Norovirus is a highly contagious virus that causes flu-like symptoms of nausea, vomiting, diarrhea and abdominal cramping.

(Image from CDC website)

The dreaded “stomach flu” that hits particularly hard in winter is not a flu at all. It is norovirus, a highly contagious virus that causes symptoms of diarrhea, vomiting and stomach cramping. According to the Centers for Disease Control and Prevention (CDC), the illness often begins suddenly and lasts for one to two days with no long-term adverse health effects. True “flu” is a respiratory disease caused by the influenza viruses; sometimes the “true flu” can also cause gastrointestinal symptoms similar to norovirus. Getting an annual flu vaccine can help prevent flu; unfortunately, there is no vaccine for the norovirus and antibiotics, useful only for bacterial infections, do not help.

Norovirus is extremely common and has gained notoriety as a vacation cruise spoiler and an unwelcome visitor in child and adult care facilities, schools, restaurants, hospitals and dormitories. Norovirus particles are extremely small and are discharged by the billions in the stool or vomit of infected people, according to CDC. Yet, fewer than 100 virus particles are highly likely to make a person sick. The virus spreads through direct contact with an infected person or when an individual touches a contaminated surface and then touches their mouth or even their nose.

A 2011 study found norovirus is the leading cause of foodborne illness in the US, responsible for 5.5 million cases each year. In many cases, sick food handlers are responsible for these outbreaks. Eating foods contaminated with norovirus is a leading cause of hospitalizations.

Recipe for an Outbreak

Close quarters and a breakdown in sanitation is the simple recipe for a norovirus outbreak. Attention to surface disinfection is critical to controlling the spread of norovirus. Proper hand washing is another “must” as the virus can be transmitted easily via contaminated hands. It is important to know that a norovirus carrier can infect others for at least three days after recovery.

These steps, from CDC, can help reduce your risk of contracting norovirus:

• Wash your hands carefully with soap and water, especially after using the toilet and changing diapers and always before eating or preparing food.
• Carefully wash fruits and vegetables, and cook oysters and other shellfish thoroughly before eating them.
• If infected with norovirus, do not prepare food for others while experiencing symptoms and for three days after recovery (see Norovirus: Food Handlers).
• After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces by using a solution made with chlorine bleach and water:

Disinfecting against Norovirus with Chlorine Bleach

• 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 the virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash hands after handling. Soiled items should be washed with detergent at the maximum available cycle length and then machine dried.

Joan Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

¹http://emergency.cdc.gov/disasters/disease/pdf/diarrhea-evac.pdf
²http://health.utah.gov/epi/diseases/norovirus/Guidelines_for_Environmental_Cleaning_125846_7.pdf

• 2011-2012 Flu Season: So Far, So Good
  Centers for Disease Control and Prevention (CDC) flu prevalence maps indicate flu season is off to a slow start. But don’t be complacent: Flu activity most often peaks during the month of FEBRUARY.

• Flu Season is Unpredictable
  In the U.S., on average, 5 -20% of the population gets the flu each year, and more than 200,000 people are hospitalized from seasonal flu-related complications. According to CDC, flu seasons are unpredictable and can be severe. Just because you have never had the flu doesn’t mean you won’t get it this year.

• Flu Risk by Zip Code?
  One study correlated the percentage of children in a given zip code with the risk of ending up in the Emergency Room with the flu. Preventing the spread of flu in children may be an important factor in slowing a flu epidemic. Experts recommend that everyone six months and older should get a flu vaccination each year.

• Vaccination Statistics
  According to CDC, the best way to prevent seasonal flu is by getting a flu vaccination each year. As of November, 2011, only approximately 36% of Americans age six months and older had obtained a flu vaccination (CDC). Most individuals are vaccinated in doctor’s offices; other popular locations are other healthcare settings, pharmacies and stores, and the workplace.

• Vaccine Protection
  The 2011-2012 vaccine is a three-component vaccine that protects against each of three main groups of influenza viruses currently circulating in humans. According to CDC, based on a recommendation from the World Health Organization, the Northern Hemisphere’s 2011-2012 seasonal influenza vaccine contains the following three vaccine viruses:

  An A/California/7/2009 (H1N1)-like virus
  An A/Perth/16/2009 (H3N2)-like virus
  A B/Brisbane/60/2008-like virus.

• A Reason to Practice Flu Prevention
  On average, flu-related complications claim 36,000 lives each year in the US in one study, according to CDC. These rates can range from a low of approximately 3,000 deaths to a high of about 49,000 deaths according to another study. Anyone can get the flu, but some people are at higher risk of developing serious flu-related complications. These include: people 65 years and older; people of any age with certain chronic medical conditions (e.g., asthma, diabetes, or heart disease), pregnant women and young children.

• Flu or Cold?
  Flu and cold are not the same. Use this interactive chart of symptoms to help you distinguish flu from cold.

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

This year 43 percent of Americans plan to be immunized in hopes of warding off the flu, according to an interclick survey reported in Infection Control Today. The survey found more women (46%) than men (38%) will roll up their sleeves for the shot this year. Men would be well-advised to be immunized, however. Based on the interclick survey responses, doing so could potentially preserve marital peace. The Walgreens report noted one-third of women respondents think their spouse is very annoying or “a nightmare” when sick, while only 14 percent of men feel the same way.

What is the flu?

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The 2011-2012 flu vaccine was developed to protect against the three influenza viruses that research indicates will likely be most common during the current flu season. This includes the 2009 influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

Flu can peak anytime between October and April in the US, according to Walgreen’s chief medical officer, Cheryl Pegus. According to the U.S. Centers for Disease Control and Prevention (CDC), vaccination before December is best since this timing ensures that protective antibodies are in place before flu activity is typically at its highest.

Who should be vaccinated?

According to CDC, everyone should get a flu vaccine each flu season, but it is especially important that the following groups be vaccinated:

• Pregnant women
• Children 6 months old and older
• People 50 years old and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including
  • Health care workers
  • Household contacts of persons at high risk for complications from flu
  • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

So,

• Try to minimize contact with others who are ill
• Wash your hands to reduce the spread of germs
• Disinfect commonly touched surfaces
• Stay home from work or school if you are sick and…

Help preserve your holiday vacation, your health and your marriage: Get a flu shot!

Ralph D. Morris, M.D., M.P.H., (of Ralph’s Closet Fame), is a semi-retired physician in northern Minnesota working as the Medical Director for Greater Northwest EMS and teaching online epidemiology at the University of North Dakota.

For more information on flu, please see www.fluandhealth.org.

Last year (the 2009-2010 flu season), a new and very different flu virus called 2009 H1N1 spread worldwide causing the first flu pandemic in more than 40 years. During this flu season, experts at the Centers for Disease Control and Prevention (CDC) expect the H1N1 virus to cause illness again. However, unlike the vaccine available last year, the 2010-2011 flu vaccine specifically protects against the H1N1 virus and two additional influenza viruses.

The CDC’s Advisory Committee on Immunization Practices (ACIP) voted to expand influenza vaccination recommendations for the 2010-2011 flu season to include all persons 6 months of age and older who do not have a contraindication to the vaccine. The recommendations are intended to remove barriers to flu immunization, such as the need to determine whether each person has a specific indication for vaccination and protect as many people as possible against the dangers of the flu.

The CDC recommends taking the following three steps to protect yourself and others from the seasonal flu:

1. Take time to get a flu vaccine.

• The CDC recommends a yearly flu vaccine as the first and most important step in protecting against flu viruses.
• The 2010-2011 flu vaccine will protect against the influenza A H3N2 virus, the influenza B virus and the H1N1 virus that caused so much illness last season.
• Everyone 6 months of age and older should get vaccinated against the flu as soon as the 2010-2011 season vaccine is available.

2. Take everyday preventive actions to stop the spread of germs.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Disinfect frequently touched household surfaces with a solution of ¼ cup chlorine bleach in 1 gallon of water.

3. Take flu antiviral drugs if your doctor prescribes them.
Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications.

There were 12,000 deaths from influenza last year. Many of those could have been prevented by receiving a flu shot. Getting a flu shot not only protects individuals it protects entire communities. The more people who are immunized the fewer cases of flu and the less likely it is for the disease to spread throughout the community. Taking the precautions described above will reduce the risk of spreading the flu and is much less costly than the medical and personal costs associated with an extended illness.

(Chris Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council.)

According to the CDC, about 70 million doses of vaccine are now available, and supply will be increasing in coming weeks, CDC Director Thomas Frieden, said in a conference call with reporters. Fewer infections, coupled with additional doses of the H1N1 vaccine offers a “window of opportunity” to vaccinate more people, improve immunity and head off the possibility of a new wave of infections.

“We’re far from out of the woods, but we have an opportunity to get more people protected in case there’s another surge or wave in future months,” said Frieden.

As National Influenza Vaccination Week winds down, do your part. Take the time to find a flu clinic near you and get vaccinated. You can find out more about the safety and effectiveness of the H1N1 vaccine here. In addition, following simple tips, such as washing your hands and disinfecting frequently touched surfaces, will help reduce your risk of contracting H1N1, prevent the spread of germs and potentially minimize the impact of a “third wave” of H1N1 as we head into peak flu season.

(Chris J. Wiant, M.P.H., Ph.D., is president and CEO of the Caring for Colorado Foundation. He is also chair of the Water Quality & Health Council).

Scientists confirmed this theory recently in a report published in The Journal of the American Medical Association, which found that one-third of California patients hospitalized with H1N1 flu were given a rapid test that came back negative. A different test that uses more sophisticated technology confirmed they had H1N1.

The discrepancy is caused by the high specificity (80-90 percent) and the low sensitivity (10-70 percent) of the rapid test for influenza A. The test often does not identify influenza A, especially in adults, who don’t shed as much virus as children. Therefore, correctly identifying those with influenza A, which could be either H1N1 or seasonal flu, is the real issue with the rapid tests. Since about 90 percent of circulating influenza A is H1N1, doctors can be fairly sure that anyone with flu-like symptoms who is also positive for influenza A – either on the rapid or more advanced tests – has H1N1 flu. But, there is still a 10 percent chance that it is seasonal flu.

Regardless, many are not taking the chance that their illness could be something other H1N1. Dartmouth pediatrician Hank Bernstein, who’s on the American Academy of Pediatrics’ infectious diseases committee, said in a recent USA Today article, if symptoms look like the flu, “it’s H1N1 until proven otherwise, almost.”

Stephen Baum, an infectious-disease physician at New York’s Albert Einstein College of Medicine, in the same USA Today story, says: “If you test positive, you got it. If it’s negative, you may still got it.”

Therefore, it is important to understand the symptoms of flu versus a common cold. Those symptoms, not the test results, should be the trigger to take relevant action – either treatment or protecting others from exposure. Further, a negative test shouldn’t make one complacent in taking steps to prevent spreading the flu. Learn what you can do to keep your family healthy this winter by visiting the “Prevention and Treatment” section on the Centers for Disease Control and Prevention H1N1 website.

(Jerod M. Loeb, PhD, is Executive Vice President, Division of Quality Measurement and Research, The Joint Commission, and a member of the Water Quality & Health Council).

In its weekly update on flu activity, the CDC reported that:

• The number of states experiencing widespread flu cases during the week that ended Nov. 21 had fallen to 32, down from 43 states the week before and a high of 48 states in late October.
• Influenza-like illnesses accounted for 4.3 percent of all visits to doctor’s offices during the week, down from nearly double that proportion in October.

Yet, officials warned that the number of people getting infected with the H1N1 virus remains high, and cases could surge again. Therefore, federal health officials are trying to avoid creating the impression that the outbreak is over.

“We’re far from being out of the woods,” said Thomas Skinner, spokesman for the CDC. “There’s still a lot of flu out there. And we wouldn’t be surprised to see another uptick in activity as we approach the end of December and beginning of January, when kids come back from Christmas break.”

Other experts argue that if there is another surge, it will be relatively mild because most people will have either been exposed to the virus or will have received the H1N1 vaccine.

Thus, federal officials urge people to continue seeking the H1N1 vaccine, despite the current drop in H1N1 influenza cases. According to a Dec. 1 article in the Washington Post, more than 60 million doses of vaccine have become available and officials are predicting millions more will be shipped to states in the coming weeks.

In the meantime, people should protect themselves by:

• Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your elbow or shoulder; not into your hands.
• Disinfecting surfaces by wiping them down with a disinfectant according to the directions on the product label.
• Washing your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoiding touching your eyes, nose or mouth. Germs spread this way.
• If you are sick with flu-like illness (fever with sore throat and/or cough), CDC recommends staying home for at least 24 hours after your fever is gone except to get medical care or for other necessities.

For more on stopping the spread of H1N1, please visit www.fluandhealth.com or the CDC’s H1N1 information page.

(Ralph Morris, M.D., M.P.H., is a preventive health and public health physician, and a member of the Water Quality and Health Council)

A recent survey by the Water Quality and Health Council shows that despite constant warnings from health officials and a recent study showing a 31 percent chance of infection through hand contact with contaminated surfaces, few Americans frequently clean the public surfaces they use. At the same time, not many have faith that others are cleaning them either. Regardless of this, just one in ten is inclined to do the job themselves.

Knowing that flu viruses can live on inanimate surfaces for hours or even days should motivate people to take personal responsibility to protect themselves; disinfecting surfaces when feasible, using disinfecting wipes or chlorine bleach – especially at home and at work – as well as washing hands and practicing good personal hygiene habits. Contacting school administrators, office managers and even health club managers will help you understand their cleaning and disinfecting protocol and how you can better safeguard against the flu.

To help people prevent the spread of H1N1, The Centers for Disease Control and Prevention (CDC) recommends keeping surfaces clean by wiping them down with a disinfectant according to the directions on the product label. Also, in addition to cleaning surfaces, the CDC advises a number of helpful tips. For more information on how to prevent the spread of H1N1 through surface disinfection, please visit www.fluandhealth.com.

Fact: A well-stocked space in your home could make all the difference.

Individuals and families should prepare for potential pandemic flu-related isolation from their communities for an extended period of time. Dr. Ralph’s Flu Preparedness Closet is a helpful checklist of what you need to have on hand.

• Food and bottled water

Ideally, a 6-8 week supply stored in the home.

• Portable power sources

An ample supply of energy resources (batteries, propane, etc.) to heat, light and operate necessary

home functions, including your home computer.

• Household products and sanitary items

Paper products (Kleenex, toilet paper, paper towels), plastic products (garbage bags, re-sealable

bags), cleaning supplies, non-water hand sanitizer, personal hygiene products, etc.

• Prescription drugs

Vital for diabetics, heart, lung and other chronic conditions that require daily medication.

• Over-the-counter medications and first aid supplies

For the treatment of fever, fl u, colds, etc. including a fully stocked fi rst aid kit for the treatment of

minor injuries and illnesses.

• A supply of household chlorine bleach

For use as an emergency water purifi er and to sanitize surfaces.

• Communications equipment

A battery-operated radio and several fully charged cell phones to maintain an open information

channel with family, friends, local authorities and community information sources.

• Home computer system/Internet services

To provide access to local, national and global news, health-related information and pandemic related news updates. Also vital to allow some individuals to continue participation at their

place of employment or school.

• Pet supplies

Food, medication and sanitation supplies for family pets.

• Neighborhood service directory

A directory of medical, emergency and community services and their locations.

• Money

Without access to ATMs and banking services, cash on-hand could be necessary to replenish supplies and purchase necessary services.

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