title: A school outbreak of Norwalk-like virus: evidence for airborne transmission.
abstract: An outbreak of gastroenteritis affected a school attended by children aged 4-11 years. Epidemiological features suggested this was due to Norwalk-like virus (NLV) and this was confirmed by polymerase chain reaction (PCR). Nucleotide sequence analysis of the PCR amplicons revealed identical strains in all five positive stool samples. Pupils were significantly more likely to become ill following an episode of vomiting within their classroom (adjusted odds ratio 4.1, 95% CI 1.8-9.3). The times from exposure to illness were consistent with direct infection from aerosolized viral particles where exposure to vomiting was high. Cleaning with quaternary ammonium preparations made no impact on the course of the outbreak. However, the outbreak stopped after the school closed for 4 days and was cleaned using chlorine-based agents. This study confirms the importance of vomiting in the transmission of NLV and provides evidence that direct infection with aerosolized viral particles occurs.
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Queens Medical Centre, Nottingham NG7 2UH.
authors.forename: P J
authors.initials: PJ
authors.lastname: Marks
authors.forename: I B
authors.initials: IB
authors.lastname: Vipond
authors.forename: F M
authors.initials: FM
authors.lastname: Regan
authors.forename: K
authors.initials: K
authors.lastname: Wedgwood
authors.forename: R E
authors.initials: RE
authors.lastname: Fey
authors.forename: E O
authors.initials: EO
authors.lastname: Caul
mesh_terms: D000336:Aerosols; D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000635:transmission*; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D004196:Disease Outbreaks; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology*; D006801:Humans; D017053:Infection Control; D019570:Inhalation Exposure; D008297:Male; D029322:Norovirus / Q000472:pathogenicity*; D016133:Polymerase Chain Reaction; D000644:Quaternary Ammonium Compounds; D012574:Schools; D014839:Vomiting
chemical_list: D000336:Aerosols; D004279:DNA, Viral; D000644:Quaternary Ammonium Compounds