title: Laboratory evidence of norwalk virus contamination on the hands of infected individuals.
abstract: Human norovirus (NoV) outbreak investigations suggest that the hands of infected individuals play an important role in NoV transmission. However, there is no experimental evidence documenting the likelihood and degree of NoV contamination on hands. As part of a clinical trial designed to evaluate the efficacy of high-pressure processing for Norwalk virus (NV) inactivation in oysters, 159 hand rinse samples were collected from 6 infected and 6 uninfected subjects. NV was concentrated from the samples by polyethylene glycol precipitation, followed by RNA extraction using an automated guanidinium isothiocyanate-silica method. NV RNA was detected and quantified using multiple NV-specific reverse transcription-quantitative PCR (RT-qPCR) assays. A total of 25.4% (18/71) of the hand rinse samples collected from 6 infected volunteers were presumptively positive for NV, with an average of 3.86 log10 genomic equivalent copies (GEC) per hand. Dot blot hybridization of PCR products obtained using a different primer set, and DNA sequencing of selected amplicons, provided further confirmation of the presence of NV in the hand rinses. NV contamination was also detected in two hand rinse samples obtained from one uninfected subject. These findings provide definitive evidence of NV contamination on the hands of infected subjects observed under controlled clinical research conditions. Such data support the need for better hand hygiene strategies to prevent NoV transmission.
authors.affiliation: Center for Global Safe Water, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Pengbo
authors.initials: P
authors.lastname: Liu
authors.forename: Blanca
authors.initials: B
authors.lastname: Escudero
authors.forename: Lee-Ann
authors.initials: LA
authors.lastname: Jaykus
authors.forename: Julia
authors.initials: J
authors.lastname: Montes
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Goulter
authors.forename: Meredith
authors.initials: M
authors.lastname: Lichtenstein
authors.forename: Marina
authors.initials: M
authors.lastname: Fernandez
authors.forename: Joong-Chul
authors.initials: JC
authors.lastname: Lee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: De Nardo
authors.forename: Amy
authors.initials: A
authors.lastname: Kirby
authors.forename: James W
authors.initials: JW
authors.lastname: Arbogast
authors.forename: Christine L
authors.initials: CL
authors.lastname: Moe
mesh_terms: D017250:Caliciviridae Infections / Q000821:virology*; D005759:Gastroenteritis / Q000821:virology*; D006225:Hand / Q000821:virology*; D006801:Humans; D009663:Norwalk virus / Q000302:isolation & purification*; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D060888:Real-Time Polymerase Chain Reaction; D019562:Viral Load
chemical_list: D012367:RNA, Viral