A cluster of acute norovirus gastroenteritis was recently reported to the Oregon Public Health Division. It occurred in a group of 17 girls on a soccer team traveling with their four adult chaparones.1 After thorough investigation, the source of the norovirus appeared to be either a reusable grocery bag (that tested positive) or its food contents (packaged chips, cookies, and open grapes) that were shared by the team.
Noroviruses have been called “the perfect human pathogens.”2 They are responsible for half of all outbreaks of gastroenteritis worldwide. A small inoculum can cause infection and large quantities of virus are shed in vomit and feces once infection is established. Due to constant evolution, there is no long lasting immunity after exposure. The viruses have been shown to survive freezing and heating (though not cooking) and can persist on surfaces for up to two weeks (as was the case here, where the virus was isolated from the grocery bag two weeks later). And it is a pro at spreading through various routes – fecal-oral, via fomites, and, a particularly unique and endearing attribute for a GI virus, by aerosolization.
How can we escape this perfect “Alien-like Predator”? Well, this may be difficult if you are on one of the unfortunate cruise ships out at sea or are confined to a skilled nursing facility in an outbreak. But even in those circumstances, the answer is as old as ancient Babylon in the reign of Nabonidus (556-539 BC) when soap was first described. Mother knew best: wash those hands! Certainly, as professional standards prescribe, we all need to wash our hands between patients. But how about before and after using the restroom, before eating, and when coming home. Consider as well that your clinic cleaning crew may vacuum the floors and wash the basins and surfaces of your office, but they don’t touch your desk, keyboards, telephones, or mouses (the proper geeky plural of mouse), stethoscopes, lab coats, or neckties.
As an aside, when the local initiatives against plastic disposable grocery bags arose (and I support them), my lovely wife, Kathryn, said, “There will be diseases spread by unsanitary reusable bags!”3 Sigh.
Marshall Kubota, MD
- Rapp KK and Keene WE. J Infect Dis 2012 Jun 1; 205-1639
- Hall AJ. J Infect Dis 2012 Jun 1; 205; 1622
- Kathryn Kubota, 2011