Posted tagged ‘diarrhea’

Norovirus: The real “stomach flu”

January 21, 2016

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

The perils of banning plastic grocery bags

March 11, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

I’m one of us who tries to remember to use those cloth, reusable bags at the grocery. Really. There’s a bunch of them, sitting in the trunk of my car, just ready to be filled and re-filled with groceries. They usually just sit there, forgotten.

Apparently, they’re more active than I realized. They’re busy growing a whole host of nasty germs.

As reported in detail by Ramesh Ponnuru at, there may be an unexpected downside to using those cloth bags. Researchers have found that they’re often filled with bacteria from human and animal stool that can make you sick. Apparently, these sorts of bacteria can be transferred from fresh veggies and other food onto the bags, and they multiply like crazy in your warm trunk.

Mmmm. Colon bacteria.

It’s not just theoretical, either—some evidence has shown that those bags really could make you sick. Local ER visits for E coli infections, caused by one of those tasty stool bacteria, increased immediately after San Francisco’s plastic bag ban, as did salmonella-related illnesses.

There is some good news: the same researchers who documented that these bacteria were  common also found that ordinary washing could dramatically decrease bacterial colonization. Too bad only 3% of the families surveyed bothered to ever wash their bags. I know I don’t.

So: could the net effect of the discouragement or banning of plastic grocery bags be detrimental to our health? I would say the jury’s out. Too many variables to be sure. But clearly, as usual, there may be unintended consequences of legislation to ban these bags. We may end up sicker. Or, we might have to wash our cloth bags—which uses more water and electricity, offsetting the environmental advantage of reusable bags. This whole situation might encourage the use of more paper, recyclable bags, but they have their own, different environmental impact on trees and water and energy use.

I don’t think there’s a simple, best answer here. It makes sense to reduce the use of resources, to re-use plastic or paper or cloth bags when practical, and to recycle things that can be recycled. Beyond that, are cloth bags definitely, always better than plastic? Maybe not.

Preventing the dreaded yuck

June 12, 2009

The dreaded tummy bug: vomiting, diarrhea, misery. Holly wanted to know, if one child gets it, what’s the best way to prevent it from knocking out the rest of the family?

In medical lingo (you know, we can’t use normal words like normal people), the dreaded tummy bug is known as “gastroenteritis.” Most commonly, it’s caused by a number of different viruses. Sometimes, it’s called a “stomach flu”, though it has nothing at all to do with influenza. The common symptoms are nausea followed by vomiting followed by diarrhea, usually in that order, and usually all occurring within a day or so. Sometimes there’s a fever, or some abdominal pain, but that typically isn’t severe.

Vomiting or diarrhea, though seldom both, can also be caused by food poisoning. When a family catches this, everyone gets sick at the same time—how special! With an infectious (usually viral) gastroenteritis, one person gets it, then another, then another, then it’s time to move to a different house, or at least burn all of your clothes and sheets.

If you can’t afford to do that, it might be more practical to follow these steps for prevention:

  1. Wash your hands.
  2. Wash your hands when you leave the bathroom.
  3. Wash your hands before you eat.
  4. Wash your hands again.
  5. Wash your child’s hands.
  6. Wash your child’s hands when she leaves the bathroom…
  7. …you get the idea.

Purell or a similar brand of alcohol-based hand sanitizer can protect against many infectious, but if your hands are “visibly soiled” you need to do a thorough wash with lots of sudsy soap and running water. What kind of soap doesn’t matter (antibacterial or medical soaps are not more effective than ordinary soap), but hand washing technique is important. You need running water and friction as you rub, and it ought to take as long to wash your hands as it takes to sing “Happy Birthday.” And blow out the candles.