Norwalk virus spreads to the Valley

The day after Christmas, Valley resident Nicole Troyer wasn't feeling well and spent most of the day resting. At 12:30 that night it struck -- one of the worst stomach bugs she has ever experienced.

"It hit me just like that," she said of the sudden onset. At almost the exact moment, her husband became ill as well. The couple wondered if they had gotten food poisoning from a local fast food restaurant where they had just eaten.

"I was lying on the futon with the trash can, and he was in the bathroom," Troyer recalled.

By the next morning, the stomach cramps and vomiting were so intense she considered going to the hospital. Instead, she went to see her doctor.

"He said, 'You don't have food poisoning. You have the Norwalk virus,'" Troyer recalled. "I was like 'Oh, great. How did it get here?'"

The Norwalk virus achieved national attention this past year as large cruise ship companies struggled to combat outbreaks. But as many Valley residents are discovering, the infectious virus doesn't just stick to ships out at sea. It has spread quickly across the nation, with thousands of cases from New York City to Washington State and, now, here in Southcentral Alaska.

"This is the first I've heard of it in Mat-Su, but it doesn't surprise me," said Jerry Troshynski with the Mat-Su Public Health Center.

Norwalk is not among those illnesses that must be reported, so Troshynski and other health care professionals say it is hard to get a handle on how many cases there are. But anecdotal evidence suggests the virus is alive and well in the Valley. In several situations, children were apparently infected by other children and then brought it home to their family. Troyer said her doctor had seen a steady influx of people with symptoms like hers, and while the virus can only be clearly diagnosed by laboratory testing of stool, the symptoms are suspiciously similar to those of the Norwalk.

The Norwalk virus, now dubbed the norovirus by many medical professionals, is one of the most common causes of gastrointestinal illness. It strikes quickly and forcefully with vomiting, diarrhea and stomach cramps. Then, for most healthy people, it leaves just as quickly. Many of the recent cases in the Valley have lasted less than 12 hours, but symptoms can last up to three days and can also include headache, fever, chills and muscle aches.

The virus is not particularly dangerous, except for very small children and the elderly who are at risk of becoming dehydrated, and those who have underlying medical conditions. But even the healthiest of people will tell you it is a bug best avoided.

"It was horrible, horrible," Troyer said, describing it as one of the most intense illnesses she has ever experienced. "I didn't eat for two days because the thought of food just made me nauseous."

So how can people avoid it?

"Wash your hands a lot," Troshynski said.

This advice is coming loud and clear from the Center for Disease Control, the Alaska Division of Public Health and local doctors and nurses -- one of the few defenses against a hardy virus like the Norwalk is consistent, thorough hand washing. This includes after using the restroom and before eating.

Once the infection is in your family or workplace, health experts recommend the ill person keep away from large groups for at least 72 hours after symptoms have subsided. That means staying home from work or school.

People are also advised to wash down surfaces that could be infected by using a 10-percent bleach solution.

"We aren't saying everyone should go around swabbing their countertops all the time … but in situations where you have a number of people becoming ill, especially contained groups of people like cruise ships or nursing homes, you should be compulsive about wiping down handrails and other surfaces people share," advised Dr. Beth Funk with the Alaska Division of Public Health.

The norovirus is most obviously spread by people consuming food or water that has been contaminated with infected feces, including situations where people haven't washed their hands after using the restroom or before eating. Dr. Funk said it is also believed the virus may be spread through the air when an ill person is vomiting in the vicinity.

Even those who are compulsive about washing their hands may not be able to avoid the virus altogether. Dr. Funk described how a colleague recently visited a relative in a nursing home where a norovirus was circulating.

"She washed her hands every time she turned around and she still got it," she said.

The germ can live on surfaces, infecting people who come into the area later as well. A person's immunity after being infected only lasts six months or so. And in some cases, there may be more than one variety circulating in a community. Dr. Funk said that was apparently the case in Ketchikan recently where residents were becoming ill, getting better and then getting ill again.

"It's got a lot of things going for it as far has having evolved into an effective little germ," Dr. Funk said.

For now, public health officials are only seeking reports of clusters of illnesses rather than individual cases that may crop up. However, Dr. Funk said she and others at the Division of Public Health are always willing to discuss concerns with people. She also advised that in the event of a cluster of outbreaks, such as at a daycare center or school, that people call the local public health center to report it.

The Division of Public Health can be reached at (907) 269-8000 and the Mat-Su Public Health Center in Wasilla at 376-2437.

Hand washing -- your body's best defense

Because the Norwalk virus is transmitted from person to person, hand washing is critical in avoiding the illness. People should frequently wash their hands with soap and running water, especially in the event that someone in a group is ill.

Hands should be rubbed vigorously during washing for at least 20 seconds, including backs of hands, wrists, between fingers and under fingernails. Hands should be rinsed well while leaving the water running. With the water running, hands should be dried with a paper towel and the water turned off using the paper towel.

Hands should be washed in the following situations -- after using the toilet; after coughing, sneezing, using a handkerchief or disposable; and before and after using tobacco, eating or drinking or other activities that contaminate the hands.

Information courtesy the Alaska Division of Public Health.

The low-down on the Norwalk

What is the Norwalk virus?

The Norwalk group of viruses was first identified in an outbreak of vomiting and diarrhea in Norwalk, Ohio, in the early 1970s. The group consists of related viruses that share similar symptoms and epidemiology, including causing gastroenteritis mainly during the winter in temperate climates.

What are the symptoms?

The most common symptoms are nausea with vomiting, diarrhea and stomach cramps. The symptoms may appear from 10 to 50 hours after exposure, but usually within a day or two. Symptoms generally last 12 to 48 hours. Illness is characterized by abrupt onset and some people experience a low-grade fever, headache, and malaise as well. Rotaviruses and other infections can cause similar symptoms, but Norwalk can be somewhat distinguished by being more frequent in older children and adults than infants and toddlers.

How is the virus spread?

Norwalk is spread by eating or drinking food or water contaminated by feces from an infected person and can be easily spread from person to person. Some medical reports also suggest that the virus can become airborne and inhaled when an infected person is vomiting in the vicinity.

How long is a person infectious?

People are infectious while symptoms are present and as long as four days after diarrhea or vomiting have stopped.

What is the treatment?

There is no treatment for this illness. Most people recover within two or three days. People should drink lots of fluids to replace fluid depleted by diarrhea and vomiting. Supportive treatment to prevent dehydration may be needed in some cases, and those with underlying medical conditions should contact their doctor.

What can be done to prevent the spread of the virus?

Thorough hand washing following toilet use and before handling food is the best way to prevent the spread of Norwalk. People who are ill should not handle food, work in daycare centers or care for patients in a health care facility for 72 hours after symptoms have subsided. A bleach solution of about 1/2 cup to a gallon of water can be used to wash down contaminated surfaces such as rails, doorknobs, bathroom fixtures and counters. Areas that have direct contamination such as vomit should be washed in a mixture of two-and-a-half cups of bleach to a gallon of water.

Information compiled from fact sheets from the Alaska Division of Public Health and Mount Sinai Hospital.