Norovirus Can Ruin Your Vacation

Posted on Wed., November 5, 2008
By Dr. Stephen J. Daniels

You´ve planned your dream cruise for months, only to have it ruined by stomach cramps, diarrhea and vomiting. Sapped of energy, all you can do is lie down and sip Gatorade, instead of swimming, dancing and going on the shore excursions you were looking forward to.

Known commonly as "stomach flu" or "food poisoning," the norovirus, also called "norvo virus" or Norwalk-like virus, periodically affects many on cruise ships, causing sick and angry vacationers to blame the cruise line for their ruined vacations.

Originally named after Norwalk, Ohio, where it was first isolated after it sickened schoolchildren in 1968, this virus often causes illness in closed or semi-closed communities, such as nursing homes, schools, dormitories and cruise ships.

Norovirus-contaminated well water caused widespread illness in both Pennsylvania and Delaware in 1987, and in December 2007, the illness sickened more than 100,000 people in England. In 1986, 1,200 people became ill on two Caribbean cruise ships.

Except in infants, the elderly, and those with deficient immune systems, norovirus infections are seldom dangerous, though they are often quite unpleasant: diarrhea, nausea, vomiting, fever and fatigue are the most common symptoms.

The illness usually begins one-to-two days after exposure, and lasts from one-to-three days, though symptoms lasting two weeks have been reported.

Most public health agencies advise food handlers not to work for two-to-three days after their symptoms resolve, but virus has been found in the stool for up to three weeks after the symptoms have stopped. So hand washing is extremely important.

The virus is quite contagious (10 virus particles are enough to infect you), so avoiding infection can be difficult.

The most common reason for norovirus spread is contaminated water, but salad ingredients, shellfish (especially insufficiently steamed clams and oysters), infected food handlers, and other foods have also been known to spread the disease.

Touching, such as shaking hands with an infected person, then touching ones nose, mouth, eyes or food, can lead to infection.

Prevention

Drinking only bottled beverages (without ice), avoiding uncooked foods, especially fruits, vegetables and shellfish (unless you personally wash the fruits and vegetables), washing or using hand sanitizer on hands, especially before touching your face, and avoiding those who are ill, are the best means of prevention.

Bleach is the best disinfectant for clothes and surfaces, though alcohol, soap and detergents are generally effective.

Treatment

The best treatments are rest, drinking oral rehydration solutions (e.g., Gatorade, Pedialyte, most "sports drinks", chicken broth), and taking Tylenol or Motrin for fever or discomfort (though Motrin can sometimes increase stomach discomfort).
There is currently no known medicine that will kill the virus and cure you quickly. Antibiotics treat bacteria, and are of no benefit in virus infections. There is currently no vaccine.
Anti-nausea (e.g., Dramamine) medicine may help
Anti-diarrhea (e.g., Imodium) medicines may also help, though some of those medicines can retain toxins and worsen the illness.
Your doctor can prescribe medicines for abdominal cramps (e.g., Donnatoa), for diarrhea (e.g., Lomotil) and for vomiting (e.g., Compazine, Phenergan), but usually the symptoms will have resolved by the time you get your appointment.

In severe cases, treatment at a hospital with intravenous fluids may be necessary.

Dr. Daniels practices family medicine at the Concord and Pittsburg Health Centers, parts of Contra Costa Health Services, the county health department.