First discovered in 1972, Norovirus is a highly contagious positive-stranded RNA virus that causes acute gastroenteritis (often called the “stomach flu”), which leads to significant global mortality, primarily through dehydration and complications in vulnerable populations such as young children and older adults. According to the most recent (modeling-based) estimates from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), the annual global mortality attributable to norovirus infection is approximately 200,000 deaths. This figure includes about 50,000 deaths among children under 5 years old, with the majority occurring in low- and middle-income countries where access to healthcare and sanitation is limited.
Norovirus causes around 685 million illnesses worldwide each year, but only a small fraction result in death due to its generally self-limiting nature. However, in high-risk groups, severe dehydration can be fatal without prompt intervention. Over 99% of deaths occur in developing regions, particularly Southeast Asia and Africa, which account for about 85% of norovirus-related fatalities. About 50,000 deaths occur annually in children under 5 years of age, often linked to malnutrition and poor hygiene. In those over 65 years of age, there is a higher risk of death in both developed and developing countries, estimated at about 800 deaths per year in the USA.
By comparison, as of March 7, 2023, the CDC reports 38 deaths classified as mpox-associated among persons with probable or confirmed monkeypox (DNA virus) in the United States during the period from May 10, 2022, to March 7, 2023. The recent monkeypox outbreak was treated as a major national and international health crisis, and a vaccine designed for preventing smallpox was deployed to provide immunity against the related monkeypox virus. This was done on an emergency use basis, with little or no clinical data to support that decision. For purposes additional comparison, adults aged 65 and older, an estimated 6,000 to 10,000 deaths occur each year due to RSV (respiratory RNA virus) in the USA.
Like Polio, morbidity and mortality (sickness and death) is largely preventable through hand hygiene, safe food handling, and clean water. In developed countries, norovirus has become the leading cause of foodborne illness outbreaks, while in developing regions, it exacerbates broader diarrheal disease burdens.
Shellfish and salad ingredients are the foods most often implicated in norovirus outbreaks. Ingestion of shellfish that have not been sufficiently heated – under 75 °C (167 °F) – poses a high risk for norovirus infection. Foods other than shellfish may be contaminated by infected food handlers. Many norovirus outbreaks have been traced to food that only one infected person handled.
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