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Article posted: 4/8/2013 6:00 AM

Norovirus infection can travel quickly

By

I was having a productive day off, blissfully unaware that back at the office my partners and staff were being hit by a not-so-subtle enemy. Returning to work the following day I found a third of the crew missing, suffering at home with violent bouts of vomiting and diarrhea.

What had happened to cause such gastrointestinal distress? Well, when a patient's mother was too sick to bring her little girl to the office to be checked for dehydration, dad took a personal day and made the trip. As the father settled into the office chair, he realized that he too was feeling queasy and in need of quick bathroom access. Unfortunately, a wave of nausea hit dad before he could reach the restroom and, much to his embarrassment, he spewed along a good portion of the hallway walls and floor.

We never found the true identity of the viral culprit, since specimen testing is typically not performed on a stomach flu patient unless he's sick enough to be hospitalized. But, because of its highly infectious nature and its ability to rapidly cause disease, I blamed norovirus, more popularly known as the "cruise ship" virus.

Norovirus is named by the Centers for Disease Control and Prevention as the leading cause of acute gastroenteritis in this country, with 21 million Americans affected each year. Not surprising since one infected individual can shed billions of norovirus particles, while as few as 18 of these tiny viral particles are capable of sickening another person.

Most norovirus sufferers experience a one- to three-day illness featuring rapid-onset vomiting along with nausea, stomach cramps and diarrhea. Norovirus can also cause more serious disease with approximately 70,000 norovirus hospitalizations and 800 deaths reported annually in the U.S. The very young and the elderly are found to be particularly susceptible to the complications of norovirus infection, including severe dehydration.

Norovirus is so widespread in the U.S. that CDC researchers estimate that by the age of 5, 1 in 6 children will be seen in an outpatient clinic with norovirus, 1 in 14 will require emergency room care, and 1 in 278 children will be hospitalized due to serious norovirus complications.

Norovirus infection travels quickly and easily through a variety of paths, with symptoms starting within 12 to 48 hours of viral exposure. CDC infectious disease experts note that norovirus is most commonly spread through close personal contact with an infected person.

The gastrointestinal virus can also be contracted by eating or drinking contaminated food or water, with the CDC listing norovirus as the No. 1 cause of food-borne disease in the U.S. Foods commonly implicated in norovirus outbreaks are leafy greens, fresh fruits and shellfish, but can include raw foods or any consumable prepared by an food handler with infectious particles of feces or vomitus on his or her hands.

Norovirus can also be picked up by touching a contaminated hard surface or object and then unknowingly putting soiled fingers in the mouth. In addition, norovirus has been shown to spread through "aerosolized vomit" that hits surfaces or manages to enter a neighbor's mouth. The virus is not thought to be acquired through inhalation.

Norovirus treatment is generally limited to rehydration with liquids given by mouth if tolerated or intravenously in more severely affected children. Based on the usual pattern of norovirus spread, the CDC recommends several simple steps to help prevent disease transmission. As always, careful hand-washing is first and foremost, with washing of all fresh produce and thorough cooking of raw foods also advised.

The group recommends rapid cleanup of contaminated surfaces using a commercially available cleaner with bleach -- if you are making your own, add five tablespoons to 1 cups of household bleach to each gallon of water. Soiled clothing should also be picked up -- preferably with gloves -- and without shaking immediately placed in the washing machine on maximum cycle length and then machine, not air, dried.

Because shedding of norovirus particles can persist, the American Academy of Pediatrics advises caregivers and food handlers to refrain from work while ill and for one to three days after recovery. The AAP's general rules regarding kids with common diarrheal illnesses include exclusion from group child care if a child has vomited two or more times in the previous 24 hours, is having two or more stools above his normal daily number, if stools cannot be contained in a diaper, or if an older child is having stooling accidents due to illness.

Ÿ Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.

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