Epidemiology and Infection

Evidence for airborne transmission of Norwalk-like virus (NLV) in a hotel restaurant

P. J. MARKS a1c1, I. B. VIPOND a2, D. CARLISLE a3, D. DEAKIN a3, R. E. FEY a1 and E. O. CAUL a2
a1 Southern Derbyshire Health Authority, Derwent Court, Stuart Street, Derby DE1 2FZ, UK
a2 Bristol Public Health Laboratory, Myrtle Road, Kingsdown, Bristol BS2 8EL, UK
a3 Derby City Council, Celtic House, Heritage Gate, Friary Street, Derby DE1 1QX, UK


An outbreak of gastroenteritis followed a meal in a large hotel during which one of the diners vomited. The clinical features of the illness suggested Norwalk-like virus (NLV, small round structured virus) infection, and this was confirmed by electron microscopy and reverse transcriptase polymerase chain reaction (RT–PCR) of stool samples. Further characterization of the virus by nucleotide sequence analysis of the PCR amplicons revealed identical strains in all the affected individuals. The foods served at the meal could not be demonstrated to be the cause of the outbreak. Analysis of attack rates by dining table showed an inverse relationship with the distance from the person who vomited. No one eating in a separate restaurant reported illness. Transmission from person-to-person or direct contamination of food seems unlikely in this outbreak. However, the findings are consistent with airborne spread of NLV with infection by inhalation with subsequent ingestion of virus particles.

(Accepted January 18 2000)

c1 Author for correspondence.