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THE ROLE OF FOMITES IN THE TRANSMISSION OF NOROVIRUSIntroduction: Acute gastroenteritis is a common illness in humans. It has a high morbidity worldwide and in the United States (U.S); a sizeable mortality is reported in developing countries. Viruses are a common cause of acute gastroenteritis and noroviruses are the leading cause of non-bacterial gastroenteritis (1). Fomites play an important role in the infection cycle of norovirus. This study explored the comparability between a quantitative microbial risk assessment (QMRA) model to predict the probability of illness from norovirus due to environmental contamination with actual observed attack rates, the impact of appropriate cleaning procedures on fomites contamination, and the role of fomites in the transmission of norovirusMethod: Data from three different norovirus illness outbreaks occurring from 2004 to 2005 in Arizona in different venues were used. Questionnaires were used to determine demographics, symptoms associated with gastrointestinal illness, medical visits, and potential exposures such as food items consumed. When available, stool samples were collected from ill participants. Fomites samples were also gathered from the different venues; houseboats, college summer camp living spaces, and a restaurant. These samples were tested for norovirus using reverse transcriptase polymerase chain reaction (RT-PCR). Viral concentration on fomites was calculated using the most probable number methodology.Results: Norovirus was found on fomites from all three outbreaks. Improper cleaning of fomites increased the proportion of norovirus positive fomites from 40 percent to 70 percent in contrast, after cleaning and disinfection with 5000 mg/L free chloride, the proportion of norovirus positive fomites decreased to 33%. The predicted values from the quantitative microbial risk assessment model were consistent with the observed epidemiological attack rates.Conclusion: This study showed unequivocally that fomites play an important role in the transmission cycle of norovirus, and that improper cleaning and disinfection procedures only serve to spread the virus to previously uncontaminated fomites. In the case of outbreaks where people are not always available to answer questionnaires, QMRA should be considered as a worthwhile alternative to a full-scale epidemiological study.