Pique the Geek 20120304: Norovirus, a Nasty Bugger

I was actually going to address another topic this evening, but after late Friday and all of yesterday (and part of today, too) this topic is on my mind.  First we shall review my symptoms then get to some material released by CDC about this nasty bugger.

Friday evening I was answering comments for Popular Culture and started feeling a little funky.   I did not think much of it then, but I noticed that when I would stand up that my equilibrium was a bit off.  It was getting late, so I shut down the computer and went to bed.

Before the next morning rolled around, Saturday, I had developed nausea (no vomiting, but it takes a WHOLE lot to make me vomit) and profuse, watery diarrhea.  I thought that it might have been from a bit of overindulgence (Friday was my birthday), but this was different.  I also was cold.

Now, I am cheap and keep my house at 58 degrees F during the winter.  With proper clothing, that is not cold at all for me.  However, the first sign of fever in me is losing the ability to thermoregulate.  I took my temperature, and sure enough, I was running 101.3 degrees, and that is very high for me because my normal is around 97.9 degrees.  I boosted the heat to 62 degrees, and betwixt running to the bathroom numerous times I was able to get some aspirin down me and also 4 mg of loperimide.

The aspirin helped with the fever, and I can not tell if the loperimide helped with the diarrhea or not, since I kept it for some time.  I got up around 10:00 yesterday morning, and by 1:00 in the afternoon was back in bed.  By that time I was quite dizzy anytime that I would move, my head spinning anytime I turned over in the bed.  That might have been from dehydration, or from the fever.

I got up again around 6:00 PM and sat on the couch for a while, not feeling like doing anything at all, but sort of achy from being in bed for so long.  At 8:00 PM I went back to bed, and stayed there, except for water and the bathroom, until 8:00 this morning.  I took more aspirin and loperimide and have been up since.

Last night was a really bad, uncomfortable night.  Every time that I would turn over waves of dizziness would overwhelm me, and a couple of times  thought I was going to toss, but I never did.  In addition to the physical discomfort, I had bad dreams (although I do not remember anything specific) and just general malaise.

What a difference 24 hours can make!  Although I am not 100 per cent just yet, I feel human.  The dizziness is gone, thermoregulation is returning to normal, and the diarrhea is for the most part gone.  By the time that this posts tonight at 9:00 PM Eastern, I should be at over 90 per cent.  One thing that I am quite aware of even now is that my mental processes are significantly slowed, but that likely has to do with the little fever left and some residual dehydration.  You will probably note that this piece does not have the crispness in writing style that many of my other pieces have, and I apologize for that.

So how did I get this?  It is difficult to say.  There are two primary modes of transmission, one by eating food contaminated with the virus and the other by being in the presence of others who are infected.  I did get some grapes at the store the other day, but I washed them before I ate them.  However, that is no guarantee that all virus particles will be removed.  I was also in a situation Thursday when I had gone to visit a friend, who happened to have a relative who had symptoms (although I did not know it at the time).  It may well be that I picked up viral particles that had been in an aerosol there.  Both scenarios fit my timeline.

Now for some technical information about the norovirus.  First of all, it is an RNA virus.  Second, since the norovirus has no lipid envelope, it is quite resistant to alcohol based hand sanitizers.  Hot water and soap or detergent is the way to go.

As I said, this is an incredibly nasty bugger.  Some estimates indicate that a single virus particle is enough to infect a person!  However, CDC is more conservative and indicates that it takes 10 particles.  That is a distinction without a difference.  Infected persons can have up to 10 trillion particles per gram of fecal material, so if one is exposed to one particle, the probability is that one is exposed to millions.  In addition, there is no vaccine (although there are some being developed) and no long lasting immunity, so you can get norovirus over and over again.  It is not killed by by levels of chlorine used to treat drinking water, so tremendous amounts of virus particles are thrown out of a toilet bowl when it is flushed after someone has vomited in it or defecated in it.  The only way to decontaminate the toilet is to use LOTS of bleach.

In most people, symptoms appear within 24 to 48 hours after exposure, and fits my timeline just fine.  In addition, symptoms usually resolve after one to two or three days, and that fits my timeline as well.  While I have been writing this piece, I also have been trying to do some light housework.  I washed and dried a couple of loads of clothes, and became as weak as a kitten.  I went to bed at 1:00 this afternoon and slept until 3:00, and I feel a bit better.  I am also rehydrating pretty well, so the worst is over now.

Studies have shown that the norovirus can stay viable on hard, dry surfaces for 12 hours or longer, and has been shown to persist in food preparation equipment and food for over a week.  In addition, it can persist for almost two weeks in contaminated fabrics.  This makes is critically important to throw away contaminated food, thoroughly wash contaminated food preparation equipment, and strip and launder contaminated clothing and bedding in the hottest water consistent with the fabric and then to dry them in a dryer at the hottest temperature that the fabric can stand.  Hard surfaces, particularly in the bathroom, should be treated with a strong solution of bleach in water, the recommendation being around 1.5 cups of bleach per gallon of water.

It is unlikely that you can give yourself the same norovirus infection again, because there is a temporary immunity.  The emphasis is temporary, so if you have food that you suspect was contaminated, do not freeze it and eat it months later, because the virus also survives freezing.  The real danger is passing it onto others in one’s household or to close friends.  People should not prepare food for others for at least three days after all symptoms pass, and there is evidence that the virus is still being shed sometime even after that.  Good handwashing and food preparation equipment sanitation is critical.

There is another route of transmission that really is just a different way of looking at being in the presence of others infected.  If a person shedding virus does not use good hand sanitation, anything that that person touches may harbor the virus.  Remember, on hard surfaces the virus can remain viable for 12 hours or longer.  That means that doing things as mundane as using a computer mouse that has been handled by an infected person, or even clearing up used dishes after an infected person has eaten from them can make it possible for one to be infected.

Whilst there is no doubt that this virus is ancient, it was only “discovered” in 1968.  This is the same virus that causes all of the gastroenteritis on cruise ships.  Because of the way that the virus persists and can be aerosolized, cruse ships are ideal environments for spreading it, due to close quarters and also to the fact that everyone eats food prepared in the galleys, where even one infected worker can contaminated hundreds if not thousands of meals.  Typically, virus is not shed until the diarrhea begins, but I had no idea that I was ill until after the first bought of that.

Another candidate for the symptoms is the rotavirus, but for several reasons I am quite sure that is not what I had.  In the first place, almost all children in the US have had multiple exposures to rotavirus, and there is a definite, long term immunity that results from infection to rotavirus.  In addition, the symptoms for rotavirus infection generally are a bit harsher and last longer than my case.  Statistics also support my conclusion, because in adults there are very few rotavirus infections due to the reason just described.

Also, other symptoms of norovirus infection were spot on in my case.  I noticed muscle aches, and at first I thought that I might be coming down with the flu.  I also had the abdominal pain, the fever, and as I mentioned the general lethargy and weakness.  However, those last two symptoms are often associated with dehydration.

Of course, I have to make some recommendations now.  First of all, in young children gastroenteritis in the US is most often rotavirus infection, and it can be severe in them.  Fortunately, most people of childbearing age already have immunity to rotavirus, but can still carry the virus without symptoms, so all of the sanitary information that I mentioned above apply to rotavirus as well.  The point is not to infect others who may still be susceptible.  That is NOT to say that children can be infected with norovirus, however.

As for norovirus, excellent sanitation is a must, and that does not always guarantee that it will not be passed.  I am pretty good about washing my hands, and I got it.  I really think that it was from aerosol exposure from my friend’s relative that got me, and there is little defense against that.  The best was not to get it is to avoid people who you suspect to be infected, but obviously that is not often possible.  Being aware of the infection is the key.  Henceforth, I shall consider any gastroenteritis in adults as a norovirus infection, and take precautions to avoid those who show symptoms.  But unless those who are infected take the proper precautions and practice good sanitation, they are still apt to infect others.

The bottom line is that it is incumbent of those of us who are now aware of this infection to take the sanitation advice that I described to prevent giving it to others.  This is little consolation for those of us who have been infected, but it is just looking out for others that make us human, so we should do what we can to prevent spreading it to others.

Well, you have done it again!  You have wasted many more einsteins of perfectly good photons reading this messy piece.  And even though when he reads me say it Limbaugh knows that his statement was far from an apology for the hurtful words that he directed towards Ms. Fluke, we know that he is really sorry about one thing:  he is losing money over it, I always learn much more than I could possibly hope to teach by writing this series, so keep those comments, questions, corrections, and other feedback coming.  Tips and recs are also always quite welcome.  I shall stay here for Comment Time as long as comment traffic warrants, and shall return tomorrow around 9:00 PM for Review time.  It is now 5:00 PM on Sunday, and I am feeling much, much better, and the intellectual fog is also lifting.

I had a little time betwixt finishing the piece and post time, so rooted around a bit for more information.  CDC states that there are around 20 million cases each year of norovirus infections, making it extremely common.  In other words, one in 15 people have it every year, although not necessarily the same one in that 15.

There is a misconception that norovirus always occurs in outbreaks.  This is far from the case, as most infections are much more isolated, occurring in settings involving only a few people at a time.  The outbreaks were hundreds at a time are more “sexy” for the news, but the vast majority of cases are much more isolated.

Outbreaks are mostly from contamination of food, according to CDC.  Betwixt June 1997 and July 2000 there were 232 outbreaks in the US, and 57% of them were foodborne.  Still, outbreaks, where scores or hundreds of cases can be traced to a single vector account for only a tiny fraction of all cases.

Once again, I apologize for this piece not being as cogent as usual.  Next time I assure you that the topic will be less personal and certainly less graphic.

Warmest regards,

Doc, aka Dr. David W. Smith

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