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Disease Focus: Norovirus

Norovirus – a Brief

By Nicole Kraatz

Norovirus is a highly contagious gastrointestinal illness. It is the most common cause of acute gastroenteritis in the United States. Anyone that comes in contact with the virus may possibly become ill. Formerly known as “Norwalk virus,”norovirus was first discovered in Norwalk, Ohio in 1972. The initial outbreak was at a local school in 1968. Particles of the virus were found in the feces of one of the infected persons, which were only visible under electron microscopy. Those infected with norovirus were categorized with experiencing nausea, vomiting, and diarrhea for 12-24 hours. Norovirus can cause inflammation of the stomach as well as the intestines.

The incubation period for norovirus, on average, is 12-48 hours. Generally, symptoms of norovirus include diarrhea, vomiting, nausea and stomach pains. Additional symptoms of the virus are fever, headache and muscle aches. Because norovirus causes patients to feel extremely ill due to constant vomiting and diarrhea, the risk for dehydration increases. Symptoms of dehydration in patients with norovirus may include decrease in urination, dry mouth and throat as well as feeling dizzy after standing up. Children that experience dehydration may experience crying with few tears or display extreme fatigue.

Because norovirus is extremely contagious, a person can become infected by being in contact with an infected person, contaminated food, water or other surfaces. It is possible for someone to be infected by norovirus multiple times due to the many different strands of the virus. There are certain places were norovirus can spread more quickly. Some of those places include daycare centers, nursing homes, schools, cruises or other areas where large groups of people are contained together.

Currently, there are no specific treatments or vaccines to cure norovirus. It is recommend for those that become ill to drink plenty of fluids to stay hydrated. The most dangerous affect of norovirus is dehydration. Severe dehydration during illness may require patients to be hospitalized in order to receive fluids intravenously. Most people that become ill with norovirus recover between 1-3 days.

Sea Sick:

Contracting Norovirus

on your Cruise

by Courtney Scott

Norovirus in the Dominican Republic
By Nora Rideg


Norovirus is a highly contagious virus that causes gastroenteritis, leading to symptoms like vomiting, diarrhea, and stomach cramps. It can spread rapidly, especially in communal environments such as hotels, resorts, and cruise ships. The Dominican Republic’s growing tourism industry has experienced norovirus outbreaks at several resorts that highlight the need for effective prevention and control measures.
Noroviruses have become a major cause of viral gastroenteritis in closed or semi-closed environments like hospitals, nursing homes, cruise ships, and hotels, where they spread rapidly among people. Primary cases typically arise from exposure to contaminated food or water, while secondary and tertiary cases spread through person-to-person contact, airborne particles, and contaminated surfaces. In the Dominican Republic, a norovirus outbreak occurred in August 2007 at a tourist resort in the northern part of the country, affecting over 800 people over 15 days with severe vomiting and diarrhea. Despite initial negative results from testing food and water for bacterial pathogens, and rigorous sanitation measures such as hyperchlorination and removal of high-risk foods from the menu, the outbreak persisted. Environmental testing later confirmed the presence of norovirus in wastewater and on certain surfaces within the resort. It was hypothesized that the virus was introduced by an ill person, with subsequent transmission occurring through contaminated surfaces or airborne particles. The outbreak peaked with the arrival of a large group of tourists, exacerbated by the resort’s crowded conditions.


Similarly, two norovirus outbreaks were investigated at tourist resorts in the Dominican Republic, affecting 402 people in Punta Cana and 371 people in Puerto Plata in January 2005. Although bacterial and parasitic pathogens were ruled out, norovirus was confirmed in stool samples from both resorts. Increased cleaning protocols and heightened chlorine levels were implemented, but water was suspected as a transmission route. Testing revealed norovirus in sewage and treated water used for landscaping, indicating inadequate treatment. Measures such as switching to inundation watering and maintaining strict cleaning procedures ultimately controlled the outbreak after one month. These incidents highlight the challenges of managing norovirus outbreaks in tourist settings and highlight the importance of comprehensive sanitation and rapid response to control such outbreaks effectively in the Dominican Republic.


Since there is poor sanitation and water system, norovirus can spread easily, impacting human health. The symptoms of norovirus, particularly diarrhea and vomiting, can lead to severe dehydration, such as infrequent or dark-colored urine, dry mouth, weakness or dizziness, and headaches. Children might also show signs like crying without tears, irritability, and excessive sleepiness. The inflammation caused by norovirus in the stomach and intestines can make eating and drinking difficult, but it’s important to try to stay hydrated and nourished. Eating and drinking more frequently in small amounts, and taking slow, small sips of fluids can help manage the symptoms. Consuming food or drink too quickly can cause the body to reject it. This is a major health risk that can result in hospitalization, especially if not treated promptly. Not only does norovirus impact human health, but it also has significant economic consequences. Negative experiences shared on social media can lead to a decline in tourism, as potential visitors may be discouraged by reports of outbreaks. This can result in financial losses for resorts, hotels, and local businesses that rely heavily on tourism.


The Caribbean Public Health Agency (CARPHA) created the Tourism and Health Program (THP) in response to the significant impact of norovirus outbreaks, including a 2012 outbreak that affected over 800 people and harmed the Caribbean's tourist economy. This program connects the tourism and health sectors to detect and prevent health threats to visitors and local communities. A key part of the THP is a real-time health information monitoring and alert system. This system allows hotels, cruise ships, and other accommodations to report illnesses and get timely help, preventing outbreaks from spreading. The THP also provides training and certification in advanced food safety and environmental sanitation to support the tourism industry. CARPHA works with international agencies, such as the US Centers for Disease Control, to maintain high health and safety standards.

References:

Cleveland Clinic. (2023, February 3). Norovirus: It isn’t the stomach flu. https://my.clevelandclinic.org/health/diseases/17703-norovirus


Domènech-Sánchez, A., Juan, C., Rullan, A. J., Pérez, J. L., & Berrocal, C. I. (2009). Gastroenteritis outbreaks in 2 tourist resorts, Dominican Republic. Emerging infectious diseases, 15(11), 1877–1878. https://doi.org/10.3201/eid1511.090350


Domènech-Sánchez, A., Juan, C., Rullan, A. J., Pérez, J. L., & Berrocal, C. I. (2014, November 17). Unmanageable norovirus outbreak in a single resort located in the Dominican Republic.
Prevent Epidemics. (2020, January 10).

 

Carpha Tourism & Health Program creates an all-inclusive response to health threats. https://preventepidemics.org/stories/caribbean-public-health-agency-carpha-works-to-provide-an-all-inclusive-response-to-health-threats/

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