Tag: stomach flu

Norovirus Illness: What Patients and Doctors Need to Know

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment

Every winter we brace for an uptick in norovirus, often dismissed as the “stomach flu.” For many, it’s just a miserable few days of vomiting and diarrhea. In reality, norovirus is a major public health issue: it spreads quickly, it’s hard to kill, and outbreaks can overwhelm entire communities.

Norovirus is part of the Caliciviridae family and is the leading cause of acute gastroenteritis worldwide. A single infected person can trigger dozens of cases. It doesn’t take much. Just 10 to 20 viral particles. The virus survives on surfaces for days, resists alcohol-based sanitizers, and tolerates a wide range of temperatures, which is why schools, nursing homes, cruise ships, and restaurants are common hotspots.

Symptoms and Impact

Illness usually starts suddenly. Patients may complain of nausea, stomach cramping, watery diarrhea, or repeated vomiting. Children often vomit more, adults tend to have more diarrhea, and fever, fatigue, and body aches can happen but aren’t always present.

For most people, symptoms last 1 to 3 days. But dehydration can become serious, especially in infants, older adults, or those with weakened immune systems. Years ago, in hospital-based practice, I admitted patients who couldn’t keep fluids down and needed IV hydration after only 24 hours of illness.

How It Spreads

Norovirus has been called the “perfect pathogen” because it finds so many ways to move from person to person. Direct contact with someone sick, eating contaminated food like undercooked shellfish, drinking contaminated water, or simply touching a door handle can all spread infection, and even vomiting can aerosolize tiny droplets of virus into the air, which is why outbreaks in crowded dining halls or cruise ships often expand so rapidly.

The incubation period is short: just 12 to 48 hours. That means someone can be exposed at a group gathering and have symptoms by the next day. Diagnosis is usually clinical during outbreaks, though lab confirmation with RT-PCR testing is reserved for severe cases or public health investigations.

Treatment

There is no antiviral medication for norovirus. Management is entirely supportive. Oral rehydration is the first step, with IV fluids for those who can’t keep liquids down, and ondansetron can help control vomiting in children and adults, though it doesn’t shorten the course of illness. A bland diet and gradual return to regular foods is usually recommended. Antibiotics don’t help, since this is viral.

Prevention

Preventing norovirus is about breaking the chain of transmission, and handwashing with soap and water works better than alcohol-based sanitizers. Surfaces contaminated with vomit or stool should be cleaned with bleach-based disinfectants, because many common cleaners aren’t effective. Shellfish should be cooked thoroughly and produce rinsed before eating.

Infected people should stay home for at least 48 hours after symptoms end, since viral shedding can continue. During outbreaks in schools or long-term care facilities, early recognition and strict cleaning protocols are what actually stop the spread, not treatment after the fact.

Why It Matters

Norovirus keeps proving how disruptive a “simple” virus can be. Cruise ships diverted from ports, schools shutting down for deep cleaning, long-term care facilities under quarantine, these are all real-world consequences. Each outbreak is a reminder that prevention matters as much as treatment.

For patients, the focus is on hygiene, hydration, and staying home when sick. For healthcare providers, it’s about rapid recognition, supportive care, and education, and for public health officials, the job is surveillance and outbreak response. Together these steps limit how far norovirus reaches.

—

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

  • Centers for Disease Control and Prevention. Norovirus. https://www.cdc.gov/norovirus
  • Hall AJ, et al. Norovirus disease in the United States. Emerg Infect Dis. 2013;19(8):1198-1205. PMID 23876403.
  • Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. 2009;361:1776-1785. PMID 19864676.
  • Atmar RL, Estes MK. The epidemiologic and clinical importance of norovirus infection. Gastroenterol Clin North Am. 2006;35(2):275-290. PMID 16880066.
Orange Electrolyte+ drink bottle and bowl of crackers on a wooden tray on bed

Gastroenteritis: Nausea, Vomiting, Diarrhea and Dehydration

On By Dr. Scott RennieIn Gastrointestinal1 Comment
shutterstock_103672964Viral gastroenteritis is an illness that we often see in the urgent care and medical clinic in both adults and children.  It causes diarrhea and vomiting. How do I get infected?  If you touch an infected person or an object that has been touched by someone who is infected (that has the virus on it), you could become contaminated.  If you eat foods or drink liquids with the virus you may also become infected.  It is important for people with the virus to wash their hands. Symptoms: Possible symptoms include nausea, vomiting, diarrhea, fever, headache or muscle aches, belly pain or cramping and loss of appetite.  If your body loses too much water, you can become dehydrated.  Symptoms of dehydration include dark yellow urine, feeling thirsty, tired, dizzy or confused.  Dehydration that is severe can be life threatening.  Babies, infants, young children and the elderly are more likely to become dehydrated. When should I call a doctor or nurse?  If you or your family member has symptoms of dehydration (mentioned above), diarrhea or vomiting that lasts longer than 24 hours, vomiting blood or have bloody diarrhea, they haven’t had anything to drink in a few hours or been able to urinate in the past 6-8 hours during the day, if a baby or young child hasn’t had a wet diaper in 4-6 hrs. Diagnosis:  Most of the time the diagnosis can be made after obtaining a history and performing a physical exam, but sometimes your healthcare provider may obtain blood tests, urine tests or tests on a stool sample. Treatment of viral gastroenteritis:  For severe gastroenteritis with dehydration patients are sometimes treated with IV fluids (a thin tube that goes into the vein).  We do not give antibiotics for viral gastroenteritis because they don’t help cure a viral infection.  We can give medicine in the IV to help reduce the nausea as well.   Sometimes suppositories or oral medications for nausea can be helpful.  Small sips of clear fluids at home every 15 minutes can help prevent dehydration.  We generally try to avoid red colored fluids so that if it passes right through, we don’t confuse the red color for blood in the stool.  Once vomiting has stopped for 24 hours, starting small bites of crackers can be tried.  The diet usually advances to a “BRATTY” diet at this point – ie. “Bannanas, Rice, Apples, Tea, Toast and Yogurt” are all bland foods that are easy on the stomach. Prevention of viral gastroenteritis:  Wash your hands with soap after using the bathroom or change your child’s diaper and before you eat.  Avoid changing diapers near where you prepare food and make sure your baby gets the rotavirus vaccine.  Rotavirus is a common infection that causes severe nausea, vomiting and diarrhea in children. Dehydration:  This is a term that medical providers use to describe when the body loses too much water.  It can be mild or severe.  Usually mild dehydration doesn’t cause problems, however severe hydration is a medical emergency and can be life threatening.  You children and babies are more at risk for dehydration because they have a small body mass and less to lose to begin with. Causes of dehydration:  Vomiting, diarrhea, sweating/high fever, medicines called diuretics or water pills.  Also some people who have nausea or sore throat might not drink enough fluids. Symptoms of dehydration:  With mild dehydration, patients might not notice any symptoms, however as dehydration gets worse it can cause: 1)   Feeling thirsty 2)   Urinating less often, or having dark yellow or brown urine 3)   Dry mouth or cracked lips 4)   No tears when a child cries 5)   Feeling tired or confused 6)   Feeling light headed or dizzy 7)   Eyes look sunken in the face 8)   Babies can have a sunken gap between the bones in the babies skull. This soft spot can feel/look caved in. When to seek help:  Call your medical provider if your child has any symptoms of dehydration.  You should also call if the patient has diarrhea that lasts more than a few days, vomits blood or has bloody diarrhea, vomiting lasts more than 24 hours, urinating much more than usual, haven’t had anything to drink in many hours, hasn’t needed to urinate in the past 6-8 hours (in adults/older children) or hasn’t had a wet diaper in 4-6 hrs.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.