By Denise Love
Norovirus is making headlines this year in early 2025 as the number of outbreak cases spiked to a record high. Headlines from CNN report a breakout in a shelter for fire victims in California, and a Medscape article in December reports a breakout on a Holland American Cruise ship. According to the CDC, there are more than 2500 outbreaks of Norovirus each year, typically occurring from November to April. From August 01, 2024, to December 11, 2024, the CDC listed 495 reported outbreaks compared to the 363 reported in the same period the prior year.
The Norovirus was first identified in 1968 and continues to cause nausea, vomiting, diarrhea, and abdominal pain yearly. Symptoms can range from mild to quite severe and vary from year to year as the mutations in the virus change over time. Anyone can contract the virus; most healthy people recover independently without complications. For most people, it is an inconvenience without long-term consequences. But for others, it can get much worse than this. In some cases, it can be deadly. The very young, the very old, and the immunocompromised are at the highest risk as their ability to fight infection is not as robust. Persistent nausea, vomiting, and diarrhea can lead to serious complications such as dehydration, electrolyte disturbances, and kidney failure, as well as others. The CDC estimates that 60% of cases of acute gastroenteritis from norovirus account for 400,000 emergency room visits and 71,000 hospitalizations per year. How can we minimize ourselves from being one of these statistics?
Number 1. Washing your hands.
Hand washing seems almost too obvious, but most people who report washing their hands either short-step it or do not do it enough. According to the annual Bradley survey on hand hygiene, Americans are more likely to step up their handwashing practices during seasonal illnesses. While this is great, the problem is that if you wait to "step up" your handwashing practices when you become aware of a problem, it might be too late. You may have already been exposed to the virus and be spreading it to others.
The only way to remove the virus from the hands is by washing with soap and water. "Hand sanitizers do not work to kill the Norovirus." The only method shown to be effective in thoroughly removing the virus from the hands is physical removal with soap and water. To properly wash your hands requires 20 seconds of vigorous rubbing with soap on all surfaces of the hands and rinsing thoroughly under running water. While no one is perfect, vigilant behavior will decrease your chances of becoming ill.
Number 2. Strict food safety and sanitation.
Ingesting contaminated food or water is one of the most common ways of contracting Norovirus. Food made during the production line, from food service workers or even yourself, if you are preparing for family and friends, is typical. Food contamination leads back to the previous method of ensuring you wash your hands before preparing food. Food service workers should wear gloves and follow food safety protocols when touching food.
Fruits, vegetables, oysters, and fish typically served raw are at the highest risk. Cooking to a minimum of 145 degrees/F. will kill the virus, but steaming vegetables will not be enough.
Number 3. Disinfection.
We all come in contact with hundreds, if not thousands, of surfaces daily as we work and live. Think about everything you touch: counter surfaces, doorknobs, appliances, tools, and our beloved cell Phones. Exposure occurs hundreds of times a day, and we don't even realize or think about it until it's too late.
Coughing, sneezing, and touching any surface or item can leave the virus on the surface, ready for the next person to touch that same surface, become exposed, and continue the transmission cycle to the next person. Touching the face or other body parts, shaking hands with a friend, and picking up a child will continue the contamination and infection cycle over and over. Any person who has recovered from the Norovirus can shed viral particles in the stool for two weeks to 60 days, even longer in the immunocompromised person. Ongoing and persistent disinfection, even when the virus may seem gone, will help end the transmission cycle.
Knowing this virus is difficult to kill is essential, and not all disinfectants will work. Only a few viral particles left alive on a surface are enough to cause infection. The recommended disinfectant is bleach or a homemade bleach solution containing 5-25 tablespoons of bleach for 1 gallon of water. To be effective, spray the bleach solution onto the contaminated surface, leave it on the surface for 5 minutes, and then clean again with soap and water.
You should also wash and disinfect any clothes or linen contaminated or from an environment with an active infection in hot water, then dry them on the hottest dryer setting possible. Wash your hands after handling any contaminated linen.
The Number 4. Avoid crowded living situations.
This may be easier said than done, depending on your life circumstances. Environments where people live close together are at a much higher risk of contracting the virus. Examples would be those living in military barracks, correctional institutions, vacation resorts, or, as previously noted, on cruise ships. The Norovirus is highly transmissible from person to person with a short incubation time of 12-48 hours. One person can transmit the virus to hundreds of others before anyone realizes a problem. And soon enough, dozens of people will be ill and have already exposed the virus to their loved ones.
Number 5. Stay hydrated.
If you have done everything right and still find yourself sick from this virus, stay hydrated. Treatment for this disease is all supportive care, which is any means that will help you feel better while trying to avoid serious complications. There are no antibiotics to cure Norovirus. In all cases, the virus has to run its course. During this time, it is essential to stay hydrated to avoid complications from this illness. Many of us will avoid going to the hospital with this method alone. Drinking a lot of fluids can be done in many ways. Plain water, chicken broth, jello, and clear soda, such as 7-up, are popular favorites. Some people like sports drinks, but a particular recommendation for children is pre-prepared electrolyte drinks over sports drinks due to their high sugar content and other ingredients that can worsen diarrhea. Small sips, taken several times an hour, will be much easier to tolerate and decrease the risk of immediate vomiting instead of ingesting large quantities all at once.
In conclusion, the Norovirus is a highly contagious viral disease without a vaccine or a cure. If you contract the disease, it will have to run its course. Most people will recover on their own, but some more weak or vulnerable people will require more medical care, from a simple doctor's visit to an extended course in the hospital. A very few may even die. The top 5 recommendations above might help you stay out of the hospital.
Citations:
Bradley, K. (2024). Annual survey on hand hygiene practices. Retrieved from [https://www.bradleycorp.com/news/survey-finds-americans-are-strategic-handwashers]
Centers for Disease Control and prevention. (2025). Norovirus. How to prevent Norovirus Retrieved from [https://www.cdc.gov/norovirus/prevention/index.html]
Centers for Disease Control and Prevention. (2025). Norovirus. Norovirus outbreaks Retrieved from [https://www.cdc.gov/norovirus/outbreak-basics/index.html]
Centers for Disease Control and Prevention. (2024). Norovirus. NoroStat Data Retrieved from [https://www.cdc.gov/norovirus/php/reporting/norostat-data.html]
Cleveland Clinic. (2024). Incubtation period Retrieved from [https://my.clevelandclinic.org/health/articles/incubation-period]
CNN. (2025). Norovirus outbreak in California shelter for fire victims. Retrieved from [https://www.cnn.com/2025/01/17/health/california-wildfire-evacuees-norovirus-outbreak/index.html]
FoodSafety.gov. (2024). Norovirus. Retrieved from [Downloads/Bacteria%20and%20Viruses%20(3).pdf]
Hall, A. J., Lopman, B. A., Payne, D. C., Patel, M. M., Gastañaduy, P. A., Vinjé, J., & Parashar, U. D. (2013). Norovirus disease in the United States. Emerging infectious diseases, 19(8), 1198–1205. https://doi.org/10.3201/eid1908.130465
Medscape. (2024). Norovirus outbreak on Holland America Cruise ship. Retrieved from [Medscape website link]
Prasad, B. V. V., Atmar, R. L., Ramani, S., et al. (2025). Norovirus replication, host interactions and vaccine advances. Nature Reviews Microbiology. https://doi.org/10.1038/s41579-024-01144-9