
Reservoir
Infectious dose
Mode(s) of transmission
Incubation period
Period of communicability
Outbreak definition
Centers for Disease Control and Prevention . (2009, July 15). Retrieved November 01, 2010, from Noroviruses Summary Document:
Centers for Disease Control and Prevention (2009) provides the Epidemiology of the norovirus.
Specific data are not available for the United States.  Estimated to cause 23 million cases of acute gastroenteritis in the United States each year.  It is also estimated that at least 50% of foodborne illness outbreaks are caused by noroviruses. Attack rates generally do not differ significantly between are or gender groups.  Norovirus gastroenteritis outbreaks are usually characterized by high attack rates.
Worldwide
Outbreaks occur throughout the year in the United States, with the lowest frequency during the winter months.
Man
<100 viral particles (highly infectious)
Consumption of fecally-contaminated food or water and by person-to-person spread or contact with contaminated fomites.  Most frequently associated with outbreaks following the ingestion of raw (and less frequently steamed) shellfish
24 to 48 hours
unknown
Provisional diagnosis of infection with noroviruses can be made if the following criteria are met (Kaplan's criteria):
1. Bacterial or parasitic pathogens are not detected
2. Vomiting occurs in more than 50% of the cases
3. Mean or median duration of illness ranges from 12 to 60 hours
4. Incubation period is 24 to 48 hours

9. Virology (Noroviruses (NoV)
a. Symptoms
b. Description
c. Classification
d. Family/Genus
e. Envelop present
f. Size
g. Shape
h. Genome
Centers for Disease Control and Prevention . (2009, July 15). Retrieved November 01, 2010, from Noroviruses Summary Document:
Centers for Disease Control and Prevention (2009) provides the virology for the Noroviruses (NoV).
Norwalk virus (NV); Norwalk-like virus (NLV); Caliciviruses; Small round structured viruses (SRSV); epidemic viral gastroenteritis, acute infectious non-bacterial gastroenteritis, winter vomiting disease
Noroviruses are a group of related, single-stranded RNA, non-enveloped viruses that cause significant gastroenteritis in humans
c. Virus
d. Caliciviridae/Norovirus
e. No
26 to 35 –nm
Spherical
Single-stranded(+)-RNA

10. Surveillance Gastrointestinal Illness Log
Anti-diarrheal Medications Log
Gastrointestinal Illness Questionnaire
24 hour GI Illness Report
2% and 3% threshold GI Illness Reports
Wheeler, R. E. (2004). Retrieved October 22, 2010, from
“CDC currently does not conduct active surveillance to monitor outbreaks of gastroenteritis caused by noroviruses (CDC 2006).” The norovirus is linked to fecally contaminated food and water, and there are stringent inspection programs in place nationwide to help prevent the food and water source from contamination. In the event of a food-borne outbreak, samples are submitted for testing, and those samples are placed into a database, which is monitored by the National Center for Infectious Disease (NCID). The CDC can monitor the NCID database to determine if there is a pattern of outbreaks, and if fatalities were associated with them, which can provide the CDC and other agencies with information to determine if food-borne outbreaks are intentional or if it is an isolated incident.

11. Transmission
In general, a reservoir is a place where microorganisms have the opportunity to flourish and multiply it requires warmth, darkness, moisture, and food. A reservoir can be either human or animal, but the norovirus is mainly found in humans due to improper food handling and contaminated water.
Montana Communicable Disease Epidemiology Program. (2010, March). Retrieved October 23,
2010, from Norovirus transmission and prevention:
“Fecal-oral spread through droplets, fomites, person-to-person contact, and environmental contamination is the
primary mode of transmission, but infectious vomitus can also play a role. Outbreaks of norovirus are often associated with
contaminated food or water. Initial foodborne transmission may be followed by secondary person-to-person transmission in the
community, within an institution, and to household contacts of ill staff members from an institution. An infectious dose can be as
few as 10 viral particles. Viral shedding preceding onset of illness can occur in 30% of those infected. And, norovirus can withstand
wide temperature ranges (0° C — 60° C). Immunity to norovirus is likely strain (genotype) specific and may only last for a few
months. Therefore, repeat infections can occur in the same person over time. Noroviruses are generally transmissible from the time
symptoms begin until up to several days after symptoms end”(Montana Communicable Disease Epidemiology Program, 2010)
The most common vehicle of transportation is considered to be food and water, and it is possible to acquire the infection from an infected person through coughing, sneezing in close proximity to other individuals. Our bodies are bombarded daily with many different virus, which can weaken our immune system and thus we become more susceptible to new virus. In addition, due to improper hand washing techniques, improper washing of food, sharing utensil, and using the same drinking glass from family members and loved ones adds to susceptibility of the human body.

12. Mortality and Morbidity
Norovirus gastroenteritis typically lasts hours, with remission occurring without sequelae. Death is extremely rare, except in individuals particularly vulnerable to profound volume depletion.
Norovirus gastroenteritis can occur in individuals of all ages. Studies using norovirus recombinant antigen have suggested an increase in antibody prevalence with advancing age. In one study, the prevalence of norovirus immunoglobulin G (IgG) rose during school-aged years, reaching a peak of 70% in persons aged years.14 It should be noted, however, that not all infected individuals sustain detectable antibody responses.
eMedicine. (2009, November 11). Retrieved October 22, 2010, from Norwalk Virus:
Norovirus gastroenteritis typically lasts hours, with remission occurring without sequelae. Death is extremely rare, except in individuals particularly vulnerable to profound volume depletion. Norovirus gastroenteritis can occur in individuals of all ages. Studies using norovirus recombinant antigen have suggested an increase in antibody prevalence with advancing age. In one study, the prevalence of norovirus immunoglobulin G (IgG) rose during school-aged years, reaching a peak of 70% in persons aged years. It should be noted, however, that not all infected individuals sustain detectable antibody responses” (eMedicine, 2009). .

13. Control and Prevention
This virus does not discriminate against socioeconomic groups; it crosses all racial boundaries, which makes is an equal opportunity virus. The Norvirus last for a short period and it is an annoyance, and because this is virus is food related we are constantly at risk ; therefore, the public health community must effectively community to the public the importance of prober hand washing technique after the use of commercial or residential rest rooms during food preparation. Infected individuals are not quarantine; therefore, they must be encourage by the public health community to getting rest, drinking fluids, and staying at home until the constant vomiting and diarrhea has subsided.
“Always wash their hands thoroughly with soap and warm water before eating or preparing food, after using the toilet, and after changing diapers. (2) Wash own hands as well as the child’s hands after changing a child’s diaper. Dispose of feces and vomitus in a sanitary manner. (3) Always wash their hands with plenty of soap and warm water if they are caring for someone who has vomited or has diarrhea, particularly after cleaning the bathroom, helping the person use the toilet, or changing diapers, soiled clothes, or soiled sheets. Hands should be scrubbed for at least 15–20 seconds after cleaning the bathroom; after using the toilet or helping someone use the toilet; after changing diapers; before handling food; and before eating”(Massachusetts Department of Public Health, Bureau of Communicable Disease Control, 2006).

14. References
CDC. (2004, December 27). Retrieved November 08, 2010, from Norovirus and Foodborne Disease, United States, 1991–2000: (2006, August 3). Center for Disease Control. Retrieved January 20, 2010, from
CDC . (2009, July 15). Retrieved November 01, 2010, from Noroviruses Summary Document:
eMedicine. (2009, November 11). Retrieved October 22, 2010, from Norwalk Virus:
EPA. (2010, August 17). Retrieved October 22, 2010, from Norwar\alk Virus:
Foodborne Illness. (2010). Retrieved November 01, 2010, from Norovirus:
Nordgren, Johan, Kindberg, Elin, Lindgren, Per-Eric, Matussek, Andreas, and Lennart,
Svensson. (2010, January 1). Center for Disease Control. Retrieved January 20, 2010,
from :
Massachusetts Department of Public Health, Bureau of Communicable Disease Control. (2006,
June). Retrieved October 23, 2010, from Norovirus & Other Caliciviruses:
Montana Communicable Disease Epidemiology Program. (2010, March). Retrieved October 23,
2010, from Norovirus transmission and prevention:
Wheeler, R. E. (2004). Retrieved October 22, 2010, from