Norovirus infection pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Norovirus is a highly contagious virus. Anyone can get infected with norovirus and get sick. Also, one can get norovirus illness many times in life. One reason for this is that there are many different types of noroviruses. Being infected with one type of norovirus may not protect one against other types. Norovirus can be found in your stool (feces) even before one starts feeling sick. The virus can stay in stool for 2 weeks or more after one feels better.
Pathophysiology
Transmission
One is most contagious when sick with norovirus illness, and during the first 3 days after recovery from norovirus illness. One can become infected with norovirus by accidentally getting stool or vomit from infected people in mouth. This usually happens by eating food or drinking liquids that are contaminated with norovirus, touching surfaces or objects contaminated with norovirus then putting fingers in one's mouth, or having contact with someone who is infected with norovirus (for example, caring for or sharing food or eating utensils with someone with norovirus illness). Environmental and fomite contamination may also act as a source of infection. Good evidence exists for transmission due to aerosolization of vomitus that presumably results in droplets contaminating surfaces or entering the oral mucosa and being swallowed. No evidence suggests that infection occurs through the respiratory system.
Noroviruses are highly contagious and as few as 10 viral particles may be sufficient to infect an individual. During outbreaks of norovirus gastroenteritis, several modes of transmission have been documented; for example, initial foodborne transmission in a restaurant, followed by secondary person-to-person transmission to household contacts. Although presymptomatic viral shedding may occur, shedding usually begins with onset of symptoms and may continue for 2 weeks after recovery. It is unclear to what extent viral shedding over 72 hours after recovery signifies continued infectivity.
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