How should we manage a norovirus outbreak in a household with a 10‑year‑old, 13‑year‑old, 47‑year‑old, and 48‑year‑old presenting with fever, chills, headache, vomiting and watery diarrhea, and what is the recommended exclusion period before returning to work, school, or food‑handling duties?

Managing Norovirus in Your Household

All household members should remain home from work, school, and food-handling duties until 48–72 hours after complete symptom resolution (meaning return to normal bowel movements with no vomiting or diarrhea), and you should focus on aggressive oral rehydration, meticulous hand hygiene with soap and water, and thorough environmental disinfection with bleach solution. 1

Immediate Clinical Management

Focus on preventing dehydration through oral rehydration:

• Provide oral rehydration solution (ORS) or clear fluids frequently in small amounts to all symptomatic family members 1, 2
• Watch for signs of moderate-to-severe dehydration: prolonged skin tenting, dry mucous membranes, severe lethargy, or decreased urination 1
• Seek emergency care if anyone develops severe dehydration, altered consciousness, or inability to keep fluids down 1
• Resume normal diet as soon as tolerated; there is no need to restrict food once vomiting subsides 1

No specific antiviral treatment exists for norovirus—supportive care is the cornerstone of management. 2

Infection Control at Home

Hand hygiene is your most powerful tool:

• Wash hands with soap and running water for at least 20 seconds after using the bathroom, before eating, and before food preparation 1, 3
• Alcohol-based hand sanitizers do NOT work effectively against norovirus because it is a non-enveloped virus; soap and water is essential 1, 3
• Hand sanitizer (≥70% ethanol) may be used only as an adjunct between proper handwashings, never as a substitute 3, 2

Environmental disinfection:

• Clean all high-touch surfaces (door knobs, light switches, bathroom fixtures, countertops) with a bleach solution of 1,000–5,000 ppm (approximately 1:50 to 1:10 dilution of household bleach) 1, 3
• First remove visible soil, then apply the bleach solution and allow adequate contact time 3
• Pay particular attention to bathrooms and any areas where vomiting occurred 3, 2
• Standard household cleaners and alcohol-based products are insufficient—bleach is the gold standard 3

Isolation and Exclusion Guidelines

Work and school exclusion:

• All family members must stay home until 48–72 hours after complete symptom resolution (defined as return to normal bowel movements with no vomiting) 1, 3
• This applies to everyone, but is especially critical for the adults if either works in food handling, healthcare, or childcare 1, 3
• The 10-year-old and 13-year-old should not return to school until meeting this 48–72 hour symptom-free criterion 1

Why this duration matters:

• Peak viral shedding occurs 2–5 days after infection, and individuals remain highly contagious even after symptoms improve 1, 2
• Viral shedding continues for an average of 4 weeks after infection, though infectivity beyond the acute phase is less clear 2
• You can still transmit the virus for up to 2 days after complete symptom resolution 1

Special Considerations for Your Household

Expected illness duration:

• In healthy individuals (like your family members), symptoms typically last 1–3 days 1, 2, 4
• However, the 10-year-old may experience a slightly longer course of 4–6 days, as young children can have more prolonged illness 2
• If anyone's symptoms persist beyond one week, seek medical evaluation for alternative diagnoses 2

Clinical course:

• Symptoms began 12–48 hours after exposure and include the acute onset of vomiting, diarrhea, nausea, abdominal cramps, and sometimes low-grade fever 1, 4
• Most symptoms resolve within 1–3 days without specific treatment in otherwise healthy persons 1

Common Pitfalls to Avoid

Do not:

• Rely on alcohol-based hand sanitizers as your primary hand hygiene method—they are ineffective against norovirus 1, 3
• Return to work or school based solely on feeling better; the 48–72 hour symptom-free period is mandatory 1, 3
• Use standard household cleaners for disinfection; bleach solution is required 3
• Assume that formed stools mean the infection has cleared—norovirus can be present in formed stools 5

Do:

• Maintain rigorous hand hygiene even after symptoms resolve, as shedding continues for weeks 1, 2
• Educate all family members about fecal-oral transmission and the importance of handwashing 1
• Consider that the person who got sick first may have been shedding virus before symptoms appeared (prodromal excretion) 5

When to Seek Medical Care

Seek immediate medical attention if any family member develops:

• Signs of severe dehydration (severe lethargy, prolonged skin tenting, inability to urinate) 1
• Inability to keep any fluids down for more than 12 hours 1
• Symptoms persisting beyond 7 days 2
• High fever (>101.5°F/38.6°C) or bloody diarrhea, which would suggest a different diagnosis 1

Why This Matters

Norovirus is extremely contagious, with as few as 18 viral particles capable of causing infection 6. Your household outbreak is typical—attack rates in household settings commonly affect multiple family members through person-to-person transmission, contaminated surfaces, and even aerosolized particles from vomiting 6. The virus is responsible for approximately 21 million illnesses annually in the United States and is the leading cause of acute gastroenteritis across all age groups 6.