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Special Report: The Norovirus

Prevention, symptoms, and survival

It’s a particularly rough year for Norovirus. (As in the highly contagious intestinal virus that can lead to intense bouts of vomiting and diarrhea.) Good times. So we asked AAP fellow (and MD Moms co-founder) Dr. JJ Levenstein to get us up to speed on the strains, the symptoms, the spread—and how to survive.

StrollerTraffic: We’ve been hearing so much about Norovirus lately. Where did it come from?
Levenstein: Outbreaks of Norovirus have been a hot topic in the news this winter, and many people mistakenly think this bad intestinal virus is a newcomer. But Noroviruses (originally called the Norwalk virus) have been around since 1972. Last week, the CDC announced that a new strain of Norovirus (Gll.4 Sydney) accounted for about 53 percent of outbreaks in the U.S.—passing GII.4 New Orleans as the frontrunner this season. And it’s a tough little bug.
 
ST: What is Norovirus, exactly?
Levenstein: This group of viruses cause inflammation of both the stomach lining (gastro-) and large intestine (-enteritis), and are now the leading cause of gastroenteritis in the United States. The CDC estimates 20 million cases of gastroenteritis are caused by Noroviruses each year, leading to over 70,000 hospitalizations (for dehydration) and 800 deaths yearly.
 
Strollertraffic: And it’s pretty contagious, right? How does someone get it?
Levenstein: Noroviruses are unique in that they are very contagious and can infect several ways. They can live—for hours—on food or liquids that have been contaminated by infected food handlers (or family and friends); they thrive in undercooked or raw seafood (oysters are notorious); and they can even hitchhike on raw fruits and veggies (especially leafy greens). Noroviruses can live on inanimate objects like tables, railings, and doorknobs, so touching contaminated surfaces and then touching your eyes, nose, or mouth can lead to infection.

StrollerTraffic: Gross. Can hand-washing help?
Levenstien: Yes. Make sure you wash hands vigorously for 20 to 30 seconds with soap and water before eating or snacking. Good hand hygiene can kill the virus before hands reach mouths, eyes, and noses. If you use hand sanitizer or wipes on the go, 15 seconds of vigorous application can discourage Noroviruses from hitchhiking on hands.
 
StrollerTraffic: How do you know if you have Norovirus? And when will it go away?
Levenstein: In addition to nausea, vomiting, and diarrhea, symptoms can include low-grade fever, muscle aches, fatigue, chills, and headache. In healthy individuals Norovirus runs its course in 2 to 3 days.

StrollerTraffic. Does it come on quickly?
Levenstein: Yes. Incubation periods are short, so you can be perfectly fine one day, and have severe nausea, vomiting, and diarrhea with belly cramping the next.
 
StrollerTraffic: What’s the best way to manage the virus?
Levenstein: Treatment is symptomatic, as there is no antibiotic for this virus, nor is there currently a vaccine. The key is to drink plenty of fluids (such as oral rehydration solutions, like Pedialyte), to stay hydrated. Avoid sugary drinks and those with caffeine, which can cause even more dehydration. Once vomiting stops, begin restoring calories with simple, easy to digest foods such as rice, pasta, eggs, chicken, soups, bread, bananas, and applesauce.
 
StrollerTraffic: Is a doctor’s visit necessary?
Levenstein: If your child (or you) feels dizzy, urination has dwindled, and her mouth feels puckered and dry, it’s time to hydrate more aggressively—and if there is still vomiting or lots of diarrhea, best to go to the ER or your doctor for hydration. In babies and tots, lack of tears, listlessness (not wanting to play, inactivity), pale cool skin, dry mouth, and persistent symptoms should trigger an immediate call to your health care provider or a visit (pronto!) to the ER.
 
StrollerTraffic: If someone brings it home, is there anything we can do to prevent the whole family from getting it?
Levenstein: If a family member is ill, clean and disinfect surfaces they touch with bleach wipes or a mixture of 1 cup of bleach per 1 gallon of soapy water. Bag up contaminated diapers and wash your hands afterwards. Don’t prepare food for your family for at least three days after YOU have been sick, to reduce chances of contagion, and don¹t eat food prepared by someone who is currently sick. Wash soiled clothing and bed linens in hot water for the maximum time your washer offers; wear gloves when handling; and don’t shake out the clothes, because the viruses can pole vault onto new surfaces. Machine dry infected linens.
 
Strollertraffic: Yikes. When does Norovirus season end?
Levenstein: Although winter is when this bad bug really flourishes, Noroviruses can cause illness year-round. So keep these preventive strategies in the back of your mind at all times!