Health Care and Norovirus

One of the worst stomach viruses that many Americans suffer is the norovirus. Typically, this has most recently been found to be rampant on cruise ships or locations where lots of people are in a semi-closed environment that allows the "bug" to spread rapidly to multiple persons in a very short time period, and it usually results in making the affected individuals extremely sick. The norovirus is known to be highly contagious; and, therefore, the illness can literally be passed around like a big bag of chips in a hurry.

Actually, according to GuideToCaribbeanVacations.com, these are a group of related viruses, referred to as "Norwalk-like viruses" or NLV, causing acute gastroenteritis in humans. The incubation period is usually between 24 and 48 hours although cases have been reported to occur within 12 hours of exposure. Symptoms are vomiting, diarrhea with abdominal cramps and nausea generally lasting 24 to 60 hours. Dehydration is the most common complication. Yet even during the worst, most publicized outbreaks of sick ship only a small percentage of passengers are usually affected. According to Princess Cruises, "Statistics have shown that the chance of contracting Norovirus on land is 1 in 12; and 1 in 4000 on a cruise ship."

According to the Minnesota Department of Health, Noroviruses are members of a group of viruses called caliciviruses, also known previously as “Norwalk-like viruses.” Norovirus is also called viral gastroenteritis, food poisoning, and calicivirus. Norovirus infection causes gastroenteritis, which is an inflammation of the stomach and the small and large intestines. And, Norovirus is by far the leading cause of foodborne illness outbreaks. This infection is often mistakenly referred to as the “stomach flu"- it is not related to the flu (influenza), which is a respiratory illness caused by influenza virus. Norovirus is not a “new” virus, but interest in it is growing as more is learned about how frequently noroviruses cause illness in people.

According to the MayoClinic.com, signs and symptoms of norovirus infection include:
--Nausea
--Abdominal pain
--Abdominal cramps
--Watery or loose diarrhea
--Weight loss
--Malaise
--Low-grade fever
The incubation period for norovirus infection is usually 24 to 48 hours after first exposure to the virus, and signs and symptoms usually last one to three days. You may continue to shed virus in your feces for up to three days after recovery. Some people with norovirus infection may show no signs or symptoms. However, they are still contagious and may unwittingly spread the virus to others.

The norovirus is a contagious virus, according to eHow.com. The virus is spread through the feces of infected animals and humans. Oysters and raspberries that were contaminated at their picking site have caused outbreaks. Food handlers who have norovirus can spread the virus to food prior to the food being consumed by you. Transmission of the virus can happen through the eating of food that is contaminated, consuming contaminated water, or by touching your hand to your mouth after coming into contact with a contaminated source. Norovirus can be dangerous. In these rare instances, malnutrition, severe dehydration and death can occur. These types of complications occur in older adults, children and those who have a compromised immune system. If dehydration becomes severe, prompt medical attention is necessary in order for fluids to be administered through an IV.

According to the Center for Disease Control, CDC, people may feel very sick and vomit many times a day, but most people get better within 1 or 2 days, and they have no long-term health effects related to their illness. However, sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhea. These persons can become dehydrated (loose too much water from their body) and may need special medical attention. During norovirus infection, this problem with dehydration is usually only seen among the very young, the elderly, and people with other illness. Anyone can become infected with these viruses. There are many different strains of norovirus, which makes it difficult for a person’s body to develop long-lasting immunity. Therefore, norovirus illness can recur throughout a person’s lifetime. In addition, because of differences in genetic factors, some people are more likely to become infected and develop more severe illness than others.

There is no vaccine to prevent norovirus infection according to the CDC. And there is no drug to treat people who are infected with the virus. Antibiotic drugs will not help if you have norovirus infection. This is because they fight against bacteria not viruses. Norovirus illness is usually brief in people who are otherwise healthy. But, the infection can cause severe vomiting and diarrhea. This can lead to dehydration (loss of too much water from the body). During norovirus infection, young children, the elderly, and people with other illnesses are most at risk for dehydration. Symptoms of dehydration in adults and children include a decrease in urination, a dry mouth and throat, and feeling dizzy when standing up. A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.

It is important to prevent dehydration during norovirus illness, according to the CDC. The best way to protect against dehydration is to drink plenty of liquids. The most helpful fluids for this purpose are oral rehydration fluids (ORF). Other drinks that do not contain caffeine or alcohol can also help with mild dehydration. However, these drinks may not replace important nutrients and minerals lost due to vomiting and diarrhea. Severe dehydration can be serious. If you think you or someone you are caring for is severely dehydrated, contact your healthcare provider right away. Plus, several products with ingredients similar to those in ORFs can be used to prevent or treat mild dehydration. These products—called oral rehydration solutions—are sold as pre-mixed fluids. Following is a list of some oral rehydration solutions commonly available in U.S. food and drug stores: Infalyte, Kao Lectrolyte, Naturalyte, Oralyte, and Pedialyte. If you are unsure about which product to use or how to use these pre-mixed fluids, contact your healthcare provider.

According to eMedicineHealth.com, pregnant females with norovirus infections tend to become dehydrated faster than nonpregnant females or males, so these individuals should rehydrate quickly. If individuals fail to take in adequate fluids and start to become dehydrated, seek medical care immediately. Most physicians do not recommend taking over-the-counter antidiarrheal medications such as diphenoxylate atropine (Lomotil) or loperamide hydrochloride (Imodium) because they may prolong the infection or cause complications. Unfortunately, there is no vaccine for norovirus, although at least one company has a vaccine preparation undergoing clinical trials. This may help in the future to prevent many of the 3 million-5 million deaths per year worldwide due to diarrhea. Since many underdeveloped countries have no commercially made electrolyte solutions available (both oral and IV), the World Health Organization (WHO) recommends the following for fluid rehydration, especially for children because they have a smaller fluid and electrolyte reserve than adults: Mix 2 tablespoons of sugar with ¼ teaspoon of table salt with ¼ teaspoon of baking soda in 1 liter of clean (treated or boiled) water. Other investigators suggest adding about ½ cup of clear (no pulp) fruit juice to this solution to provide added potassium.

According to the CDC, you can decrease your chance of coming in contact with noroviruses by following these preventive steps:
--Frequently wash your hands, especially after toilet visits and changing diapers and before eating or preparing food.
--Carefully wash fruits and vegetables, and steam oysters before eating them.
--Thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness by using a bleach-based household cleaner.
--Immediately remove and wash clothing or linens that may be contaminated with virus after an episode of illness (use hot water and soap).
--Flush or discard any vomitus and/or stool in the toilet and make sure that the surrounding area is kept clean.
--Persons who are infected with norovirus should not prepare food while they have symptoms and for 3 days after they recover from their illness.

According to eMedicineHealth.com, because the norovirus has been reported to survive on surfaces up to four weeks at room temperature, disinfection is recommended with commercial products or a solution of ½ cup of bleach to 1 gallon of water. Norovirus is killed at temperatures above 140 F, so steaming or boiling (usual minimal time is one minute) can kill the virus. Also, because of the potentially long (about two to four weeks) environmental survival at room temperature, often an area in which an outbreak occurs will need to be disinfected. Repopulating an area with uninfected people without disinfecting the area may produce another outbreak. So, consequently, areas (for example, dorms, barracks, cafeterias, and cruise ships) should be disinfected after a norovirus outbreak to prevent further infections.

According to the Mayo Clinic, seek medical attention if you develop diarrhea that doesn't clear within several days. Also call your doctor if you experience severe vomiting, bloody stools, abdominal pain or dehydration. Novovirus can be spread rapidly by those who have not followed safe guidelines or who have not used common sense personal hygiene. For most people, the disease is not deadly, just very inconvenient with temporary health issues. For some, the results can be worse, especially if care is not administered in a timely basis. If you feel that you may have symptoms, see your primary care provider as soon as possible and stay away from everyone so you do not pass along the virus.

Until next time. Let me know what you think.