The Norwalk Virus

It’s strikes suddenly, making you feel as if something truly evil has invaded your body while you submit to a violent attack of vomiting and diarrhea. It’s the Norwalk virus; a name that’s received a lot of publicity within the past few months after health officials determined it was the cause of some 1,200 cases of severe illness among passengers on various cruise ships. After one or two days, its departure is as abrupt as its arrival. You feel like a wrung-out rag, but you’re delighted it’s over.

The Norwalk virus, also known as Norovirus and the “winter vomiting virus,” is an extremely common form of viral gastroenteritis that temporarily debilitates an estimated 23 million Americans every year and can flourish just about anywhere, including homes, nursing homes, restaurants and rest rooms, according to the National Centers for Disease Control and Prevention in Atlanta.

As expected, the virus is back again this winter. And its arrival has been reported around the country, including New Jersey, Massachusetts, Minnesota, Rhode Island, Manhattan and every other region of New York State.

Much of the general public never heard of the “Norwalk” virus – named for the Ohio town where the virus first surfaced in 1972 and one of many different viruses that can cause gastroenteritis -- until the recent cruise ship health crises put a national spotlight on this bug.

“I think people talk about ‘stomach flu,’ but they don’t have a name for it and they clump together different things under stomach flu,” said Marc-Alain Widdowson, an epidemiologist with the CDC.

Most people go undiagnosed because they usually are on the mend after one or two days and a specific lab test that detects the Norwalk virus are still not widely available. In addition, many state health departments, including New Jersey and New York, keep track of the virus only through reports of outbreaks among clusters of residents in nursing homes and other long-term care facilities. Still, “There is no doubt that Norovirus is a significant cause of undiagnosed diarrhea in the community,” said Eddy Bresnitzz, assistant health commissioner and state epidemiologist with the New Jersey Department of Health and Human Services.

Since October, a handful of Norwalk cases have been detected at one New Jersey nursing home, and they were among 1,377 nursing home residents who came down with some type of gastrointestinal virus so far this year, according to the state health department. During the same period last year, 154 cases were reported, said Bresnitz, who attributed the sharp increase to heightened awareness from the publicity surrounding the cruise ship outbreaks, coupled with the health department’s “strong encouragement that institutions report these outbreaks.”

Increases in Norwalk cases also have been experienced in New York, New Hampshire, Massachusetts, Minnesota and Pennsylvania. In Massachusetts, the number of cases has doubled this year. “No one’s really sure why we’re seeing so many additional cases this year,” said Roseanne Pawelec, spokeswoman for the Massachusetts Department of Public Health. “But the speculation includes better awareness because of the cruise ship outbreaks and there’s also some speculation it’s a more virulent form of the virus that’s at work.”

Norwalk is most often spread from person to person and through hand-to-mouth contact. Although Norwalk can occur at any time of the year, cases seem to spike during the winter, when people are more likely to be crowded together in confined spaces.

Some people will have no symptoms of the virus but will still be infected, which means they can pass it along to others. Nausea, intense vomiting and diarrhea are the obvious clues that you’re grappling with a case of Norwalk. Symptoms can begin to occur within one ore two days after exposure.

The virus generally runs its course after 24 to 48 hours, but it can take several days or weeks for your body to completely rid itself of the bug, Matyas said.

If you or someone in your household comes down with the virus, it’s important to take in enough fluids to prevent dehydration. If you lose too many fluids, you could land in the hospital, hooked up to an intravenous line. Those most vulnerable to dehydration are the very your, the elderly and people with chronic medical conditions.

You should seek medical help if you’re unable to replace the fluids you lost and are feeling increasingly worse, said Widdowson of the CDC.

You also need plenty of rest. Because the virus is so contagious, you should stay home until you’re well again or you could infect your co-workers or classmates. Antibiotics don’t work because they would have no effect on a virus, and no medications exist that will help you get rid of the virus sooner. You just have to let it run its course.

The Norwalk virus is extremely hardy and may be able to survive on surfaces with rubbing alcohol or household cleaners containing chlorine bleach. You also should promptly wash soiled clothing.

There is a simple, but all too often ignored, way to prevent the Norwalk virus.

“Wash your hands. It’s the most effective medical intervention we have. If everyone washed their hands, we’d have a lot less disease,” said physician Peter Wenger, assistant professor of preventive medicine at the University of Medicine and Dentistry of New Jersey -- New Jersey Medical School, Newark.