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A Viral Misery That Loves Company
By Jane E. Brody : NY Times : March 24, 2014
I have often felt sorry for people whose cruise ship vacations were marred by a nasty gastrointestinal virus that kept them quarantined in their cabins and sometimes cut short the trip.
But now that I’ve endured two separate bouts of this bug, formerly called Norwalk virus and now known as norovirus, my empathy has skyrocketed. Norovirus is, to put it mildly, misery incarnate. One minute you’re fine, and the next you think you’re dying — or that dying would be preferable.
My first infection was almost certainly acquired at a Hanukkah party several years ago; at least 23 attendees became ill. The next evening at a school event with my grandsons, I abruptly abandoned them to race to the restroom. I sweated through my clothes and could not stand unaided. I spent the night on my bathroom floor, with frequent intermissions on the toilet.
Fast forward to this February. The symptoms were virtually identical, but this time I could only guess at the source of my discomfort: a salmon-avocado sushi roll I had eaten for lunch 36 hours earlier.
Noroviruses have the dubious distinction of being the leading cause of gastrointestinal infections in the United States, where they account for an estimated half of all such ailments. The Centers for Disease Control and Prevention reports that each year noroviruses cause an estimated 21 million illnesses and 800 deaths.
About 80 percent of infections occur from November to April, when people tend to congregate in enclosed spaces with little fresh air circulating.
The current strain, first identified in Sydney in 2012, has been responsible for several outbreaks on cruise ships, where the highly contagious and difficult-to-kill virus can easily infect hundreds of passengers.
It has been nicknamed the Ferrari of viruses for the speed at which it can spread through groups. An outbreak on the Queen Mary 2 in December 2012 sickened 204 passengers and 16 crew members.
One infected traveler on the Royal Caribbean’s Vision of the Seas, among 118 guests and three crew members similarly afflicted last March, reported being confined to his cabin for two days, during which time he counted 28 trips to the bathroom.
Nausea, vomiting and diarrhea are the usual symptoms. Others include stomach cramps, muscle aches, low-grade fever, headache and fatigue that can persist for days after the main symptoms abate. Although usually lasting just one to three days, a norovirus infection can be hazardous, particularly for infants, the elderly and people with compromised immunity. The greatest risk is dehydration stemming from vomiting and watery diarrhea.
The virus spreads readily in confined spaces like day care and retirement centers, schools, hotels and nursing homes, as well as on cruise ships. Most ships try hard to prevent outbreaks, providing alcohol-based hand sanitizers for passengers and crew, but the virus often persists despite such deterrents.
A case, or capsid, that surrounds the virus makes it especially hard to kill. It can even survive hand (and sometimes machine) dishwashing and laundering. And when a toilet with contaminated excretions is flushed, the virus can become airborne unless the lid is shut first.
Contaminated clothing, linens and towels should be handled carefully (preferably with gloves), machine-washed separately in hot water, and machine-dried. Contaminated toilets and other hard surfaces should be washed with a 10 percent bleach solution (one part bleach to nine parts water), hydrogen peroxide, Lysol or a commercial bleach-based cleaning product. Carpets and upholstered furniture need steam cleaning. No vaccine is yet available. One, developed by LigoCyte Pharmaceuticals, is being tested. In a randomized trial financed by the manufacturer, it reduced the risk of infection in 98 volunteers by 52 percent. The existence of at least five genetic groups and 31 subgroups of norovirus makes developing an effective vaccine difficult.
Meanwhile, frequent hand washing with soap and hot water for at least 30 seconds, especially after using the toilet, is the best preventive. Failing to do so risks transferring the virus to foods, drinks or utensils used by others. It takes only a small inoculation of norovirus to cause illness.
Furthermore, the virus can persist for days or weeks on hard surfaces, which speaks to the importance of thoroughly washing your hands before eating, preparing food and drinks or serving others. You can also infect yourself by touching your nose or mouth with virus-contaminated hands.
Anyone who becomes infected should refrain from handling food or drink to be consumed by others during the course of symptoms and for at least three days after. Occasionally, an infected person can spread the virus for a week or two after recovering, so diligent hand-washing after using the toilet is a must.
Restaurant workers, most of whom do not get paid sick leave, are a major concern; those who come in sick or too soon thereafter can spread the virus to hundreds of diners. Affected customers may label the ailment “food poisoning,” which it is in a sense, but the real source is the handler.
Foods most often linked to norovirus outbreaks include raw shellfish, leafy greens, fresh fruits and ready-to-eat foods. Vegetables and fruits should be washed, and shellfish are safest when thoroughly cooked. Symptoms usually occur within 12 to 48 hours of ingesting norovirus.
As I experienced, the illness comes on suddenly: You’re fine one minute then very sick the next, as if hit by a Mack truck. There is no treatment other than replacing lost fluids. If vomiting is severe, medications can reduce it, but experts advise against taking an antidiarrheal drug like Lomotil or Imodium, which can prolong the infection.
It is best to avoid sugary drinks, which can aggravate diarrhea. My doctor advised me to follow a so-called BRAT diet — bananas, rice, applesauce and toast — for a day or so, supplemented by plain fluids, broth or diluted juice.
Drink a cup of liquid to compensate for each large, loose stool. A rehydration drink like Pedialyte is suitable for adults as well as babies and children. But avoid foods high in fat and sugar, as well as spicy foods, alcohol and coffee, for about two days after symptoms are gone.