My noro nightmare: vomit on a plane

A few years ago I had a noro nightmare.

Jack, my then four-year-old son, and I were visiting my brother and sister-in-law in Calgary (that’s in Canada). I was there for a talk, Jack tagged along to hang out with the fam – and so we could buy him hockey equipment (there’s way more selection in the true north).Jackpic2

As we went from store to store, in and out of the car, Jack said that his stomach hurt. I asked him what would make him feel better and he suggested eating Doritos would do the trick.

Ten minutes later, half a bag in, Jack yacked all over the car.

We went home, he stayed on the couch all day complaining of stomach cramps. He fell asleep around 6pm.

We left for the airport at 5am the following morning and he puked in the car (and all over his clothes) again.

After going through security and customs we boarded our first flight to Minnesota. Jack seemed to be better and wasn’t complaining of nausea. When we got to our connection airport he talked me into buying him an ice cream sundae. It wasn’t my proudest parenting moment.

Back in the air about an hour following the dessert-for-lunch meal and all was fine. Until we hit some turbulence as we approached Raleigh. The shaking plane triggered another round of puke, which ended up on him and the window.

The flight attendants responded quickly, and provided me with plastic bags to contain the pukey clothes and coffee pods to manage the smell.

Because there are some sympathy yackers out there.

The flight crew let us off the plane first (although we were in the second-to-last row). I picked Jack up with one arm, carried the vomit-covered clothes bag in the other with our carry-on strapped on my back. I squeezed down the aisle, potentially inoculating the plane with norovirus.

The post-script to the story is that while I didn’t get sick (surprising since I handled all the puke) my brother and sister-in-law did. And maybe a few other passengers.

‘Highest standards of cleanliness and hygiene’ 56 sickened in Norovirus outbreak at UK bar

Fifty-six people who fell ill after attending functions at a bar in Bridgend county had the norovirus, it has been confirmed.

Hi-Tide bar in PorthcawlPublic Health Wales said the Hi-Tide bar in Porthcawl remains open after the outbreak of diarrhoea and vomiting.

The outbreak has now been declared over.

A bar spokesman said: “We are confident that we provided, and will continue to provide, the very highest standards of cleanliness and hygiene.”

“We would like to wish all those affected a full and speedy recovery,” the spokesman added.

Pumpkin carving gathering linked to noro outbreak

As my kids get older I start to relive my youth. Last week’s Halloweeen festivities reminded me of costume parades, classroom pumpkin carving competitions and seed roasting.

All shared activities, which turnout to be pretty good norovirus sharing grounds.F2XEZKMG1BB7VQI.MEDIUM

According to the Register Guard, over 100 students and teachers at a Eugene, Oregon school were out with norovirus symptoms following pumpkin carving festivities.

One of two pumpkin-carving events held prior to Halloween may have been the cause of a suspected norovirus outbreak at O’Hara Catholic School, Lane County officials say.

The school welcomed students and staff back to class Tuesday following an extended five-day weekend after the outbreak caused at least 100 people to fall ill. School Principal Tammy Conway said about 40 percent of students were absent on Tuesday.

The long weekend came after 16 staff and faculty members of the school on West 18th Avenue called in sick last Thursday, prompting administrators to cancel classes and close the school for the remainder of the week.

Jason Davis, spokesman for Lane County Health and Human Services, said on Tuesday that after ruling out several other potential causes, a pumpkin-related incident could be the culprit.

Davis stressed that a confirmed culprit for the virus has not yet been identified, though a number of different leads have been ruled out, including a staff-wide breakfast.

“A lot of parents just decided to keep their kids home as a precaution, which isn’t really necessary at this point,” he said.

Norovirus is extremely contagious and usually transmitted when someone accidentally gets traces of stool or vomit from an infected person in their mouth, according to Davis. He said the virus is transported primarily by fecal matter, either in food or on hard surfaces, and is not transmitted through the air.

Not quite There’s some nice science out of the NoroCORE project that shows aerosolization is possible.

Philadelphia: Ingredients not on menu

The Philadelphia Inquirer continues its efforts to improve restaurant inspection disclosure in the City of Brotherly Love. Philadelphia Department of Public Health keeps its restaurant inspection reports secret for 30 days, unnecessarily risking the health of unsuspecting diners at restaurants with serious hygiene problems.

Philadelphia’s is the only health department in the nation’s 10 largest cities that has such an asinine policy, as reported last week. Phoenix takes 72 hours to process its reports and make them public, while the rest – including New York, Chicago, and Los Angeles – publish them immediately.

Within Pennsylvania, Pittsburgh also posts inspection reports immediately. So do Bucks, Montgomery, and Chester Counties. Across the Delaware, Camden and Burlington Counties post the information online within five days. A metropolis like Philadelphia should be able to keep up. health department spokesman told that sanitation reports are kept confidential for a month to give establishments time to challenge them. It’s fine to allow restaurants to appeal inspectors’ findings, but not at the expense of diners who deserve to know if a restaurant’s cleanliness has been questioned. Besides, there have been only four such appeals since 2009.

The 30-day grace period is too long. It suggests that the health department lacks confidence in its inspectors’ ability to evaluate sanitary conditions. If that is the case, then rather than err on the side of a restaurant that may have a rat or roach problem, the department should improve its inspectors’ skills and reduce the possibility of inaccurate assessments.

The department’s website ( notes that every inspection report is a “snapshot” that “may not be representative of the overall, long-term sanitation and safety status of an establishment.” That’s an important caveat. But it doesn’t mean that having carefully cultivated a reputation for fine dining, Philadelphia should risk it by being too slow to point out which of its restaurants should be avoided.

There’s a lot of norovirus in Nevada schools

The famed winter vomiting virus appears to be making life miserable for Nevada school kids. According to the Reno Gazette Journal over 1700 students in 20 schools have had the virus over the past 5 weeks and the outbreak appears to be spreading.

The case count might be real or it might be inflated due to self reporting (kids who want to stay home) or protective parents who don’t want noro in their house (keeping their kids home).

An outbreak of norovirus has reached such heights in local public schools that health officials stopped counting the number of people infected by the highly contagious illness, which causes days of diarrhea and vomiting.200187143-001

But the Washoe County Health District estimates – based on schools’ absenteeism and reported illnesses – that 1,760 students and staff have been afflicted at 20 schools and a few daycare centers, quadrupling the number of infections since the outbreak started at half as many schools on Oct. 1.

“We were hopeful it wouldn’t get to this point,” said county Director of Epidemiology Randall Todd, noting the virus’ rapid spread to a new school every few days.

The health district has advised the Washoe County School District and families to do three things at outbreak schools, which are concentrated in northern Reno, Spanish Springs and Sparks. The health district isn’t identifying the affected daycare centers.

Disinfect high-traffic areas of the school where surfaces are repeatedly touched, such as railings, desks, chairs and doors. Thoroughly clean and disinfect the area around a vomiting incident up to a 25-foot radius.

Wash hands frequently with soap and water — antibacterial hand-sanitizer does not kill the virus.

Sick students and staff must stay out of school for 72 hours after their last symptoms.

Such a “substantial outbreak” wouldn’t be possible if parents and staff were following all three protocols advised for outbreak schools, said Todd, positing that at least one recommendation isn’t being followed.

The health district hasn’t recommended closing any schools, and school officials said they don’t want to go there either for the sake of academics.

But they’re in luck. The week-long fall break starts Monday.

“We’re keeping our fingers crossed that fall break will give us the boost we need to put this behind us,” said Todd.

Norovirus hospitalizes thousands of Canadians annually

Most people get over a bout of norovirus relatively quickly and without a visit to a health care provider. In extreme cases, a couple of days worth of vomit and painful stomach cramps can send folks to the hospital, especially if they become severely dehydrated.

Our hoser colleagues have estimated that between 4000 and 11,000 people are hospitalized as a result of Norovirus annually in Canada, resulting in a cost burden of over $21 million CAD (or about 5 million Timbits).images

Estimated hospitalizations attributed to norovirus and rotavirus infection in Canada, 2006–2010
V.K. Morton, M.K. Thomas and S. A McEwen
Epidemiology and Infection / Volume 143 / Issue 16 / December 2015, pp 3528-3537

Enteric viruses including norovirus and rotavirus are leading causes of gastroenteritis in Canada. However, only a small number of clinical cases are actually tested for these pathogens leading to systematic underestimation of attributed hospitalizations in administrative databases. The objective of this analysis was to estimate the number of hospitalizations due to norovirus and rotavirus in Canada. Hospitalization records for acute gastroenteritis-associated discharges at all acute-care hospitals in Canada between 2006 and 2011 were analysed. Cause-unspecified gastroenteritis hospitalizations were modelled using age-specific negative binomial models with cause-specified gastroenteritis admissions as predictors. The coefficients from the models were used to estimate the number of norovirus and rotavirus admissions. The total annual hospitalizations for rotavirus were estimated to be between 4500 and 10 000. Total annual hospitalizations for norovirus were estimated to be between 4000 and 11 000. The mean total annual cost associated with these hospitalizations was estimated to be at least $16 million for rotavirus and $21 million for norovirus (all figures in Canadian dollars). This study is the first comprehensive analysis of norovirus and rotavirus hospitalizations in Canada. These estimates provide a more complete assessment of the burden and economic costs of these pathogens to the Canadian healthcare system.

Katie’s Norovirus Nightmare

The NoroCORE Collaborative is running a series of posts for Halloween on norovirus nightmares. The first post comes from one of my graduate students, Katie Overbey.

During Spring Break of 2014 I was spent the week with my boyfriend in New Orleans and we stayed with my aunt. As one does in New Orleans, we ate lots of tasty food and tried lots of drinks. On the Saturday of our trip, after eating at my aunt’s favorite Mexican restaurant (side note: who eats Mexican food when they visit New Orleans?) she decided to take us on what has since been deemed the ‘drinking tour of the French Quarter.’ KatieOverbeyAfter about three hours I started to feel queasy right in the middle of the iconic Pat O’Briens Bar. We thought maybe I was hungry from our day of activities so we headed to get dinner. The place was packed and while waiting for our food, it hit me. I weaved through the crowd to get to the bathroom, just to discover that one stall was broken, the other was occupied and there was a line. I apologized to the people in line for what was about to happen and then proceeded to throw up in the sink, because as anyone who’s had norovirus knows – when it decides to hit, there’s not much you can do.

After cleaning up as best I could (though after my master’s research I now know that bathroom was doomed because of all my aerosolized vomit) we headed back to my aunt’s as fast as possible. I proceeded to get sick all night long, which ironically put a damper on the rest of my relaxing vacation.

At first, my aunt and boyfriend thought I had enjoyed the drinking tour too much, but I knew that what I had was way worse. I suspect that it had something to do with the Mexican food because after my aunt ate some of my leftovers, she got sick too.

Katie Overbey is an MS student in Food Science at NC State studying how to better communicate with schools having norovirus outbreaks and environmental detection of norovirus

40 sick in Norovirus outbreak at Brisbane camp

Looks like I picked the wrong week to send the kid to camp (I didn’t).

airplane.sniffing.glueQueensland health is trying to identify the cause of a suspected norovirus outbreak.

A highly contagious stomach bug is suspected to have hit about 40 primary school pupils after a Year 4 camp at the weekend.

In an email to parents yesterday, Grovely’s St William’s School principal Anthony Lucey said one family had a confirmed diagnosis of norovirus.

Brisbane Catholic Education communications manager John Phelan said about 40 children had been affected since symptoms were first reported last weekend after children returned from Camp Warrawee at Joyner.

“Once students began reporting as ill, we immediately contacted both the camp and Queensland Heath,” Mr Phelan said.

Losing my religion.

Foodborne viruses in fresh produce

Norovirus (NoV) and hepatitis A virus (HAV) are the most important foodborne viruses. Fresh produce has been identified as an important vehicle for their transmission.

foodborne.virus.produceIn order to supply a basis to identify possible prevention and control strategies, this review intends to demonstrate the fate of foodborne viruses in the farm to fork chain of fresh produce, which include the introduction routes (contamination sources), the viral survival abilities at different stages, and the reactions of foodborne viruses towards the treatments used in food processing of fresh produce. In general, the preharvest contamination comes mainly from soli fertilizer or irrigation water, while the harvest and postharvest contaminations come mainly from food handlers, which can be both symptomatic and asymptomatic. Foodborne viruses show high stabilities in all the stages of fresh produce production and processing. Low-temperature storage and other currently used preservation techniques, as well as washing by water have shown limited added value for reducing the virus load on fresh produce. Chemical sanitizers, although with limitations, are strongly recommended to be applied in the wash water in order to minimize cross-contamination. Alternatively, radiation strategies have shown promising inactivating effects on foodborne viruses. For high-pressure processing and thermal treatment, efforts have to be made on setting up treatment parameters to induce sufficient viral inactivation within a food matrix and to protect the sensory and nutritional qualities of fresh produce to the largest extent.

Comprehensive Reviews in Food Science and Food Safety

Dan Li, Ann De Keuckelaere and Mieke Uyttendaele

Norovirus surrogates are tough to inactivate in cotton and polyester

A couple of years ago Sam, the almost-5-year-old yacked all over the backseat of the van on a car trip. The polyester carpeting and cotton fabric-covered seats smelled for weeks. We even tried to hose the van out, leaving the doors open for a couple of days (and then a frog set up shop in there).

It was most likely motion sickness that led to Sam’s vomit event, but people with noro puke on all sorts of surfaces. My friend Angie Fraser and colleagues at Clemson just published what happens when you try to inactivate norovirus surrogates on different surfaces including polyester and glass.

From the discussion: images

Our results indicated that surface and virus type had a significant influence on RE (that’s recovery efficiency – ben). We found that both FCV and MNV exhibited higher RE when inoculated onto glass than either polyester or cotton. In addition, the recovery of both viruses from cotton was significantly lower than that of polyester. Compared with FCV, MNV exhibited a higher recovery from soft porous surfaces; however, it was only significant for cotton. Previous studies have also document- ed the ability of HuNoV surrogates to be recovered with greater efficiency from hard nonporous surfaces than from soft porous surfaces. Viruses may become more tightly bound to soft porous surfaces due to their ability to absorb the virus-containing media and trap viruses in the subsurface.

Recovery and Disinfection of Two Human Norovirus Surrogates, Feline Calicivirus and Murine Norovirus, from Hard Nonporous and Soft Porous Surfaces

Journal of Food Protection, Number 10, October 2015, pp. 1776-1924, pp. 1842-1850(9)

Yeargin, Thomas; Fraser, Angela; Huang, Guohui; Jiang, Xiuping


Human norovirus is a leading cause of foodborne disease and can be transmitted through many routes, including environmental exposure to fomites. In this study, both the recovery and inactivation of two human norovirus surrogates, feline calicivirus (FCV) and murine norovirus (MNV), on hard nonporous surfaces (glass) and soft porous surfaces (polyester and cotton) were evaluated by both plaque assay and reverse transcription quantitative PCR method. Two disinfectants, sodium hypochlorite (8.25%) and accelerated hydrogen peroxide (AHP, at 4.25%) were evaluated for disinfection efficacy. Five coupons per surface type were used to evaluate the recovery of FCV and MNV by sonication and stomaching and the disinfection of each surface type by using 5 ml of disinfectant for a contact time of 5 min. FCV at an initial titer of ca. 7 log PFU/ml was recovered from glass, cotton, and polyester at 6.2, 5.4, and 3.8 log PFU/ml, respectively, compared with 5.5, 5.2, and 4.1 log PFU/ml, respectively, for MNV with an initial titer of ca. 6 log PFU/ml. The use of sodium hypochlorite (5,000 ppm) was able to inactivate both FCV and MNV (3.1 to 5.5 log PFU/ml) below the limit of detection on all three surface types. AHP (2,656 ppm) inactivated FCV (3.1 to 5.5 log PFU/ml) below the limit of detection for all three surface types but achieved minimal inactivation of MNV (0.17 to 1.37 log PFU/ml). Reduction of viral RNA by sodium hypochlorite corresponded to 2.72 to 4.06 log reduction for FCV and 2.07 to 3.04 log reduction for MNV on all three surface types. Reduction of viral RNA by AHP corresponded to 1.89 to 3.4 log reduction for FCV and 0.54 to 0.85 log reduction for MNV. Our results clearly indicate that both virus and surface types significantly influence recovery efficiency and disinfection efficacy. Based on the performance of our proposed testing method, an improvement in virus recovery will be needed to effectively validate virus disinfection of soft porous surfaces.