Role of fomite contamination during an outbreak of norovirus on houseboats

An outbreak of suspected norovirus gastroenteritis among three consecutive groups of houseboaters on a large recreational lake in Arizona was investigated to assess the role of fomite contamination, and to provide recommendations for prevention of future outbreaks. Interior boat surfaces were sampled for norovirus using transport swabs. Onboard toilet reservoirs were swabbed as a surrogate for stool samples from ill participants, since none were available, and onboard potable water supplies were sampled for norovirus. All samples were analyzed using RT-PCR with primers specific for human norovirus. Widespread fomite contamination was documented in the houseboats; 83% (5/6) of bathroom surface samples, 40% (2/5) of kitchen surface samples, and 100% (3/3) of doorknob samples were positive for the presence of norovirus. Samples of onboard potable water supplies were all negative. One of the participants on the first boating trip arrived already displaying symptoms of gastrointestinal illness prior to boarding the boat. This investigation demonstrates the potential role of widespread fomite contamination in outbreaks in confined spaces. To prevent or minimize future outbreaks in confined spaces, the adoption of practices such as surface disinfection and the utilization of methods to identify and exclude those with gastroenteritis from trips or activities in confined spaces, where others may become infected, are recommended.