Norovirus: The real “stomach flu”

The Pediatric Insider

© 2016 Roy Benaroch, MD

Informally, it’s sometimes mistakenly called “the stomach flu” or “a tummy bug”—an illness with some aches and fevers, but mostly vomiting and diarrhea, that often occurs in mini-epidemics in households, daycares, and schools. One kid gets it, and the rest of the dominoes fall, in a most unpleasant and stinky manner.


The illness has nothing at all to do with influenza, by the way. Influenza is a respiratory virus, spread by mucus, that mainly causes aches and fever, along with cough and sometimes some vomiting or abdominal pain. Influenza cases are concentrated during a few months of winter, and there’s a vaccine that can prevent at least some cases.

The “stomach flu” isn’t a flu at all. Technically, we call it an “acute gastroenteritis”, with inflammation of the stomach and intestines, sometimes shortened to just a “gastro” or “AGE”.  These days, the most common cause, year-round, is a nasty and clever little virus called “norovirus”, or “noro” for short. (Docs are always in a hurry. We prefer short words.)

Here’s a lovely thought: volunteers who touched a surface smeared with 30 microliters of infected feces—that’s about half of a drop—all got enough virus on their hands to potentially make them sick. And, get this, if they then touched a doorknob or telephone or another surface, that would transfer enough virus to get the next person sick. In fact, 10 people in a row, serially touching surfaces one after another, would all potentially get sick after the first person touched that first surface, with half a drop of stool. Seriously. Someone did this experiment.

The incubation period between contact with the virus and symptoms is 12-48 hours, though people who are becoming sick become contagious before symptoms start. Though the illness itself is usually brief, typically lasting only a few days, virus continues to be shed in the stool for several weeks, and maybe at low levels for even longer. Both vomit and diarrhea can be loaded with infectious viral particles – and it’s so contagious that documented transmission has occurred in people just walking through an emergency department near someone who has been vomiting.

There is some good news. The virus itself cannot make you sick if it just gets on your skin. It has to invade your body through a “mucus membrane,” like your mouth or nose or eyes (this is true of almost all infectious, by the way—they need a break in the skin barrier or a wet membrane to get through). So as long as you wash your hands well before you eat or drink or touch your face, you ought to be OK.

“Wash your hands well” – that’s not so easy. A CDC-recommended decontamination handwash is 60 seconds of rubbing with soapy water, a 20 second rinse, and drying with disposable paper towels. Do that before and after every patient (as every health care worker should), and by the end of the day your hands will be bloody cracked dry stumps (OK, maybe it’s not that bad. But my knuckles get pretty raw. I know, boo hoo me.) Hand sanitizers containing 70% alcohol help, some, though they’re no substitute for full-on soapy water hand washes.

If vomiting and diarrhea does strike your children, here’s what you ought to do:

  • Keep them home. Please, please keep them home.
  • Wash hands well, and wash hands frequently.
  • Decontaminate surfaces with diluted bleach. Standard detergent sprays help, but bleach is da bomb.
  • Offer frequent, small sips of fluids. They don’t have to eat (and don’t make ‘em eat if they don’t want to), but continued fluid intake is essential.
  • Seek medical attention if your child shows signs of significant dehydration, especially listlessness, an inability to drink, or very little urine output.

Get me a bucket

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3 Comments on “Norovirus: The real “stomach flu””

  1. wzrd1 Says:

    Don’t forget to give your tyke plenty of apple juice before a doctors visit – if you want the unending anger from the staff.
    I’ve yet to meet pediatric staff that doesn’t complain about the odor that permeates the waiting area throughout the office itself.

    On a more serious note, it only takes around 6 – 8 viral particles ingested to become infected (yeah, someone actually tested that as well). So, please, please, please, wash your lunch hooks frequently. Doing that, you will avoid a few days of misery and if ill, can prevent sharing the not-joy of the infection.


  2. K. Esta Says:

    If only there were a seasonal vaccine for this. I would be first in line.


  3. AMD Says:

    Oh have mercy! We had this ONCE, and I know we’ve only had it once (despite getting other here and there) because of the severity. I literally thought I was going to die. At my son’s 2nd birthday party, we hosted about 30 friends (say 10 kids and their parents). One of our little friends (and her mother and sister) had been sick that Wednesday, but “fine since then” (our party was on Saturday). Having no clue what I was inviting into my home, and assuming (entirely wrongly as it turns out) that no one could possibly still be contagious 72 hours after last symptoms were shown, I said “no problem, come on over!” Fast forward to the actual party, when my mom came over and said “someone threw up in your living room.” I was busy with our youngest (then only 4 months), so mom offered to clean it up, but no one seemed to have seen which child did the deed. So the party goes on, and the child who had been sick earlier in the week wanted, as littles are wont to do, to help blow out the candles. Only she didn’t ask first, and it was already in progress by the time I saw what was happening. I *did* have a momentary thought of “oh dear”, but the party went on from there. I’m sure you can imagine where this story is going – by Sunday night, I was so sick I thought I was actually going to die. We thought it was food poisoning because of the violence of the symptoms. I called my pediatrician Monday morning and asked if I could still nurse my 4 month old with food poisoning. She said “are you sure it’s not norovirus?” I said I wasn’t sure what it was but I was about to die. About that time, the 2 year old tossed his breakfast at my husband’s feet (but was otherwise happy as a clam). My husband, now trying to “work from home” with two vomiting family members and a 4 month old, called my mom to beg for reinforcements. We are in ATL and she’s in Chattanooga, so she said no problem, she’d be down shortly. Only she had to stop about three times on the way down because her “coffee wasn’t agreeing with her”. By the time she got to my house, my husband was caring for three vomiters and my mom was trying to decide whether to make a break back for Chattanooga in between bouts. Even Zofran (leftover from my pregnancy) could not stop this beast. I’ve never been so sick in my life!! So meanwhile, we (stupidly) started checking on others who’d been at our party. It will not surprise you to hear that the verified body count on this lovely outbreak (@#$#@ that cake!) was at least 11. We stopped asking after that, couldn’t bear to hear any more and felt so badly.


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