Total IgA and norovirus-specific salivary IgA titers were determined using GII.4 Den Haag VLPs for baseline I, GII.4 New Orleans VLPs for baseline II, or the outbreak-specific VLP [24 (link)]. Briefly, 96-well plates were coated with 1 μg/mL anti-human IgA or 1 μg/mL VLPs. Two-fold serial dilutions of saliva and purified human IgA (Sigma) as a standard were tested in duplicate. Bound IgA was detected using goat anti-human IgA-horseradish peroxidase (HRP) conjugate followed by color development with 3,3′,5,5′-tetramethylbenzidine (TMB) substrate (Thermo Scientific).