STATE OF NEW HAMPSHIRE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
DIVISION OF PUBLIC HEALTH SERVICES
29 HAZEN DRIVE, CONCORD, NH 03301-6504
John A Stephen 603-271-4469 1-800-852-3345, Ext. 4469 TDD Access: 1-800-735-2964
Commissioner Fax: 603-271-0545, Website: www.dhhs.state.nh.us
Mary Ann Cooney
Message Type: Health Advisory
TO: School Nurses and DHHS Outbreak Team
FROM: Jose Montero, MD, MPH, State Epidemiologist
SUBJECT: Outbreaks of Viral Gastroenteritis in Schools
NH Department of Health and Human Services (NH DHHS) recommends:
• Vigilance for suspect gastrointestinal outbreaks in school settings
• Timely reporting of suspect outbreaks to the NH DHHS Communicable Disease Control
and Surveillance Section at 603-271-4496 (after hours 1-800-852-3345 ext.5300)
• Strict adherence to infection control practices during a suspect outbreak (see
NH DHHS has received multiple reports of gastrointestinal illness in communities, schools, and
childcare facilities. Many of these illnesses are caused by Norovirus and are transmitted person-
to-person or through contact with contaminated surfaces. Noroviruses are one of the most
common causes of acute viral gastroenteritis in the United States. These viruses are highly
communicable and can be transmitted in a number of ways including person-to-person contact,
consumption of contaminated food and water, airborne droplets of vomit, and contact with
contaminated surfaces. Infection is primarily characterized by vomiting and diarrhea, which may
also be accompanied by abdominal cramps, nausea, fever, and headache. Symptoms of infection
may last between 12 and 60 hours. Aside from supportive therapy for dehydration in severe cases,
there is no treatment given for Norovirus infection since it is a viral agent and symptoms usually
resolve within 48 hours.
Infection Control Recommendations During an Outbreak:
1. Promptly clean areas contaminated with vomit and feces and follow up disinfections with
freshly prepared 0.1% (1000 ppm) hypochlorite solutions.
2. Review kitchen hygiene practices and health status of all food workers, exclude any
symptomatic food handlers from work until full recovery.
3. Assess health status of students and staff and exclude all symptomatic individuals from
school/work until full recovery.
4. Practice frequent hand washing and gloving by all food workers in the facility.
5. Practice frequent hand washing by all students and staff.
6. Use gloves and aprons whenever contact with an affected individual or contaminated
environment is anticipated.
7. Wash hands after contact with affected individuals, on leaving affected areas or before
handling food or drinks.
8. Clean soiled carpets and soft furnishings with hot water and detergent or steam clean; avoid
9. Clean frequently handled objects such as door handles.
10. Conduct terminal cleaning 72 hours after resolution of the last case.
Attachment: Norwalk Virus Fact Sheet
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warrant immediate action
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Cancel: Prior communications alert has been canceled
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Actual Communication or alert refers to a live event
Exercise Designated recipients must respond to the communication or alert
Test: Communication or alert is related to a technical, system test and should be
Extreme: Extraordinary threat to life or property
Severe: Significant threat to life or property
Moderate: Possible threat to life or property
Minor: Minimal threat to life or property
Unknown: Unknown threat to life or property
Yes: Indicates sensitive content is included
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National: Indicates national recipients
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You have received this message based upon the information contained within our
emergency notification database. If you have a different or additional e-mail or fax address
that you would prefer to be used please contact Kcapron@dhhs.state.nh.us