Surviving “The Stomach Bug”: What You Need To Know

stomach virus kiddoBy Catherine C. Grant, MSPAS, PA-C

It’s BAAAAAACCKKK!!!
Nothing conjures up feelings of fear, dread and empathy like hearing that the stomach bug is going around!  If you live in Richmond Hill, Bryan County, or anywhere in the greater Savannah, GA area, it is a pretty good bet that you know someone who has recently suffered with this unpleasant illness or have been infected yourself.  What do you need to know to protect yourself, your family and your community from getting SICK???? 

 

The stomach bug is also known as the stomach flu or in medical circles, viral gastroenteritis. It is not actually a “flu” at all, and is unrelated to influenza viruses which cause respiratory illness as opposed to gastrointestinal.  For this reason, annual flu shots do not protect against the “stomach flu”.

What IS the “stomach bug” then?

Gastroenteritis simply means inflammation of the stomach and intestines.  The most common cause of acute gastroenteritis in the United States is Norovirus, accounting for 19-21 million cases annually.  To keep it interesting, there are many, many other types of viruses that can cause gastroenteritis including Rotavirus and Astrovirus, which predominantly affect children but can infect adults as well, and Adenoviruses and Enteroviruses, which infect children and adults.  Each of these viruses have numerous strains that have been identified, and countless that are yet to be discovered.  And just because viruses don’t play fair, the strains we know about are constantly mutating and changing.   So while you may have been infected by one particular strain of a virus and then developed antibodies against it, you will not always be protected against a new version of the same virus.

How does viral gastroenteritis make you feel?

The most common symptoms include nausea, vomiting, stomach cramps and diarrhea.  It is also common to experience fatigue and loss of appetite.  One may also experience mild fever, headache, chills and muscle aches.

How do you get the “stomach flu”?norovirus on head of pin

The stomach bug is extremely contagious.  It spreads easily and quickly.  These viruses are transmitted through what is known as the fecal-oral route (YUCK!), meaning the virus is found in the feces and vomit of those infected.  Even microscopic amounts may contain thousands to millions of particles of the virus, and it takes as few as 18 norovirus particles in your food or on your hands to make you sick. Viruses can also be transmitted by eating contaminated food or drinking contaminated liquids, touching contaminated objects and then putting them in your mouth, and sharing utensils or cups with infected individuals.   If that isn’t enough to give you the heebie-jeebies, consider the fact that norovirus can survive on household surfaces for up to 2 weeks and can survive some disinfectants, such as alcohol-based hand-sanitizers.  This makes it difficult to eradicate.

 

Is there a season for the “stomach flu”?

According to the CDC, rotavirus technically occurs from November through April, however we do see illnesses occur outside of this timeframe. Norovirus gastroenteritis occurs all year round with 80% of the outbreaks occurring between November and April.

How do I know if I have the “stomach flu” or food poisoning?

Often when you or a loved-one starts having symptoms of an upset stomach, such as nausea, vomiting and diarrhea, you wonder if you caught a stomach bug or if you just ate something bad.  Typically this is also to determine whether or not you are contagious.  Non-contagious food poisoning occurs when we eat something that has not been properly stored, allowing bacteria to grow in it.  The bacteria produces toxins that make you sick, even if the food is reheated. When trying to determine the cause of your symptoms, think back to what you’ve done in the past days.  If you have been around someone in the past couple of weeks who had vomiting and/or diarrhea illness that is the most likely culprit.   If you haven’t been around anyone ill (that you know of), but ate potato salad and a sandwich that had been on a party buffet all afternoon, restaurant food such as rice, salad or dipping sauce, you got sick within seven hours of eating the suspected food and got well shortly after, you probably have non-contagious food poisoning.  If it has been 24 hours or more since you ate the suspected food, it is unlikely you have food poisoning and most likely you have viral gastroenteritis and are contagious.   It can be extremely difficult to know for sure which illness you have, so it is best to be cautious and assume you are contagious.

How is the “stomach bug” diagnosed?

Your healthcare provider will discuss your history and will review your symptoms.   They will perform a physical exam to rule out other more serious causes of your symptoms, such as appendicitis, pancreatitis or cholecystitis (inflammation of the gallbladder).  They will also evaluate for complications of vomiting and diarrhea such as dehydration.  Typically this is what is known as a clinical diagnosis meaning your healthcare provider can make the diagnosis based on the history and physical exam without bloodwork or additional lab testing.   There are instances however, when symptoms are unclear or prolonged, and additional lab testing may be recommended.

How is it treated?

Treatment for the “stomach bug” is initially focused on resting the stomach and intestines.  At first you should not try to eat anything and only drink very small amounts of clear liquids.   It is much better to drink small amounts of liquid, frequently than large volumes of liquid, as large volumes can induce more vomiting.  Your healthcare provider can prescribe medication to decrease the symptoms of nausea, vomiting and diarrhea, if indicated.   It is important to drink plenty of clear liquids to replace fluid loss and prevent dehydration.  Don’t forget that popsicles count and are a great way to get little ones to take fluids when they aren’t feeling like eating. Once vomiting is under control, one can advance their diet slowly from clear liquids to a bland diet meaning eating things that are easy to digest.   You often hear about BRAT diet, Bananas, Rice, Applesauce and Toast, all things that are easy to digest.  Some sources suggest avoiding dairy as it can be more difficult to digest, but it does not bother others.  Boiled chicken has also been found to be easy to digest and when added to the bland diet as a source of protein, has been shown to improve recovery times.

What potential complications should I be looking for?

The most common complication is dehydration.  Children can get dehydrated very quickly so it is important to stay on top of how much they are drinking and to get creative about replacing lost fluids, such as with popsicles.   Be aware of signs of extreme thirst, dry mouth and less frequent, drier diapers.  It is also common for diaper-wearing children who have diarrhea to get a diaper-rash.  You can prevent this painful rash by checking and changing diapers frequently and by using a barrier cream (such as Desitin) at the first sign of diarrhea.  The key is to keep the poop off of the skin and it is important to reapply a thick coat at every diaper change once you have thoroughly cleaned the diaper area.   If any symptoms persist longer than a couple of days, seem to be getting worse instead of better, or if abdominal pain becomes more concentrated in one area, it is important to contact your healthcare provider sooner rather than later.

When can I send my child back to school or daycare after having the “stomach bug”?

Since people are still contagious with the “stomach bug” for 3 days after symptoms have stopped, ideally your child should be well for 3 days before you send them back to school or day care.  That means it should have been 72 hours since they last vomited or had diarrhea.  If they are not eating normally and do not have normal poop, then they are still sick and still contagious.  Parents are often unsure about how long to keep a child home after a vomiting illness, and commonly send their kids back as soon as they are feeling better.  48 hours is the minimum amount of time to wait to ensure your child is over the illness.  There is often a delay between the vomiting and diarrhea segments of the illness.

My daughter experienced this during her most recent illness a couple of weeks ago.  She first became sick on Thursday morning and vomited several times that day, Thursday evening and into very early Friday morning.  She did not vomit again all day Friday and seemed “back to normal” Friday afternoon, with the exception of not eating well.  Most of the day Saturday she had normal energy levels and seemed to be improving but late in the day Saturday she vomited again (SERIOUSLY?! Here we go again….) and Sunday she experienced significant fatigue and her first bout of diarrhea.  This is just an example of why it is important to wait at least 48 hours to ensure your child is indeed over the illness and to minimize exposure to others during the time in which they are contagious.

How can I avoid getting the “stomach bug”? 

  1. Wash Your Hands The single most effective way to prevent the spread of viral gastroenteritis is frequent, thorough hand-washing with soap and water. Always wash your hands AFTER using the toilet and changing diapers and BEFORE eating, preparing, or handling food.  Alcohol-based hand sanitizers can be used in addition to hand washing, but not as a substitute.  Many hand-sanitizers are NOT effective in killing norovirus! (YIKES!)
  2. Stay Home if You Are Sick Avoid contact with infected individuals and stay home if you are ill. When you are sick, you should not prepare food for others or care for others for AT LEAST 2 to 3 days after you recover.  This applies to sick workers in schools, daycares, healthcare facilities, and other places where they may expose others.  Keep sick infants and children out of areas where food is being handled and prepared. Don’t share food when you are sick.
  3. Clean and Disinfect Contaminated Surfaces After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces. Use a chlorine bleach solution with a concentration of 1000-5000 ppm (5-25 tablespoons of 5.25% household bleach per gallon of water).  You can also use another disinfectant registered as effective against norovirus by the Environmental Protection Agency (EPA).  It is important to note that all household cleaners are not effective at killing Norovirus!
  4. Thoroughly Wash Laundry Immediately remove and wash clothes or linens that may be contaminated with vomit or stool (poop). You should handle soiled items carefully and without agitation, wear disposable gloves while handling and wash hands thoroughly after.  Wash the items with detergent at the maximum available cycle length and machine dry them.
  5. Wash Fruits and Vegetables and Cook Seafood Thoroughly Carefully wash fruits and vegetables before preparing and eating them.  Cook oysters and other shellfish thoroughly before eating them.  Be aware that Norovirus is fairly resistant and can survive temperatures often used to quick steam shellfish.