Norovirus is a nasty one. It’s the leading cause of epidemics of vomiting/diarrhea and causes over 20 million cases of gastrointestinal disease (“stomach flu” with vomiting, diarrhea, abdominal pain, fever and achiness) in the US each year. Our experience with Norovirus historically is worse in years with “novel” or new strains of infection. Unfortunately there’s an new strain circulating around the globe. “Sydney 2012” was discovered in Australia last March and just last month the CDC officially announced it’s causing the majority of Norovirus infections. Over 1.2 million people in the United Kingdom have had it and the FDA reports this strain may potentially cause more hospitalizations. Time will tell if we have more Norovirus this year, too.
When new strains arrive, we tend to see a 50% increase in the number of cases of “stomach flu.” Norovirus is remarkably potent and contagious. It often isn’t killed by hand sanitizer (see #3 below). You touch the virus and touch your mouth and you could get it. We can get Norovirus multiple times in our lives because our immunity wanes after infection and new viral strains develop which cause unique disease. We get Norovirus from contaminated food, contaminated surfaces we touch, and from other people who vomit or have diarrhea and spread the virus. This is the cause of the stomach bug that you often associate with cruise ship outbreaks or daycare outbreaks when everyone starts vomiting one afternoon…
Around the holidays a stomach bug swept through our home. It did so for many of my patients, too. During the first week of January, I had a day in clinic where approximately 75% of the families I saw in clinic mentioned someone in their home had been vomiting over the past week. Unusual. I can’t tell you what virus it was (I didn’t test any child’s stool or vomit in the lab), but my bet is on Norovirus…
Facts About Norovirus
- Norovirus is an unpleasant but generally well-tolerated illness. Most children and adults do fine getting over Norovirus without medicine or visits to the doctor but it’s known to be more dangerous for infants and the elderly. It is the leading cause of outbreaks of the “stomach flu” each year. It tends to cause 1-3 days of sudden-onset vomiting, diarrhea, stomach upset, and/or fever and achiness. The biggest risk is severe dehydration.
- Vomiting and diarrhea typically come on suddenly so it seems like “food poisoning.” In truth, about 1/2 of “food poisoning” is caused by Norovirus contamination but we can get it from food prepared by someone with the virus, contaminated food or surfaces we touch. Outbreaks occur in enclosed places like cruise ships, daycare, and nursing homes where people live in close quarters. Most common foods where Norovirus comes into our bodies is raw oysters, leafy greens, and fresh fruit. A reminder even when we’re tired we should always wash that lettuce that says it’s been “triple cleaned.”
- You’re most contagious with Norovirus on the day you’re vomiting and/or having diarrhea or stomach upset and for the subsequent 3 days. The virus is in your vomit, your diarrhea, and can live on surfaces that you touch with contaminated hands for days. The virus can stay in your and your baby’s stool for up to 2 weeks after you’re sick. You can even get Norovirus from particles that get aerosolized into the air from vomit when it hits the table or floor.
What To Do About The “Stomach Flu”
- Hydration: The biggest health risk from Norovirus is dehydration. Your biggest goal is stay hydrated for the 1-2 days of vomiting and diarrhea. When you and your children are ill, take slow sips of fluids throughout the day to keep your fluids up. Don’t give them a sippy cup or water bottle full at first–often a big amount of liquid at once will come right back up! Think spoonfuls.
- No Perfection Prevention: You can’t prevent the “stomach flu” or Norovirus with a vaccine or antibiotic. Your best defense is hand-washing and sanitizing when exposed to the virus. Wash your hands before eating.
- Wash With Soap And Water: Use soap and water after using the toilet, changing a diaper, cleaning up after your children’s vomit or when they have accidents. There is some data that Norovirus isn’t killed off by hand-sanitizer. You have to wash your hands with water and soap to be the most safe. Here’s a list of cleaning sanitizer products that kill Norovirus.
- Don’t Prepare Food: One of the biggest ways that Norovirus is transmitted is through contaminated food. Don’t prepare food while you’re ill or for 3 days after you’ve had the “stomach flu.”
- Sanitize your home: Use an affordable bleach water solution after vomiting and diarrhea strikes. It’s easy to make with bleach from the grocery store. Mix between 5-25 tablespoons of bleach in 1 gallon of water. Use this bleach water solution (it’s cheapest) for cleaning the bathroom, counters, and toys. Don’t hesitate to mix it up and re-clean the day after you or your child is improved as their stool will likely still contain some of the very contagious virus particles. Wash all clothes in long washing cycle and then use a dryer to further kill potential virus that remains.
- When To See The Doctor: If your child is having severe pain that causes them to double-over or yell out in pain, it likely isn’t Norovirus. If your child isn’t making good tears, isn’t making a wet diaper every 6 hours or not peeing. If your child reports feeling dizzy when you stand up, call your child’s clinician for advice or a possible visit to rule-out dehydration.
Julie says
I know in many elementary schools including my child’s the teacher just has the kids use hand sanitizer before lunch with no sanitizing clean up at their desks where they eat either before or after eating. Never mind the fact most kids esp. the real young ones don’t wash their hands properly after using the bathroom and that isn’t monitored by anyone. In a perfect world the teacher would have enough time and resources to be able to have all kids wash up before eating or at least ask kids upon re-entering the class “did you wash your hands” or better yet if there is a sink in the classroom ask them to wash again “just to be sure.” But I guess there just isn’t enough time and resources to do so. It isn’t any wonder though that these diseases spread so quickly I doubt my son’s school is an anomaly.
Shellfish Sam says
You mention the association between raw oysters and Norovirus. Are oysters a common host of Norovirus or is the oyster contaminated by an Norovirus-infected human during preparation?
Thanks for the tips.
SS
Wendy Sue Swanson, MD, MBE says
SS,
Oysters are thought to be a big source of Norovirus (along with other seafood) because they are contaminated at the source—meaning they come from contaminated water. Because they are raw when served the virus is in the shellfish.
Food can also be contaminated after it’s been cooked if it’s handled by someone with the virus.
Check out this link from the CDC for more: https://www.cdc.gov/norovirus/food-handlers/work-with-food.html
Carol Costner says
What is the safest way to wash greens even if they are triple washed or not?
Wendy Sue Swanson, MD, MBE says
Hi Carol,
You can buy some veggie cleaners but mostly it’s recommended you rinse veggie well with running water.
Here’s info on food safety (including washing greens) from the CDC
https://www.cdc.gov/foodsafety/prevention.html
Vic says
I worked in a very large grocery store chain, in the produce department and was quite shocked to see employees and supervisors that were ACTIVELY ill, working with preparing fresh vegetables for the “green wall”. One day a supervisor was vomiting, then returning to work on washing and cutting the veggies, then back to vomit, then back to work again. Never, ever, EVER trust someone else to clean the foods that you are going to give to your family, you have no idea what their standards are!
Michael Bradley says
Great advice! I get a lot of people asking me about a cure
for the norovirus. Well, there isn’t one. Prevention is the key and
washing is the way. I keep hand sanitizer near me for those
emergencies, but washing regularly is critical. I tell my son, stop
licking your fingers…you should too!
Jenn says
We were at a birthday party when the little girl who was
sitting next to my daughter, vomited everywhere. I quickly removed
my little girl and had her use hand sanitizer and a wet wipe with
antibacterial agents to clean her hands. She and her little brother
just got over the Norovirus. Are there any other preventitive
measures I can take to try to keep this at bay? I heard an old
wives tale about grape juice to prevent once exposed.
Jenn says
Oh I should mention, I removed her from her seat, but not
from the room.
joan says
norovirus is a virus, so antibacterial cleaners will do nothing. It has been shown the hand sanitizers don’t kill it. The only way to decontaminate your hands is a good 20 second hand wash.
Bleach is the only effective way to clean up after someone who is sick.
Kurt Guenther says
Norovirus is not influenza. Especially if you are promoting the fact that you are a doctor, please stop using “stomach flu” to describe it. It may cause people to relativize their symptoms and treatment. Thank you. By the way. I have it right now and it is worse than anything I’ve ever experienced as “the flu.”
Wendy Sue Swanson, MD, MBE says
I have authored copious content on influenza, common terms used to describe it and difference between what the public refers to as “the flu” and what they call “stomach flu.”
I’m sorry that my mention of common terms upset you, usually I do this to provide distinction between the two and remove misunderstandings.
katie says
Hey guys great advice. I have had “Noravirus” for 4 days now I went to the GP they said to wait it out. Are there any ways I can ease the symptoms things I can eat or drink or even do. I’ve found that a hot water bottle on my tummy eases the cramps. Any advice would be great! Thanks in advance
jennxj6 says
if it was me I would go to a IV clinic and let them give me a bag of saline solution with vitamins in it to relieve my body and to get some fluids back in it that’s with the military would probably do I was in the desert and needed some fluids just a suggestion
Vivienne Frances Bradshaw says
About a week ago 21st March I felt quite ill when I got up in the morning. Upset stomach feeling sick dizzy I had to go back to bed. All the week I had hot and cold sweats headache. I rang my doctor’s surgery and told them the symptoms they said we think you have the Norovirus don’t come to the surgery it is highly contagious and you could pick something else up to. Drink plenty of water eat lightly and rest. My husband got me some stomach remedy medicine from our local chemist. When the symptoms began to go I started to go for a short walk but I had to return home as I felt so worn out and tired. I still feel so tired and ache all over. I have had flu in the past but this virus is horrible I hope I don’t get it again in a hurry.
Nicole says
Check your statement on the triple washed greens. According to the website you link to, prewashed, ready to eat greens should not be washed again. And they also do not recommend commercial cleaners. https://www.foodsafety.gov/keep/basics/clean/index.html
Wendy Sue Swanson, MD, MBE says
Thanks, I followed the link. I wish they sourced their statement about bagged, pre-washed greens being safe to wash without eating!
Amanda says
Thank you for the article!
FYI, the link to the CDC with sanitizing products that kill norovirus doesn’t work.