Transmission of Stomach Flu (Gastroenteritis): Cause and Prevention

Transmission of Stomach Flu (Gastroenteritis): Cause and Prevention

An outbreak of the flu and a stomach virus has caused havoc across the state of Oklahoma, leading many children to miss school in the Enid area and parents to stay home from work. The Missoula City-County Health Department is also seeing an increase in the number of reported flu cases and a slew of gastroenteritis viruses, otherwise known as the stomach flu. One such gastroenteritis is called norovirus, which is the bug that caused schools in Arlee to shut down for a couple of days in January because of an outbreak among students and staff.


Absenteeism is becoming more common in Austin, TX as children come down with respiratory and stomach flu viruses, along with other diseases that are more prevalent. It is so common, in fact, that norovirus infections are second only to the common cold in reported illnesses. In New York City, an outbreak of norovirus has been ongoing since November. Some 500 infected people have been showing up each day at emergency rooms around the city, health department officials said. Microbiologists estimate that norovirus causes 23 million cases of the stomach flu in the United States each year.

Stomach Flu (Gastroenteritis) is a leading cause of severe diarrhea in both adults and children. Gastroenteritis is an inflammation of the gastrointestinal tract (the pathway responsible for digestion that includes the mouth, esophagus, stomach, and intestines). Many different viruses can cause viral gastroenteritis, which can pass through a household, school, or day-care center quickly because it's highly infectious. A majority of traveler’s diarrhea cases among U.S. travelers to Mexico and Guatemala were attributed to Norovirus.

Norovirus, until recently known as Norwalk-Like Virus (NLV), is the most common cause of non-bacterial gastrointestinal infections in the USA. Because viruses are much smaller than bacteria, it was only when electron microscopes arrived in the lab in the 1970s that health officials could properly investigate virus-based infections. Stomach Flu (Gastroenteritis) for noroviruses are known to be a major cause of food and waterborne gastronteritis outbreaks in domestic and unique settings, such as cruise ships, and also have been documented among military groups during deployment overseas.

Aaron Margolin, professor of microbiology at the University of New Hampshire and director of UNH's Virus and Waterborne Disease Laboratory says; the fast-spreading virus is greatly affected by sanitation. "It all boils down to the fecal-oral route. People will inadvertently consume the fecal material of another individual," he says. Lax hand-washing, among anyone from food-preparers to caregivers to hand-shakers, is a primary route for the virus to spread; studies have shown that 75 percent of men and 50 percent of women do not wash their hands after using the restroom

Stomach Flu (viral Gastroenteritis) is common where there are lots of people in semi-enclosed spaces, such as nursing homes, schools, cruise ships and hospitals. Acute viral gastroenteritis, an inflammation of the gastrointestinal tract, is an illness of fever, diarrhea and/or vomiting caused by an infectious virus. It only takes a few particles of the virus to cause illness in a susceptible person. It usually is of acute onset, normally lasting less than 10 days and self-limiting. Many types of viruses can cause gastroenteritis. The most common ones are:

These viruses are often found in food (especially seafood such as shellfish), contaminated water, Contact with an infected person, unwashed hands, dirty utensils. Touching surfaces like door handles, light switches, table tops and toilets that have been frequently touched by infected people. Uncooked foods can often become contaminated following exposure to contaminated irrigation waters or after human handling in the case of produce.

Food can be contaminated either by direct contact with contaminated hands or work surfaces that are contaminated with stool or vomit, or by tiny droplets from nearby vomit that can travel through air to land on food. Although the virus cannot multiply outside of human bodies, once on food or in water, it can cause illness. Some foods can be contaminated with norovirus before being delivered to a restaurant or store, cruise ships, nursing homes, hospitals, schools, banquet halls, summer camps, and family dinners. Several outbreaks have been caused by the consumption of oysters harvested from contaminated waters. Other produce such as salads and frozen fruit may also be contaminated at source.

People working with food who are sick with norovirus gastroenteritis are a particular risk to others, because they handle the food and drink many other people will consume. Since the virus is so small, a sick food handler can easily – without meaning to – contaminate the food he or she is handling. Many of those eating the contaminated food may become ill, causing an outbreak.

The norovirus can spread from a contaminated pillowcase to a clean towel in a pile of laundry. To disinfect laundry, wash with hot water and dry on "high." Add bleach to wash if heavily soiled with vomit or feces.

Transmission may happen with having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing foods or eating utensils with someone who is ill). Shaking hands, kissing, sharing food, drink, or eating utensils for example, with an infected person, or touching environmental surfaces (like doorknobs or handrails) that have been contaminated with flu virus particles and then touching your food, utensils, water…etc may cause transmission of the virus.

People who no longer have symptoms may still be contagious, since the virus can be found in their stool for up to 2 weeks after they recover from their illness. Also, people can become infected without having symptoms and they can still spread the infection.

There is no evidence that the Stomach Flu (Gastroenteritis) virus spreads through the respiratory system; it is most likely ingested through the nose or mouth from touching an infection source and then putting the hand near the nose or mouth, or from aerosol droplets from an infected person entering the oral route of another.

Another way to catch viral Stomach Flu is by breathing in airborne viruses after an ill person vomits. If the illness is not quickly recognized and steps immediately taken to control it, the infection will spread rapidly from person to person.

This highly contagious norovirus, often called the stomach flu, can be passed from one person to another through contact with commonly shared items such as computer keyboards and computer mice, U.S. health officials report.

On Thursday, the U.S. Centers for Disease Control and Prevention reported on a norovirus outbreak at a Washington, D.C., elementary school last February in which some of the victims picked up the virus from contaminated computer equipment. "There is evidence that shared objects and surfaces help transmit disease," said Dr. Shua Chai, a CDC epidemiologist and co-author of the report, published in the Jan. 4, 2008 issue of the CDC's Morbidity and Mortality Weekly Report.

"This is the first time that we have demonstrated that keyboards and computer mice can be a source of transmission of norovirus," he added. Most outbreaks are food-borne, Imperato said. "Smaller percentages are due to person-to-person contact, and an even smaller proportion is water-borne," he said. "Outbreaks in schools account for about 12 percent of all the outbreaks." Contamination of surfaces such as computer keyboards is fairly common, Imperato added.

There is no evidence that sick persons can become long-term carriers of the virus, but the virus can be in the stool and vomit of infected persons, from the day they start to feel ill to as long as 2 weeks after they feel better.

PETS: Campylobacter infection is an infection transmitted by household pets carrying Campylobacter jejuni bacteria, which cause diarrhea, abdominal pain, and fever in people. The campylobacter bacteria may exist in the intestinal tract of an infected domestic or wild animal, and a person can become infected through contact with contaminated water, feces, or unpasteurized milk. More than 2 million cases of campylobacter infection occur each year in the United States, and C. jejuni is now the leading cause of bacterial gastroenteritis.

Prevention: Here are some steps for the prevention of transmission seasonal winter illnesses:

Norovirus can spread from a contaminated pillowcase to a clean towel in a pile of laundry so disinfect everything the person came into contact with, including light switches, the experts say. Sanitize cleaning rags by washing with hot water and bleach and dry on high, and don't forget to wipe off the bleach bottle.

Avoid close contact with people already sick. Avoid ice cubes, because ice cubes may be made from contaminated water. Use bottled water to brush your teeth.

Stay home when you are sick until all symptoms resolve. Avoid touching your face after you've been in public and cover your mouth when you when coughing and sneezing. APIC advises to wash hands frequently with soap and water for at least 15 seconds or use hand sanitizer containing at least 60 percent alcohol.

Avoid touching your eyes, nose or mouth, since many germs are transmitted from your hands. Linens (including clothes, towels, tablecloths, napkins) soiled to any extent with vomit or stool should be promptly washed at high temperature. Oysters should be obtained from reputable sources and appropriate documentation kept. Washing raw vegetables thoroughly before eating and appropriate disposal of sewage and soiled diapers also help to reduce the spread of norovirus and prevent illness. In small home-based catering businesses or family owned or operated restaurants, sick children and infants in diapers should be excluded from food preparation areas.

Practice health habits, including eating nutritious foods, drinking plenty of water, getting plenty of rest and being physically active. Professor of microbiology at the University of New Hampshire and director of UNH's Virus and Waterborne Disease Laboratory advised "What appears to be a recent surge in outbreaks may actually just be the result of better detection and identification of the virus," he adds. However, he warns that people in all types of communal settings, such as childcare centers, nursing homes and dormitories are at risk for norovirus if sanitation and hygiene habits lag.

For most healthy individuals, drinking plenty of fluids and resting at home is sufficient to recover from a norovirus infection and there is no need for hospital treatment. Food preparation should also be avoided until three days after symptoms have disappeared. Gradually begin to eat bland, easy-to-digest foods, such as soda crackers, toast, gelatin, bananas, rice and chicken.

Stop eating if your nausea returns. Avoid milk and dairy products, caffeine, alcohol, nicotine, and fatty or highly seasoned foods for a few days. Doctors say with proper rest and treatment, the stomach flu should clear up in about three days. Routine rotavirus vaccination beginning at about 2 months of age is recommended for all U.S. children.

Cruise companies should improve their procedures for monitoring and dealing with norovirus infections. For instance, one company, Carnival Cruises, has trained its staff to look for signs of illness in passengers at embarkation. Put linens soiled with vomit or fecal matter in a plastic bag before sending them to the laundry. Encourage staff working in the laundry to wear gloves, a mask, and a disposable gown (or to change their clothes) when physical contact with soiled linens is necessary.

When traveling overseas, only drink bottled water must be consumed. Food buffets, uncooked foods or peeled fruits, vegetables and ice in drinks must be avoided.

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