About norovirus
Learn what norovirus is, how it makes you sick, how it spreads, and how you can prevent yourself and others from getting sick.
Reporting norovirus outbreaks
A norovirus outbreak is defined as an increase in people experiencing diarrhea or vomiting above what is normal for a facility, with regard to time and place. This includes illness in both children and staff. There does not need to be a diagnosis or laboratory testing for a group of ill people to be considered an outbreak.
The following examples would be considered an outbreak and should be reported:
- A child care program with 30 children has 10 children in the toddler and preschool classrooms call out sick with symptoms of vomiting and diarrhea over the course of two days. Two staff who work in the same classrooms also call out sick. This is an increase above what is normal for the program and should be reported as an outbreak.
- An elementary school with 250 students has 100 students absent over the course of a week. Some are known to have been sick with a “stomach bug.” Additionally, 15 students were seen by the school nurse with sudden vomiting. During a typical week, 25 students are absent and only 1 or 2 are seen by the nurse for vomiting. This is an increase above what is normal for the school and should be reported as an outbreak.
- A high school with 800 students has 50 students absent in a single day. Most are athletes on the girls’ varsity and junior varsity soccer teams. The coach reports that several have reported having diarrhea and vomiting that began Wednesday night, the day after a game. While 50 students absent is not unusual for the school, it is not typical for so many students to be sick among members of a sports team. This should be reported as an outbreak.
Suspected norovirus outbreaks should be reported by child care programs and schools as soon as they are identified by completing the following online form: Gastrointestinal Illness Child Care & K-12 School Cluster Reporting Form.
After submitting the online form, the local board of health or a DPH epidemiologist will call the submitter to provide guidance on outbreak management and control.
For any questions regarding the reporting, investigation, or control of suspected norovirus outbreaks, please contact your local board of health, or the DPH Division of Epidemiology at (617) 983-6800.
Prevention and control recommendations for norovirus outbreaks
The following steps should be taken to stop the spread of norovirus in child care programs and K-12 schools:
Wash hands
- Teach staff and students how to properly wash hands using soap and warm running water for 20 seconds. Hand sanitizer does not work well against norovirus.
- In child care programs:
- Monitor young children to make sure they are correctly washing their hands when they arrive, before eating or being fed, after going to the bathroom or receiving a diaper change, and before participating in shared sensory or water tables.
- Teach staff to wash their hands frequently. Staff should wash hands after handling diapers, before preparing food or feeding children, before eating, and before taking or giving medicine.
- In schools:
- Make sure students and staff follow all handwashing policies. Hands should be washed after going to the bathroom or helping students go to the bathroom, before eating or touching food, and before taking or giving medicine.
- Have staff supervise younger students washing their hands.
Environmental cleaning
- Follow CDC and EPA guidance on cleaning and disinfection:
- Check that cleaning products are effective against norovirus and are being used throughout the child care program or school.
- Clean and disinfect areas immediately after someone vomits or has diarrhea.
- Clean and disinfect surfaces and objects frequently touched like tables, desks, doorknobs, toys, faucet handles, etc. at least daily and when dirty.
- Clean and disinfect bathroom toilets and sinks at least daily and when dirty.
- In child care programs: Clean and disinfect diapering areas and potty chairs after each use, and bathroom toilets and sinks at least daily and when soiled.
Exclusions
- Staff and children ill with gastrointestinal illness symptoms such as vomiting or diarrhea should not attend programs or schools in accordance with the Gastrointestinal Illness Symptom Checklist for Children and Staff in Child Care Programs and K-12 Schools.
Limit opportunities for transmission
- Teach staff about the rapid onset of norovirus symptoms. Make sure leak-proof, washable or disposable containers are available in classrooms and other areas of the facility for anyone who suddenly needs to vomit.
- Consider cancelling or delaying group activities, including those scheduled after normal hours.
- Limit contact of children and staff across classrooms, especially classrooms with people sick and those without anyone sick.
- In child care programs:
- If possible, group staff who worked with sick children in the same classroom or area. This will help limit the spread to classrooms without anyone sick.
- Limit sharing of items (e.g., toys or books) among children within a classroom, and across classrooms.
- Don’t share food among children and staff.
- In schools:
- Don’t allow sharing of food, stop the use of self-service in cafeterias, and consider switching to single-use dining materials if reusable ones cannot be promptly and thoroughly cleaned.
Notify
- In child care programs: Notify parents/guardians when cases of norovirus infection occur in children or staff. Licensed daycare facilities must notify all parents/guardians in accordance with DPH recommendations when any communicable disease or condition has been introduced into the program (606 CMR 7.11).
- In schools: Consider notifying parents/guardians during suspected or confirmed outbreaks of norovirus. The local board of health or a DPH epidemiologist can help determine whether notification is recommended.
Exclusion of children and staff
Staff and children ill with gastrointestinal illness symptoms such as vomiting or diarrhea should not attend programs or schools in accordance with the Gastrointestinal Illness Symptom Checklist for Children and Staff in Child Care Programs and K-12 Schools.