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Norovirus - How to prevent the spread of infection

In the media we often hear about Norovirus outbreaks in hotels, restaurants, cruise ships, schools and hospitals. It's commonly known as the “Winter vomiting virus” or the “Cruise ship bug”. However, what we may not appreciate is that the Norovirus is thought to account for up to 50% of worldwide foodborne gastroenteritis, making it a global public health concern.

So, why does the virus cause such widespread problems and how can outbreaks be prevented or controlled?

Symptoms of the Norovirus illness normally start around 24 to 48 hours after the initial infection. The most common symptoms are vomiting and diarrhoea. Some other people may have a mild fever, headaches, stomach cramps and aching limbs.

There is no specific treatment for a Norovirus infection. But the symptoms can lead to dehydration which is a particular concern for the vulnerable groups. Particularly children, the elderly, and those with other illnesses. Those who have a Norovirus infection should drink plenty of fluids, try re-hydration products, and eat a light diet.

Most people are free of Norovirus symptoms after two to three days. However they may still be carriers of the virus for several days longer. 80 deaths in the UK each year are believed to be Norovirus related. Most of these being elderly with other serious health problems.

Where does Norovirus come from?

“Norovirus” actually consists of a large number of different strains of the virus and new strains continue to evolve. The name is derived from its very first identification. Following an investigation of an outbreak of viral gastroenteritis in a school in Norwalk, Ohio during 1968. Initially the virus was known as the 'Norwalk virus'.

The Norovirus, like all viruses, needs a living host in order to reproduce. However, it can however survive outside the body for several days and be carried in food or water. It only takes a very small number of viral particles (~20) to make you ill. There are tens of thousands of viral particles in the vomit and faeces of an infected person. Individuals can also be a carrier of the virus after their symptoms have disappeared. This then makes it easier for the infection to spread.

The following are the commonest sources and infection routes:

Norovirus does not reproduce in food, but it can be carried on it. For example, if shellfish have been collected from water contaminated by sewage or if vegetables have been grown or washed with sewage contaminated water.

During food preparation, contamination from these foods might also be transferred to other foods.

The virus can survive on frozen foods and there have been a number of examples of Norovirus outbreaks originating from consumption of thawed, contaminated foods such as soft fruits. An infected person can easily contaminate any foods they prepare. Especially if they handle ready-to-eat foods with hands which are contaminated with viral particles.

How we spread it

Unfortunately, an infected person can have a sudden and uncontrollable urge to projectile vomit. Vomiting in public places produces an infectious aerosol containing thousands of viral particles which can then infect those nearby. Infections may also spread if the vomit material is not cleaned away effectively and contaminates other people. Small particles of the vomit might also land on surfaces and be picked-up on people's hands or even land on food some distance from the sick person and get eaten inadvertently.


Infected persons may spread viral particles if they do not wash and dry their hands thoroughly after using the toilet. Adults can also become infected if they are helping in the toileting of young children.

If viral particles have landed or been transferred onto a surface, touching the surface with the hands then touching the mouth can result in infection.

Direct person to person contact is another method of spreading the virus, even the shaking of hands could transfer it. In the family home, the infected person can also easily pass Norovirus to the rest of the family.

We can see how easily Norovirus outbreaks can occur in cruise ships, hospitals, schools and care homes. The start of the outbreak may originate from contaminated food or from a single infected person. Norovirus can then rapidly spread as people are in close proximity to each other. Any contaminated food could be eaten by many people. It can also be challenging to quickly and effectively clean a contaminated public place if somebody has vomited.

People in countries without access to clean water have additional risks of becoming infected by Norovirus and, once infected, they are more at risk of dehydration. Travel to countries with poor hygiene standards and lack of clean water is also a risk.

What can we do to help prevent the spread of Norovirus?

Prevention of a Norovirus outbreak is notoriously difficult, but good hygiene practices can help reduce the spread of the infection:


Good hand hygiene is a VERY important infection control measure. The thorough washing and drying of the hands allows for the removal of dirt and debris containing the viral particles. This is a good way of cleaning the harder to reach places, such as under the fingernails. It is particularly important to wash and dry the hands after using the toilet and before preparing food as this will limit the spread of the infection.

Other important times are after cleaning surfaces; after clearing up vomited material, after toileting of young children and after handling baby’s nappies. During a Norovirus outbreak, or when helping an infected person at home, it makes sense to wash and dry the hands more frequently throughout the day - touching a contaminated surface then placing the hands in the mouth can lead to infection.

Hand gels should not be used as a replacement to washing and drying of hands. Instead it should be used as an additional precaution when the hands are not visibly dirty or when soap and water are not available. However, care must be taken to use products which are proven to be effective against Norovirus. There is some evidence that because of the structure of the virus, it is not very susceptible to some alcohol-based sanitisers.

Disinfect any surfaces which might be contaminated with Norovirus. Use bleach where possible or another disinfectant with proven efficacy against Norovirus. This applies in particular to areas where a person has vomited as well as the toilet and bathroom. Soft materials such as curtains should be thoroughly washed and laundered. Carpets may need professional disinfection treatments. Food preparation surfaces and hand contact surfaces should also be disinfected as part of normal cleaning and disinfection routines.

Keep your environment clean by using disposable disinfectant wipes on non-porous surfaces. This is a fast and effective way to kill norovirus and reduce the chance of infection. Spot-cleaning throughout your day with wipes such as universal disinfectant wipes will make a difference and help protect you, not only against norovirus but other viruses, bacteria, yeasts, and TB. 

PDI Sani-Cloth Universal Wipes are tested against EN 14476 to be effective at killing norovirus in only 30 seconds. As these universal wipes are alcohol-free they can be used around animals, children, and those with respiratory difficulties.

Rules for sufferers

Those who have been ill with suspected Norovirus are normally advised not to return to their normal places of work or study until at least two days after the symptoms have stopped. During this time they should not prepare food for others and should avoid contact with others. Those working in the healthcare or food industry should follow their employer’s rules on recommended times before returning to work.

Those who are ill with Norovirus or who have recently recovered from it must not visit hospitals or care homes. A hospital ward may stop taking new admissions and allowing visitors in, if there is a Norovirus outbreak.

Those ill on holiday should be isolated from others – on cruise ships they are advised to stay in their cabins and use their own toilet facilities. Obviously staff must help them by providing food, cleaning and support. If not helped in this way then passengers will be much more likely to go back into public areas while still infectious.

Food safety

Adherence to the principles of food safety will go a long way into helping prevent the spread of infections. These include good personal hygiene, cleaning, thorough cooking, minimising of food handling, avoiding cross-contamination and discarding food which is suspected of any contamination. Food on open buffets or shared snacks in a bar area are a particular concern as there is potential for contamination, especially if guests help themselves to food and transfer the virus from their contaminated hands.

Avoid eating raw, unwashed salad and vegetables.

Purchase shellfish from reputable sources.

Organisations such as the hospitals, care homes, schools and leisure facilities should have documented procedures for preventing the spread of infection and responding to a Norovirus outbreak. Staff training is particularly important, especially for those who prepare and handle food. These people need to understand the principles of hygiene and food safety through their training, supervision and mentoring. Organisations should adhere to the latest food handler “Fitness to work” guidelines. These recommend that suspected Norovirus sufferers are excluded from the workplace. Often organisations will also have a dedicated team of rapid-response cleaners who clean up after a vomiting incident.

Cleaning routines

These cleaners should have been trained to protect themselves from becoming ill by using personal protective equipment (such as disposable aprons and gloves). They know how to carry out the cleaning and understand their role in helping to prevent the spread of infection. Those working in kitchens and handling food should not act as cleaners in circumstances such as this, as it creates an extra risk of spreading the virus onto food.

Norovirus is highly contagious and infection leads to unpleasant symptoms, especially for the vulnerable groups in the community. Those in countries with poor hygiene standards and without access to clean drinking water are at risk of serious dehydration. Although good hygiene practices are recognised as reducing the spread of the infection. We are still learning from the experiences of those who have to deal with Norovirus outbreaks and we continue to be surprised by the resilience of the virus when it is outside the body.

Click here to view our PDI infection control range

If you require further information about Norovirus and preventing its spread can be found in the following sources:-


Food Standards Agency 


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