August 10, 2018

Norovirus: What It Is and How to Prevent Giving and Getting It

By David Buhner, MD, Public Epidemiologist

You may have heard recently about an outbreak of norovirus in Brevard, North Carolina impacting more than 200 people. It appears that the outbreak is now over with no new cases diagnosed within 48 hours since it ended; however, hand hygiene and protecting ourselves is still more important than ever. We asked our infection prevention expert and public epidemologist, David Buhner, MD, what we need to know about norovirus.

Q: What is norovirus and how does someone get it?

A: Norovirus is a very contagious virus that spreads very easily and causes vomiting and diarrhea. Anyone can get infected and sick with norovirus – you can get the illness many times in your life because there are many different types of the virus. You can get it by accidentally getting tiny particles of feces or vomit from an infected person in your mouth. This can happen if you eat food or drink liquids that are contaminated with norovirus, touch surfaces or objects contaminated with norovirus then put your fingers in your mouth or have direct contact with someone who is infected with norovirus, such as by caring for them or sharing food or eating utensils with them.

Q: If you do get norovirus, what’s the best way to avoid giving it to others?

A: If you get norovirus illness, you can shed billions of norovirus particles that you can’t see without a microscope. And it only takes a few norovirus particles to make other people sick. You are most contagious when you have symptoms of norovirus illness, especially vomiting, and during the first few days after you recover from norovirus illness.

Hand hygiene is essential. Wash your hands thoroughly with soap and water especially after using the toilet or changing diapers, always before eating, preparing or handling food and before giving yourself or someone else medicine.

You can use alcohol-based hand sanitizers in addition to hand washing. But, you should NOT use hand sanitizer as a substitute for washing your hands with soap and water. Hand sanitizers aren’t as effective as washing hands with soap and water at removing norovirus particles.

Q: Is there a “right” way to wash your hands?

A: Wash your hands under running water. Wet your hands with clean, running water (warm or cold) and apply soap. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers and under your nails. Scrub your hands for at least 20 seconds. Need a timer? Hum “happy birthday” from beginning to end twice. Rinse your hands well under clean, running water. Turn off the tap with a paper towel. Dry your hands using a clean paper towel or air dry them. Use a paper towel to open the door to leave the restroom.

Q: How and when should someone seek medical care if you think you have norovirus or a similarly contagious stomach virus,?

A: Most cases of diarrhea resolve without treatment. However, severe diarrhea can cause dehydration, which can be life-threatening if untreated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems.

You should seek medical attention for your child if:

  • Diarrhea doesn’t improve after 24 hours
  • Hasn’t had a wet diaper in three or more hours
  • Has a fever of more than 102 degrees F (39 degrees C)
  • Has bloody or black stools
  • Has a dry mouth or tongue or cries without tears
  • Is unusually sleepy, drowsy, unresponsive or irritable
  • Has a sunken appearance to the abdomen, eyes or cheeks
  • Has skin that doesn’t flatten if pinched and released

Schedule a doctor’s visit for yourself if:

  • Your diarrhea lasts more than two days without improvement
  • You become dehydrated — indicated by excessive thirst, dry mouth or skin, little or no urination, severe weakness, dizziness or lightheadedness, or dark-colored urine
  • You have severe abdominal or rectal pain
  • You have bloody or black stools
  • You have a fever of more than 102 degrees F (39 degrees C)

In short, practice good hand hygiene at all times to avoid infections and stay healthy.

David Buhner, MD, is a public epidemiologist in our Infection Prevention department at Mission Health.
Learn more about Infection Prevention at Mission Health at

Tips to remember for seeking medical attention:

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