Norovirus Outbreak Traced to Reusable Grocery Bag

Lara C. Pullen, PhD

May 09, 2012

May 9, 2012 — In October 2010, 17 Oregon girls attending a soccer tournament in Washington state, along with 4 of their adult chaperones, all developed nasty gastroenteritis symptoms. Investigators initially were worried that the outbreak may have spread to other players in the tournament, and that local restaurants may have been the source of the pathogen.

The culprit turned out to be norovirus, however, and investigators traced its source to a reusable, open-top grocery bag that had been stored in a hotel bathroom, according to a report on the outbreak by Kimberly K. Rapp, PhD, MPH, from Oregon Health and Sciences University, and William E. Keene, PhD, MPH, from the Oregon Public Health Division in Portland, published online May 9 in the Journal of Infectious Diseases.

The investigation determined that virus aerosolization occurred within the hotel bathroom and settled on the grocery bag and its contents. The outbreak occurred among individuals who touched the bag and consumed the contents (risk difference, 0.636; P < .01).

Previous studies have shown aerosolization of vomit and feces to be important in norovirus outbreaks. The current research confirms that the aerosol contamination of fomites can contribute to persistent problems on cruise ships, in nursing homes, and in other settings. "While we certainly recommend not storing food in bathrooms," the authors note in a journal news release, "it is more important to emphasize that areas where aerosol exposures may have occurred should be thoroughly disinfected; this includes not only exposed surfaces, but also objects in the environment."

Norovirus outbreaks can best be prevented with dedicated bathrooms for sick persons. In addition, cleaning staff should be informed about the need for adequate sanitation of surfaces and fomites to prevent spread.

Noroviruses are a leading cause of gastroenteritis worldwide and are the most common cause of food-borne outbreaks in the United States (21 million cases annually). In an accompanying editorial, Aron J. Hall, DVM, MSPH, from the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, notes, "The complex and varied transmission webs through which noroviruses are spread make development of effective prevention and control measures a daunting task."

The authors and editorialist have disclosed no relevant financial relationships.

J Infect Dis. Published online May 9, 2012.

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