The Norovirus Buffet: 13 of 19 Guests Sickened

Local public health officials report a recent uptick in norovirus — a.k.a stomach flu, and I suspect much of it was centered at the home of my friend and co-author, Beth Jones. She kindly agreed to write up her sorry tale:

Missy is cute, blond, sweet, and four years old. She doesn’t look like a vector. But she initiated such a path of norovirus destruction at our Christmas party that it will forever be remembered as: The Party Where (Almost) Everyone Got Sick. Really, really, sick.

We had friends, a delicious buffet, mulled cider and spiced eggnog. Children ran through the house in dress-up costumes. The tree twinkled, conversations hummed. It was the lovely party we’d hoped for.

At the end of the day, Missy sat on the bottom of our staircase and complained that her stomach hurt. It was no surprise; the kids had been been playing for hours, eating on occasion. Picking up food, tasting it, putting it down. If I were to make a guess, my very unscientific norovirus research would lead me to that act of picking up and putting down. I’d wager that an infected half eaten snickerdoodle or a slice of smoked ham nibbled and abandoned by Missy was the cause of everything that followed.

According to the CDC, people can become infected by the highly contagious norovirus in a variety of ways including “direct contact with an infected person… when sharing food, drinks, or eating utensils…” Our luscious buffet was the likely vehicle for a fast-moving virus.

The party was on Saturday. The norovirus has a 48-hour incubation period. By Monday, Missy was in Children’s Hospital Boston receiving intravenous fluids; she couldn’t even drink water without vomiting. Her mother could barely get out of bed. Two friends mistakenly thought they had food poisoning. Another guest thought the mulled cider had caused her to throw up. Like dominos, nearly everyone was slammed by the virus, knocked down and lying flat in bed or crawling to the bathroom. Thirteen of the 19 people at our party were sick within two days of the holiday festivities.

The virus struck with speed and efficiency. It’s clear why 13 people got sick, but why not the other six (two of whom were me and my husband)? Why didn’t we end up with the virus, too? We had more exposure than some of the guests who got sick; we all ate food from the same buffet. This is the part I find the most mystifying. Could our baseline of health be higher? In addition to us, two of the people who didn’t get sick are Eric Glissmeyer, MD, a pediatric ER doctor at Children’s Hospital (who is frequently exposed to norovirus patients), and his wife, a former pediatric ER nurse. Do we have some kind of built in immunity? Resiliency?

Not necessarily, says Dr. Glissmeyer. “It’s very common that we see infections that affect a certain number of people and not others, and we have a very difficult time determining what caused them. Sometimes it doesn’t matter, if everyone’s improving as expected. It’s more important to identify the exact cause if there was exposure from a commercial entity so that we can determine what we can do to prevent it from reoccurring.”

It’s hard to know if the virus is lurking on your buffet table, acknowledges Dr. Glissmeyer. “Most of the time it doesn’t smell, doesn’t taste, and some foods are just more commonly infected with certain viruses.” But there are a few reliable culprits. “Norovirus is more commonly found in some varieties of raw shellfish, oysters being the worst offender,” he told me. “So if you’re so inclined to eat raw oysters, they’re not the best thing to bring to a party.” Since we had no shellfish at our party, we will likely never have an answer.

The CDC’s website provides information on how to avoid the virus, but they don’t offer an explanation as to why some people who are exposed drop like flies, others get sick briefly, and some of us seem to walk away unscathed. If I could figure out why I stayed healthy, I’m sure I could bottle a potion and sell it to Merck. Or maybe this time I just got lucky.

CDC information on norovirus is here. And five possible explanations for what happened, from an expert in communicable diseases, are here.

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  • Rbartlett

    The incubation period of norovirus is 24 – 48 hours http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm071344.htm (see 7. Course of Disease and Complications) . Contrary to one of the comments by the expert in communicalble diseases, norovirus doesn’t grow in number in food (regardless of the temperature of the food). According to the CDC, most norovirus is transmitted via person-to-person contact. One feature of norovirus is common secondary transmission due to its low infective dose, and the fact that its shed in the feces well after the person recovers. Thus, one would expect additional cases in those homes with a primary case of norovirus, separated in time by at least one incubation period (i.e., additional cases 1 – 2 days after the initial cases). The best way to confirm the causitive organism is through a stool sample. Without this information, one can only surmise that the outbreak was consistent with norovirus

  • Debbie Smoyer CRRN

    You guys washed you hands more than others. It is all about hand hygiene.