Dreaded ‘stomach flu’ wreaks havoc on families — and it’s only going to get worse.

Once the virus hits, the attacks are often swift and brutal. The stomach and intestines become inflamed. Bouts of vomiting and diarrhea follow that leave victims weak and exhausted. And since the bug is extremely contagious, it can spread easily to others, especially in places like day-care centers, schools, cruise ships and nursing homes.

If all of this sounds familiar to those of you who were laid viciously low over the holidays, it’s because the arrival of cold weather usually coincides with an increase in one of winter’s most dreaded horrors: norovirus. Although norovirus is often referred to, incorrectly, as stomach flu, it has nothing to do with influenza, which is a respiratory virus. While you can get sick from norovirus at any time during the year, it’s most common in the winter.

That’s when people tend to congregate more, and the closer you are, the more you tend to share your germs. Colder temperatures also seem to make it easier for the germs “to stick around on surfaces a little bit longer,” said Aron Hall, an epidemiologist who tracks norovirus at the Centers for Disease Control and Prevention.

For Laura Thai-Jenkins, an elementary school teacher who lives in Olney, Md., with her husband and three boys, illness has been nonstop over the past two weeks. Her 6-year-old got sick before Christmas but recovered after a few days. Then her 8-year-old went to a birthday party last Friday. On New Year’s Eve, he threw up more than 10 times, she said. Two days later, the virus hit her oldest boy, who is 11. And the entire cycle started all over again Tuesday when the youngest came home from school and vomited.

That prompted Thai-Jenkins to take photos of her ailing sons — two resting on sofas and the third lying in a recliner. She posted a picture on Facebook and sent the rest to her mother.

“They each have a bucket and a blanket,” she said Wednesday. The stomach bug “took them all down pretty quickly.”

Heather Felton, a Louisville pediatrician, said her practice had a multitude of cases of gastroenteritis — the medical term — the week before Christmas. Many patients spiked fevers between 102 and 103 degrees.

“We don’t usually get that high for your typical stomach bug,” she said. Felton, who is part of a physicians-moms group on Facebook that has about 60,000 members, said the severity of gastroenteritis cases was a recent discussion thread, with doctors from Virginia and Ohio reporting similar symptoms.

“Most of what people are saying is that it’s more severe, lasting longer, and people feel a lot worse,” she said Wednesday. Some of the physicians fell ill themselves, she added, and posted that the virus “really knocks me off my feet.”

Jeff Bernstein, a Silver Spring pediatrician, said his practice has had a noticeable increase in cases in the past three weeks, with the peak just before the Christmas weekend. Most have been manageable and typical for this time of year. But in some cases, he said, the abdominal pain was so severe that families were worried about appendicitis.

On average in the United States, norovirus annually causes 19 million to 21 million cases of acute gastroenteritis, meaning inflammation of the stomach or intestines or both, according to the CDC. This year, norovirus outbreaks reported to the CDC appear to be “pretty much on par with previous years,” Hall said. Thanksgiving is typically the unofficial start of the season, with another uptick near the holidays at the end of December.

“So far, we’re seeing essentially the same viruses in circulation as we saw during last season,” he said, with no indication of new or especially virulent strains. But it’s still early. Data from the last several years show that outbreaks probably will spike between February and March.

All states report norovirus outbreaks to the CDC, but agency officials also rely on a surveillance system that gets faster real-time assessments. Any outbreak reported to nine state health departments across the country is reported to the CDC within seven days.

Norovirus is typically spread through vomit and stool. People become sick by eating food or drinking liquids that are contaminated with norovirus, by touching surfaces or objects contaminated with the virus, and then putting their fingers to their mouth, or by caring for or sharing food or eating utensils with a sick person.

Most people who are sick from norovirus get better in one to three days. People are most contagious when they are sick and during the first few days after symptoms have gone away. There is no specific medicine to treat the illness. To prevent dehydration, drink plenty of liquids to replace fluids lost from throwing up and diarrhea. Severe dehydration may require hospitalization for treatment with intravenous fluids.

There are many different types of norovirus, so yes, you can get sick from the virus many times in your life. Being infected with one type may not protect you against others.

For people planning to attend the Jan. 20 inauguration of President-elect Donald Trump or the Women’s March on Washington the next day — both events likely to draw hundreds of thousands of people — public health officials are stressing the importance of frequent hand-washing and staying home if you’re not feeling well.

To prevent norovirus infection:

  • Wash hands thoroughly with soap and water, especially after using the toilet or changing diapers, and always before eating, preparing or handling food. Alcohol-based hand sanitizers can help reduce the number of germs, but they’re not a substitute for washing with soap and water.
  • Wash fruits and vegetables and cook seafood thoroughly.
  • If you’re sick, don’t prepare food or care for others who are sick for at least two days after symptoms stop.
  • Clean and disinfect potentially contaminated surfaces.
  • Immediately remove and wash clothes or linens that may be contaminated with vomit or stool.



Antibiotics aren’t supposed to be effective against viruses. But new evidence in mice suggests antibiotics may help fight norovirus, a highly contagious gastrointestinal virus, report scientists atWashington University School of Medicine in St. Louis.

The researchers found antibiotics could help prevent norovirus infections. The same team also showed that a recently identified immune system molecule can cure persistent norovirus infections even in mice with partially disabled immune systems. The surprising findings, available online in Science, will appear Jan. 16 in the journal’s print edition.

Outbreaks of norovirus are notoriously difficult to contain and can spread quickly on cruise ships and in schools, nursing homes and other closed spaces.

The researchers found that norovirus works its way into gut tissue in mice that have been pretreated with antibiotics but that the virus cannot establish a persistent infection. Follow-up studies showed that norovirus needs a bacterial collaborator to establish a persistent infection in the gut. Eradicating the bacterial partner with an antibiotic can prevent persistent norovirus infection in mice.

“The virus actually requires the bacteria to create a persistent infection,” said senior author Herbert W. Virgin IV, MD, PhD, the Edward Mallinckrodt Professor of Pathology and head of the Department of Pathology and Immunology. “The virus appears to have a symbiotic relationship with the bacteria — they share the job of establishing persistence.”

No studies have indicated that animals or insects carry and spread human norovirus. Therefore, scientists suspect that the sources of outbreaks may be people who have persistent norovirus infections but don’t have symptoms, such as stomach pain, nausea, diarrhea and vomiting. Virgin and his team decided to explore this possibility by studying a mouse model of chronic norovirus infection.

In additional tests, the scientists found they could restore the norovirus infections by transplanting fecal material from untreated mice into mice that earlier had been treated with the antibiotics. The transplants contained the bacteria eliminated by the antibiotics.

The scientists also looked for mouse proteins essential to preventing chronic norovirus infections. They found that a receptor protein for an immune inflammatory factor known as interferon lambda was required for antibiotics to prevent infection. Giving the mice interferon lambda also prevented norovirus infection, suggesting it also should be evaluated as a treatment for norovirus.

In the second study, the Washington University researchers reported that treatment with interferon lambda offers a significant advantage: It not only prevents the start of persistent norovirus infections but also eliminates established persistent infections. This was true even in mice lacking immune cells that scientists thought were essential to eradicating viral infections.

“I believe that’s a new concept in immunology,” said Virgin. “We thought that interferon lambda and other related molecules in the immune system could only contain viral infections until other parts of the immune system, including antibodies and T cells, finished the job.”

The researchers speculated that other viruses and bacteria may form similar symbiotic partnerships in humans.

“We need a much more detailed understanding of how antibiotic treatment affects the links among host, bacteria and virus,” Virgin said.

Pesticide Spraying May Spread Norovirus.

Story at-a-glance

  • Contaminated water used to reconstitute pesticides could be a relevant source of infectious norovirus in fresh produce
  • If farmers use contaminated water to reconstitute their pesticides, the virus is likely to still be active when it’s sprayed onto crops, a new study found
  • In addition to fresh produce, ready-to-eat foods and restaurant foods are often associated with norovirus outbreaks
  • Buying organic produce, washing your produce before eating, and washing your hands regularly may help to reduce your risk of norovirus.

Norovirus is the leading cause of food-borne outbreaks in the US, with fresh produce (especially leafy vegetables and fruits) among the most common culprits.1

While you can be infected with norovirus through direct contact with someone who’s infected, this virus is often spread through the fecal-oral route, when you consume food or water that’s contaminated.

According to the US Centers for Disease Control and Prevention (CDC), sick food handlers are the main source of food-borne norovirus outbreaks and caused about half of such cases from 2001 to 2008.2

This makes sense, since norovirus outbreaks are commonly associated with contaminated foods from restaurants and long-term care facilities. It turns out there may be an additional culprit, however, an insidious one that to date has received very little attention.

Spraying Pesticides

Dirty Water Used to Dilute Pesticides May Spread Norovirus

Contaminated water has long been recognized as a potential introduction source of norovirus to fresh produce, but typically this has centered on water used to irrigate crops.

Researchers from the Netherlands decided to look into the water used to reconstitute pesticides to determine if that could be a relevant source of infectious norovirus, and their results revealed a strong possibility that it could.3

They tested four fungicides and four insecticides commonly used on lettuce and raspberries (two foods associated with norovirus outbreaks), diluted with water that had been spiked with norovirus.

In seven of the eight pesticides tested, norovirus persisted even two hours later. As reported by Environmental Health Perspectives:4

Farmers mix pesticides with water from sources including wells, irrigation ditches, rivers, and lakes. All these water sources have been known to harbor norovirus. Until recently, no one had tested whether norovirus in contaminated water remains infectious after pesticides are added.”

The study suggests that if farmers use contaminated water to reconstitute their pesticides, the virus is likely to still be active when it’s sprayed onto crops. The researchers concluded:

The application of pesticides may therefore not only be a chemical hazard, but also a microbiological hazard for public health. The inclusion of antiviral substances in reconstituted pesticides may be appropriate to reduce the virological health risk posed by the application of pesticides.”

Though the researchers recommended adding antiviral substances to water, a much simpler, and healthier, option is to buy organic produce as much as possible, since this eliminates the use of chemical pesticides.

Signs and Symptoms of Norovirus

Noroviruses are the leading cause of gastroenteritis in the US, responsible for up to 21 million illnesses, 71,000 hospitalizations, and 800 deaths each year.5 They generally cause a nasty infection that leads to diarrhea, abdominal pain, and vomiting within 24-48 hours of exposure. Norovirus infection is often referred to as the “stomach flu,” although it shouldn’t be confused with influenza, which is a respiratory infection.

The symptoms of norovirus infection can be quite debilitating, but most people recover on their own within a few days. Those most at risk of complications (typically dehydration) are infants, the elderly, and those with compromised immune systems.

The elderly living in nursing homes and children in day care facilities are often among those hardest hit, due to their close proximity with others and the highly contagious nature of these viruses. This is also the reason why cruise ships are sometimes associated with norovirus outbreaks. To get an idea of just how contagious this group of viruses is, a person with norovirus infection may shedbillions of norovirus particles, but it takes just 18 of these particles to infect someone else.6

How Norovirus Is Spread Via Your Food

As far as food poisonings go, noroviruses are strongly associated with restaurant-prepared or store-bought “complex foods” – foods that contain a number of ingredients so that the specific culprit cannot be pinpointed. Ready-to-eat foods, including salads, sandwiches, ice, cookies, and fruit, are also risks, although eating any food that is contaminated with vomit or feces from an infected person could lead to infection.7

Not only can the virus be spread before a person starts feeling sick, but it also remains in a person’s stool for two weeks – or more – after the symptoms resolve. So if a food handler is not careful, he could continue to spread the virus to others for some time.

Even heating a food may not be enough to get rid of this resilient virus. Noroviruses can survive heating up to 140°F as well as quick-steaming methods often used to prepare shellfish.8 It can also survive being frozen. Of course, if the featured study is correct it’s possible that your food could be contaminated before it’s even harvested while it’s sprayed with pesticides in the field.

The Keys to Lowering Your Risk of Stomach Flu

As mentioned, buying organic produce may be one of the best ways to lower your risk, as it will reduce your exposure to pesticides and the potentially contaminated water used to reconstitute them. Washing your vegetables and fruits before use may also help to reduce your risk (although probably won’t get rid of norovirus completely).

Because many norovirus outbreaks are tied to restaurant or ready-made foods, the more you prepare your own food at home, the lower your risk of contracting this food-borne infection is likely to become.

Finally, washing your hands remains one of the best strategies for preventing the stomach flu. Washing your hands (and your children’s hands) with soap and water if you’ve been in a public place and before eating is essential. Be careful not to over-wash your hands, however, as this can create tiny cuts in your hands where a virus can enter. Other common sense measures for preventing the stomach flu include:

  • Trying not to touch your eyes, mouth, or nose (which is how the virus enters), especially if your hands are not clean
  • Avoiding sharing utensils, drinking cups, hand towels, etc. with others
  • Try oil of oregano. Carvacrol, an active substance in oregano oil, may be effective against norovirus, as it has been found to break down the virus’ tough outer layer. The study found oregano oil may inactivate norovirus within one hour of exposure. Not only can you try adding oregano oil to your natural cleaners to use as a surface disinfectant, but oregano oil can also be taken internally. When choosing an oregano oil, generally the higher the carvacrol concentration, the more effective it will be.

Along with the practical precautions mentioned above, preventing the stomach flu also involves keeping your immune system healthy by following these five steps to boost your immune system health.

What to Do if You’re Infected with Norovirus

Most people will become infected with the stomach flu at some point during their lives. If this happens, make sure the vomiting and diarrhea does not cause you to become dehydrated, as dehydration can be life threatening. So if you begin to become dehydrated, it is vital that you go to an emergency room for evaluation and treatment.

Initially, however, the following simple protocol is often very effective in clearing up the stomach flu long before you get to this point. If you have thrown up, put your stomach at complete rest for at least three hours. Avoid water, crackers, soda… everything for at least three hours after the last time you throw up.

Once three hours have passed and no further vomiting has occurred, then try sipping small amounts of water slowly. If that is tolerated and you have not vomited further, you can gradually increase the water. Do this for one to two hours and if that is tolerated then you are ready for the final phase: large doses of a high-quality probiotic, taken every 30 to 60 minutes until your symptoms go away.

Small amounts of fresh crushed ginger root, which is available in nearly every grocery produce section, finely cut up and swallowed whole can be enormously helpful for the nausea. But remember, it should not be taken for at least three hours after the last time you throw up.

Source: mercola.com

What place for racecadotril?


Worldwide, there are about two billion cases of diarrhoeal disease every year and it is the second leading cause of death in children under 5 years of age, killing 1.5 million children annually.1 The most severe threat posed by diarrhoea is dehydration. In the UK, the incidence of diarrhoea is about one episode per person per year,2 and approximately 10% of children younger than 5 years old present to healthcare services with gastroenteritis each year.3▼Racecadotril (Hidrasec) is the first in a new class of antidiarrhoeal drug (‘enkephalinase inhibitor’) that has an antisecretory mechanism and is licensed in adults, children and infants (over 3 months of age) for symptomatic treatment of acute diarrhoea or as complementary treatment when causal treatment is possible.4–6 Here we review the evidence for racecadotril and its place in the management of acute diarrhoea.


Source: BMJ




Prevent the Spread of Norovirus.

Norovirus causes about 20 million gastroenteritis cases each year in the United States. There’s no vaccine to prevent infection and no drug to treat it. Wash your hands often and follow simple tips to stay healthy.

Noroviruses are a group of related viruses. Infection with these viruses affects the stomach and intestines and causes an illness called gastroenteritis (GAS-tro-en-ter-I-tis; inflammation of the stomach and intestines).

Anyone Can Get Norovirus

Anyone can be infected with noroviruses and get sick. Also, you can get norovirus illness more than once during your life. The illness often begins suddenly. You may feel very sick, with stomach cramping, throwing up, or diarrhea.

Noroviruses are the most common cause of gastroenteritis in the United States. CDC estimates that each year more than 20 million cases of acute gastroenteritis are caused by noroviruses. That means about 1 in every 15 Americans will get norovirus illness each year. Norovirus is also estimated to cause over 70,000 hospitalizations and 800 deaths each year in the United States.

Many Names, Same Symptoms

You may hear norovirus illness called “food poisoning” or “stomach flu.” It is true that food poisoning can be caused by noroviruses. But, other germs and chemicals can also cause food poisoning. Norovirus illness is not related to the flu (influenza), which is a respiratory illness caused by influenza virus.

Symptoms of norovirus infection usually include diarrhea, throwing up, nausea, and stomach cramping.

Other, less common symptoms may include low-grade fever, chills, headache, muscle aches, and general sense of fatigue.

Norovirus illness is usually not serious. Most people get better in 1­ to 2 days. But, norovirus illness can be serious in young children, the elderly, and people with other health conditions; it can lead to severe dehydration, hospitalization and even death.

You may get dehydrated if you are not able to drink enough liquids to replace the fluids lost from throwing up or having diarrhea many times a day. Symptoms of dehydration include a decrease in urination, a dry mouth and throat, and feeling dizzy when standing up. Children who are dehydrated may also cry with few or no tears and be unusually sleepy or fussy.

The best way to prevent dehydration is to drink plenty of liquids. Oral rehydration fluids are the most helpful for severe dehydration. But other drinks without caffeine or alcohol can help with mild dehydration. However, these drinks may not replace important nutrients and minerals that are lost due to vomiting and diarrhea.

If you think you or someone you are caring for is severely dehydrated, contact your doctor. For more information on norovirus and dehydration, see norovirus treatment.

Norovirus Spreads Quickly

Norovirus can spread quickly from person to person in crowded, closed places like long-term care facilities, daycare centers, schools, hotels, and cruise ships. Noroviruses can also be a major cause of gastroenteritis in restaurants and catered-meal settings if contaminated food is served.

Norovirus and Food

Norovirus is a leading cause of disease from contaminated foods in the United States. Foods that are most commonly involved in foodborne norovirus outbreaks include leafy greens (such as lettuce), fresh fruits, and shellfish (such as oysters). However, any food item that is served raw or handled after being cooked can become contaminated with noroviruses.

The viruses are found in the vomit and stool of infected people. You can get it by

  • Eating food or drinking liquids that are contaminated with norovirus (someone gets stool or vomit on their hands, then touches food or drink).
  • Touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth.
  • Having direct contact with a person who is infected with norovirus (for example, when caring for someone with norovirus or sharing foods or eating utensils with them).

People with norovirus illness are contagious from the moment they begin feeling sick until at least 3 days after they recover. But, some people may be contagious for even longer.

Norovirus: No Vaccine and No Treatment

There is no vaccine to prevent norovirus infection. Also, there is no drug to treat people who get sick from the virus. Antibiotics will not help if you have norovirus illness. This is because antibiotics fight against bacteria, not viruses. The best way to reduce your chance of getting norovirus is by following some simple tips.

Stop the Spread of Norovirus

Practice proper hand hygiene

Wash your hands carefully with soap and water, especially after using the toilet and changing diapers and always before eating or preparing food. If soap and water aren’t available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.

Take care in the kitchen

Carefully wash fruits and vegetables, and cook oysters and other shellfish thoroughly before eating them.

Do not prepare food while infected

People with norovirus illness should not prepare food for others while they have symptoms and for 3 days after they recover from their illness.

Clean and disinfect contaminated surfaces

After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces by using a bleach-based household cleaner as directed on the product label. If no such cleaning product is available, you can use a solution made with 5 tablespoons to 1.5 cups of household bleach per 1 gallon of water.

Wash laundry thoroughly

Immediately remove and wash clothing or linens that may be contaminated with vomit or stool. Handle soiled items carefully—without agitating them—to avoid spreading virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash your hands after handling. The items should be washed with detergent at the maximum available cycle length and then machine dried.






Norovirus Infection Causes Substantial Problems in Elders.

Hospitalization rates and mortality rose during outbreaks in nursing homes.

Gastroenteritis outbreaks, 86% of which are caused by norovirus, are common in nursing homes. Norovirus infection is thought to be associated with substantial morbidity and mortality in nursing home residents, but the exact risk is undefined.

In this retrospective cohort study, researchers used linked databases of infection outbreaks and Medicare nursing homes to assess the incidences of hospitalizations and deaths during norovirus outbreaks in 308 nursing homes in Oregon, Wisconsin, and Pennsylvania. Four hundred seven outbreaks were reported during 2009 and 2010, with a median of 26 cases per outbreak. In analyses adjusted for seasonal differences, risk for hospitalization was 9% higher and risk for death was 11% higher during outbreaks than at other times.

Comment: These results put some hard numbers to the trends that are observed clinically: Risks for hospitalization and death rise during norovirus outbreaks in nursing homes. The authors estimate that about 100 excess hospitalizations and 45 excess deaths occurred in these homes during the study period, which translates to 500 to 600 excess deaths in nursing home residents nationwide during 2 years. Norovirus vaccine development (now under way) and more aggressive infection control strategies are warranted.

Source: Journal Watch General Medicine