title: Healthcare epidemiology: gastrointestinal flu: norovirus in health care and long-term care facilities.
abstract: Noroviruses, recognized as the leading global cause of viral gastroenteritis and a major contributor to food-borne illness, present a growing challenge in health care and long-term care facilities. The virus spreads easily and by multiple routes. A visitor to a ward might initiate an outbreak by person-to-person contact, vomiting staff members or patients can disseminate the virus by airborne means, and contaminated surfaces, such as doorknobs and computer keyboards, can sustain an epidemic. In addition, although self-limited in healthy hosts, the virus can cause increased morbidity in more-vulnerable people. The GII.4 strain of the virus now dominates in multiple recent worldwide epidemics as well as in health care and long-term care facilities. Much like the influenza virus, norovirus appears to evolve by antigenic drift and evading the immune system, causing waves of global epidemics. Previous attempts at controlling outbreaks, both in the community and in closed facilities, provide guidance about the vigilance and action required by the health care community to diminish the clinical impact of norovirus infection.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Said
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Sears
mesh_terms: D017250:Caliciviridae Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control; D006268:Health Facilities; D006801:Humans; D008134:Long-Term Care; D029322:Norovirus