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Medically Speaking
About Noroviruses
By Margaret T. Hessen, MDFlu season is on the wane, and the recent warm weather has made us think optimistically of spring and summer. Unfortunately, we still have at least one hurdle to get over—the late winter viral scourge known by the descriptive if unattractive nickname of “winter vomiting disease.” A number of Philadelphia area schools and nursing homes have experienced large outbreaks of gastro-enteritis, or “stomach virus.” In some school outbreaks, over half the student body has reported sick in one day. These outbreaks have been attributed to noroviruses (or Norwalk-like viruses), a common cause of “winter vomiting disease.”
Noroviruses are common in the winter and early spring, and cause a short-lived (24-72 hour) illness characterized by low grade fever, nausea, vomiting, and diarrhea with mild cramping. They are highly contagious, and therefore spread rapidly in close quarters such as public schools, college dormitories, nursing homes, and even cruise ships. They are generally more uncomfortable than dangerous, though the very young and the elderly can suffer complications associated with dehydration.
Doctors usually diagnose the disease based on the symptoms, the time of year, and the presence of a high rate of similar disease in the community. Laboratory tests can be performed on specimens of stool or vomitus for confirmation. Currently, the Philadelphia Department of Public Health Division of Disease Control is requesting that physicians report clusters of cases and that specimens be collected for testing.
There is no treatment for the virus itself, but symptoms such as fever and vomiting can be treated with over-the-counter or prescription medicines. It is particularly important to try to control vomiting in order to avoid dehydration. Juice, water, and oral re-hydration solutions can help to prevent dehydration and to treat mild cases. Improvement usually occurs within 24-72 hours. If it does not improve within that time, or if the condition seems worse than described above (e.g., high fever, significant abdominal pain, bloody diarrhea, inability to urinate), prompt medical evaluation should be sought.
During the course of an outbreak such as we are seeing in some local communities, it is particularly important to maintain good hand-washing practices in order to prevent infection. Use of a hand sanitizer may be helpful in situations where soap and water are not available. Vomitus and fecal matter contain infectious virus, and are highly contagious even in miniscule amounts. Potentially contaminated surfaces should be washed with a bleach solution, after which hands should be washed thoroughly. Contaminated clothing should be washed promptly in soap and hot water.
People recovering from the illness may be contagious even after symptoms resolve. Food handlers may not return to work until they have been free of symptoms for 72 hours.Such epidemics can be controlled with strict adherence to the precautions listed, and with appropriate “sick leave” during the period of illness. Whether “cause and effect” or not, norovirus outbreaks also tend to dissipate with a sustained period of warm weather. Spring can’t come too soon!
-end-Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.
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