During respiratory illness season there a more graphic, yet shorter-lasting virus making the rounds especially among kids: Norovirus.
What is Norovirus?
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"Norovirus is a viral infection, most people refer to it as the stomach flu. But it's a distinctly different virus than influenza," says Doug Kasper, MD, an infectious disease specialist with OSF HealthCare. "It's acquired by contact, meaning you touch it. Then it gets from outside your body, usually in through your mouth, and then into your GI (gastrointestinal) system."
Norovirus symptoms and concerns
"Symptoms usually come on very quickly. Roughly a day or two after exposure, the person will notice gastrointestinal symptoms like nausea, abdominal pain, bloating pain, gas and diarrhea," Dr. Kasper says. "Most people that don't have an immuno-compromised history, the symptoms will pass in 2-3 days. It can be a much bigger problem in people who are chronically ill. It leads to dehydration and low food intake. So, if someone is more vulnerable or they have underlying GI issues like Chron's disease, ulcerative colitis, it can cause more profuse symptoms."
Concern for reinfection
"One of the main issues with Norovirus, is that everybody is susceptible to it. There is no vaccine and there is no significant immunity that is generated by infection," Dr. Kasper says. "Which also means you can be reinfected shortly after you've had infection."
Neutralize Norovirus at the source
"Because people get so sick and they're using the same bathroom, where they're all in the same area, you really have to neutralize Norovirus at the source. Because otherwise people will just reinfect each other over and over again," Dr. Kasper says.
Dr. Kasper emphasizes that alcohol hand gels do not kill Norovirus. Washing your hands with soap and water and practicing good hand hygiene is extremely important.
For cleaning the contaminated areas and surfaces, use bleach-based products. You must clean bathrooms, common living areas and food preparation counters, Dr. Kasper adds. The Centers for Disease Control and Prevention (CDC) recommend leaving the bleach disinfectant on the affected area for five minutes. Then clean the whole area again with soap and hot water, followed by washing any dirty laundry, taking out the trash, and once again washing your hands.
The CDC reports that 685 million total cases of acute gastroenteritis (which leads to vomiting and diarrhea) comes from Norovirus. 200 million of those cases come from kids under 5 years of age, normally peaking in January.
Clean all products the person would've touched while they have Norovirus. Norovirus is "durable," Dr. Kasper says. It can last on surfaces for up to a few days.
Where Norovirus is most common
"We see this a lot in school-aged children, daycares, nursing homes and assisted living facilities where many people are congregating," Dr. Kasper says. "The main issue with Norovirus becomes environmental cleaning and hand hygiene."
Dr. Kasper adds that spikes are typically seen when kids go back to school in the fall or early winter.
“Kids share meals at lunch, or they touch each other through play when they're sick," Dr. Kasper says. "With older adults, especially if they're living in their home, it's less likely because they're just not around that many people or touching things throughout the day."
How food preparation can increase Norovirus spread
"It's not the actual food; it's the person preparing the food. What we worry about with Norovirus is the hand hygiene of the worker. Whether it's at a cafeteria or a restaurant, or even at the home," Dr. Kasper says. "To get infected with Norovirus, the person has to ingest it. It's not a skin infection, so most of the time we put our hands to our mouth, it's when we're eating. So, if somebody is preparing food, and the food becomes contaminated, you acquire it by touching or ingesting the contaminated food. But it's not coming from the food primarily, it's coming from the person who prepares the food."
Norovirus is highly transmissible
"You need a very small amount of virus, very few copies, for somebody to become infected," Dr. Kasper says. "With any virus, there's a certain amount the person has to acquire to trigger an infection. So, it's not one copy, but Norovirus is on the end of the spectrum where you need many fewer copies to generate infection."
Why Norovirus is dangerous for immunocompromised people
"The immune system is what clears Norovirus. So, somebody who has an intact immune system, although they'll get sick and it'll be very unpleasant, generally they will get better within a period of days," Dr. Kasper says. "Somebody who is immunocompromised, whether it's through having a transplant or medication steroids, they can really struggle to clear Norovirus for a longer period of time. What really builds up is the fluid loss leads to dehydration and possible electrolyte loss that leads to other complications. Then anorexia can occur when you're not hungry to eat. That can compound for somebody that is in a frailer state to begin with."
Most senior living communities have specific cleaning guidelines they’re expected to follow by government agencies. Schools follow different guidelines, Dr. Kasper says, but a lot of the guidance is based on using industrial-based cleaners to try and stop the spread of illnesses.
Norovirus is reported in outbreaks, not a specific number of cases, because the virus spreads so fast and can affect a large amount of people in a smaller space. “When contact happens, infection is likely to occur,” Dr. Kasper adds.
Norovirus is common and not unexpected, Dr. Kasper says. There are no new strains that come out like we see in the flu or COVID-19. The need for communication on the virus is simply to bring awareness to cleaning habits and to give advice on how to keep others safe.
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