The norovirus is highly contagious and causes acute gastroenteritis. It alters the intestinal lining, causing vomiting and diarrhea that releases billions of virus particles. Only a small number are needed to infect a new host. The virus is spread easily through contaminated food, water, and surfaces. It is resistant to freezing, heating and many disinfectants. Prevention relies on proper handwashing and surface cleaning. Norovirus causes around 21 million illnesses in the US each year.

1. PATHOGENPATHOGEN
The
Perfect Human

2. Highly
Contagious
Diarrhea
The Norovirus alters
the intestinal lining,
causing cells to dump
fluid, which gets
washed out of the body
along with many, many,
many noroviruses.
http://phenomena.nationalgeographic.com/2013/01/02/the-norovirus-a-study-in-puked-perfection/

3. each GRAM of
feces contains
around 5 BILLION
noroviruses ready to
INFECT a new host.
http://jid.oxfordjournals.org/content/205/11/1622.full

4. but it only takes
about 20 VIRUSES to
establish an infection.
http://www.ncbi.nlm.nih.gov/pubmed/21876931

5. Highly
Contagious
Vomit
Noroviruses hijack
our nervous system to
slow down the passage
of food from the
stomach into the
intestines.
http://www.mdpi.com/1999-4915/2/3/748

6. when that
STORED FOOD comes
flying out of the mouth,
it provides a vehicle for
noroviruses to SPREAD.

7. Easily
Spread
Airborne
Noroviruses easily
float through the air
and settle on
surfaces like food,
countertops, sinks or
toilets.
http://jcm.asm.org/content/48/7/2552

8. Tougher Than
Bear Grylls
Freeze, Cook or Clean
noroviruses survive
both freezing and
heating and resist
many common chemical
disinfectants.
http://phenomena.nationalgeographic.com/2013/01/02/the-norovirus-a-study-in-puked-perfection/

9. noroviruses
can SURVIVE on
surfaces for up
to 2 WEEKS.
Maybe even years in still water
http://blogs.scientificamerican.com/artful-amoeba/2012/01/17/misery-inducing-norovirus-can-survive-for-months-perhaps-years-in-drinking-water/
http://www.sciencedirect.com/science/article/pii/S0168160505005854

10. Rapid
Evolution
Limited Immunity
noroviruses are genetically diverse and
evolve rapidly. That means we’ve only
got a few months of immunity, and then
we’re fair game for another brutal bout
of projectile puking and diarrhea.
http://www.ncbi.nlm.nih.gov/pubmed/16343580?dopt=Abstract

11. What Doesn’t
Kill You...
ModerateVirulence
noroviruses are only moderately virulent
allowing a large pool of potential hosts
to survive...
and be reinfected.
again.
and again.
and again...

12. Recipe for an Outbreak
1 car dealership
1 Infected toddler
1 baby changing station
Several Billion Noroviruses
2 big packs of dry paper towels
16 employees (12 sick)
Ingredients:
http://www.micro-blog.info/2013/07/this-is-what-happens-when-norovirus-sprays-from-a-toddler/
http://www.salahqutaishat.com/1/post/2013/07/the-st-hit-the-fan-at-an-auto-dealer-in-oregon.html
http://www.ncbi.nlm.nih.gov/pubmed/23559462

13. Recipe for an Outbreak
Directions:
1. Bring an infected toddler to
car dealership and liberally
spray baby changing station
with feces. Leave the
mess for a dealership
employees to cleanup.

14. Recipe for an Outbreak
Directions:
2. Clean up the baby
changing station using only
dry paper towels. Leave
some infected feces (with
billions of noroviruses)
visible on the baby
changing station. For
additional outbreaks leave
the feces visible for weeks.

15. Recipe for an Outbreak
Directions:
3. Return to the meeting,
touch surfaces, handle food
and infect 75% of your
co-workers

16. Treatment
NOTHING!
•antiviral drugs
•vaccine
•time
•plenty of fluids
Dehydration is the most
common complication and
in severe cases can
require IV fluids.
http://www.cdc.gov/norovirus/about/treatment.html

17. But it is
possible to
PREVENT
Norovirus
outbreaks.

18. Prevention
The best way to help
prevent norovirus is
to practice proper
hand washing and
general cleanliness.
http://www.cdc.gov/norovirus/preventing-infection.html
WashYour Hands

19. Prevention
Remove vomit or diarrhea
right away!
Use soapy water to wash
surfaces that contacted
vomit or diarrhea and all
nearby surfaces, such as
door knobs and toilet
handles
http://www.disinfect-for-health.org/wp-content/themes/disinfect/pdfs/NorovirusIncident_8.5x11_Eng_Color.pdf
Clean contaminated
surfaces

20. Prevention
Rinse thoroughly with
plain water
Wipe dry with paper towels
http://www.epa.gov/oppad001/list_g_norovirus.pdf
Clean contaminated
surfaces

21. But DON’T STOP here.
Norovirus can survive on
surfaces after cleaning

22. Prevention
Disinfect surfaces by
applying a chlorine bleach
solution or EPA approved
disinfectant
Disinfect Surfaces

23. Prevention
Prepare a chlorine bleach
solution (or disinfectant)
Allow disinfectant to air
dry for surfaces unlikely
to have food or mouth
contact
Rinse all surfaces
intended for food or mouth
contact with plain water
before use
Disinfect Surfaces

24. Cleaning and
Disinfection Resources
• Restroom Cleaning Procedures
• EPA Approved Disinfectants
• Baby Changing Station Sanitation
Instructions
• Industry Cleaning Tips

25. Norovirus BREAKS BAD
millions of times each year

26. More Common
Than the
Cold?
No. But...
Norovirus is the most
common cause of acute
gastroenteritis in
the United States
https://www.osha.gov/Publications/norovirus-factsheet.pdf

27. So What’s
the Big
Deal?
It’s expensive!
•21 million illnesses
•2 million outpatient visits
•400,000 emergency department visits
•70,000 hospitalizations
•800 deaths each year
http://www.cdc.gov/norovirus/php/illness-outbreaks.html

28. It’s more
common
than you
think
A.G.E.
(acute gastroenteritis)
•179 million episodes occur annually
•50% caused by norovirus
•NORS started tracking in 2009
•Most illnesses are not tied to a
reported outbreak (1/3000)
http://wwwnc.cdc.gov/eid/article/19/8/13-0482_article.htm

29. The first identified
OUTBREAK was in 1968
at Bronson Elementary
school in NORWALK Ohio
http://en.wikipedia.org/wiki/Norovirus

30. That’s why it’s sometimes
called NORWALK VIRUS.
Norwalk virus is the species, where as norovirus is
the genus (but there’s only one known species in
the genus anyways).

31. Discovery
The 1968 outbreak of
gastroenteritis at Bronson
Elementary school in
Norwalk Ohio prompted a
lot of scientific study.
But it wasn’t until 1972
that Dr Albert Kapikian
discovered the virus
behind that outbreak.
http://www.niaid.nih.gov/labsandresources/labs/aboutlabs/lid/epidemiologysection/Pages/kapikian.aspx
Dr.Albert Kapikian

32. What Can
YOU do?
Report unclean
conditions
•Report unclean restrooms to management
•Wash your hands regularly
•Stay home when you’re sick (really, no need to
be a hero, let someone else finish those TPS reports.)
http://www.salahqutaishat.com/

33. Photo Attributes
• Photo Credit: <a href="http://www.flickr.com/photos/28634332@N05/5654415647/">NASA's Marshall Space Flight Center</a> via <a href="http://compfight.com">Compfight</a> <a href="http://
creativecommons.org/licenses/by-nc/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/47353092@N00/8102307987/">AJC1</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-sa/
2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/24315793@N02/3010888802/">Reggie Rachuba</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/
by-nc-nd/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/70591690@N00/2693551009/">ZeroOne</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-sa/
2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/34864797@N07/3473249591/">parkydoodles</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-
nc-sa/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/10819063@N06/3654276952/">tbSMITH</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-nc-nd/
2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/37129284@N02/5093910979/">greg westfall.</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by/
2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/35703177@N00/3095149875/">The U.S. Army</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by/
2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/93247490@N00/441858611/">Mark Lobo .</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-nc-
nd/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/95492938@N00/81671961/">Kaptain Kobold</a> via <a href="http://co
• mpfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-nc-sa/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/34838158@N00/3370167184/">alexkess</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-nc-nd/
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2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/93587218@N00/2452029695/">Mel B.</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by/
2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/98005720@N00/4100788909/">Amarand Agasi</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-
nc-sa/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/45940879@N04/5421517469/">Kalexanderson</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by-
nc-sa/2.0/">cc</a>
• Photo Credit: <a href="http://www.flickr.com/photos/99479626@N00/3492602261/">Eneas</a> via <a href="http://compfight.com">Compfight</a> <a href="http://creativecommons.org/licenses/by/
2.0/">cc</a>

34. ThankYou
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