What are the common symptoms of norovirus infection. How long does the stomach flu typically last. What are effective home remedies for treating norovirus symptoms. How is norovirus transmitted and prevented. When should you seek medical attention for stomach flu symptoms.

Understanding Norovirus: The Leading Cause of Stomach Flu

Norovirus is the primary culprit behind what we commonly refer to as the “stomach flu.” This highly contagious virus is responsible for more than half of all gastroenteritis cases worldwide. Despite its nickname, norovirus is not related to influenza, which primarily affects the respiratory system. Instead, norovirus targets the gastrointestinal tract, causing a range of uncomfortable symptoms that can disrupt daily life.

Why is norovirus so prevalent? The virus’s resilience and ease of transmission contribute to its widespread nature. Noroviruses can survive on surfaces for days, making them challenging to eliminate from the environment. Additionally, they require only a small number of viral particles to cause infection, allowing them to spread rapidly through communities, especially in closed settings like schools, cruise ships, and healthcare facilities.

Key Facts About Norovirus

• Norovirus causes about 20 million cases of acute gastroenteritis in the United States annually
• It is responsible for 58% of foodborne illnesses in the US
• The virus can spread through contaminated food, water, surfaces, or direct contact with an infected person
• Norovirus outbreaks can occur year-round but are more common during winter months

Recognizing the Symptoms of Norovirus Infection

Identifying norovirus infection early can help manage symptoms and prevent its spread to others. The onset of symptoms typically occurs 12 to 48 hours after exposure to the virus. While the severity of symptoms can vary, most people experience a combination of the following:

• Sudden onset of nausea
• Frequent vomiting
• Watery diarrhea
• Abdominal cramping and pain
• Low-grade fever
• Chills and body aches
• Headache
• Fatigue

How long do norovirus symptoms typically last? For most healthy individuals, symptoms resolve within 1 to 3 days. However, in some cases, particularly in vulnerable populations such as young children, older adults, and those with compromised immune systems, symptoms may persist for up to 14 days.

Distinguishing Norovirus from Other Gastrointestinal Illnesses

Given the similarity of symptoms, it’s often challenging to differentiate norovirus from other gastrointestinal illnesses such as food poisoning or even COVID-19. However, understanding the nuances can help in proper diagnosis and treatment.

Norovirus vs. Food Poisoning

The primary distinction between norovirus and food poisoning lies in the onset and duration of symptoms. Food poisoning typically occurs within hours of consuming contaminated food, while norovirus symptoms usually appear 12 to 48 hours after exposure. Additionally, if multiple people who shared a meal experience similar symptoms, food poisoning is more likely. In contrast, norovirus can affect individuals who haven’t necessarily eaten the same food.

Norovirus vs. COVID-19

While both norovirus and COVID-19 can cause gastrointestinal symptoms, COVID-19 is primarily a respiratory illness. About 20% of COVID-19 patients may experience nausea, vomiting, or diarrhea, usually in the early stages of infection. However, these symptoms are typically followed by respiratory symptoms such as cough, shortness of breath, and loss of taste or smell. If gastrointestinal symptoms are accompanied by respiratory issues or persist for an extended period, it’s advisable to consult a healthcare provider and consider testing for COVID-19.

Effective Home Remedies for Norovirus Symptoms

While there’s no specific medical treatment for norovirus infection, several self-care measures can help alleviate symptoms and promote recovery:

1. Hydration: Replacing lost fluids is crucial. Drink plenty of clear liquids such as water, clear broths, or oral rehydration solutions. For children, pediatric electrolyte solutions like Pedialyte are recommended.
2. Rest: Allow your body to focus on fighting the virus by getting ample rest.
3. Gradual Diet Reintroduction: As symptoms improve, slowly reintroduce bland, easily digestible foods such as bananas, rice, applesauce, and toast (the BRAT diet).
4. Over-the-Counter Medications: For adults, anti-diarrheal medications like loperamide (Imodium) may provide relief. However, consult a healthcare provider before using these, especially for children or older adults.
5. Avoid Certain Foods: Steer clear of dairy products, caffeine, alcohol, and fatty or spicy foods until fully recovered.

Is it safe to use over-the-counter medications for norovirus symptoms? While these medications can provide relief, they should be used cautiously. Anti-diarrheal medications may prolong the time the virus remains in your system. Always consult a healthcare provider before using any medication, especially for children, older adults, or those with underlying health conditions.

Preventing the Spread of Norovirus

Given its high contagiousness, preventing the spread of norovirus is crucial. The virus can be transmitted through various routes, including direct contact with an infected person, consuming contaminated food or water, or touching contaminated surfaces. Here are essential prevention strategies:

• Hand Hygiene: Wash hands thoroughly with soap and water, especially after using the bathroom, changing diapers, and before preparing or eating food. Alcohol-based hand sanitizers can be used as a supplement but are not as effective against norovirus as soap and water.
• Proper Food Handling: Wash fruits and vegetables thoroughly. Cook shellfish completely, as they are a common source of norovirus outbreaks.
• Surface Disinfection: Clean and disinfect contaminated surfaces with a chlorine bleach solution or other disinfectants effective against norovirus.
• Laundry Care: Handle and wash contaminated clothing or linens carefully, using hot water and machine drying.
• Isolation: If infected, stay home and avoid preparing food for others for at least 48 hours after symptoms resolve.

How effective are common household disinfectants against norovirus? While many household cleaners can kill a variety of germs, not all are effective against norovirus. The Centers for Disease Control and Prevention (CDC) recommends using chlorine bleach solutions or products specifically registered with the Environmental Protection Agency (EPA) for use against norovirus.

When to Seek Medical Attention for Norovirus Symptoms

While most cases of norovirus infection resolve on their own, certain situations warrant medical attention:

• Inability to keep liquids down for 24 hours
• Severe dehydration symptoms (extreme thirst, dry mouth, reduced urination, dizziness)
• Bloody stools
• Fever above 104°F (40°C)
• Symptoms lasting more than 3 days

For infants, children, older adults, and individuals with compromised immune systems, medical attention should be sought earlier, as these groups are at higher risk for complications.

What are the potential complications of untreated norovirus infection? While rare in healthy individuals, severe dehydration is the most significant risk, particularly for vulnerable populations. In extreme cases, this can lead to electrolyte imbalances, kidney problems, and even be life-threatening if left untreated.

The Impact of Norovirus on Public Health and Economy

Norovirus outbreaks have significant implications beyond individual health. The virus’s ability to spread rapidly can lead to widespread illness in communities, affecting schools, workplaces, and healthcare facilities. This, in turn, has economic repercussions:

• Lost productivity due to sick days
• Increased healthcare costs
• Disruptions in the food service and hospitality industries
• Strain on healthcare systems during outbreaks

How substantial is the economic impact of norovirus outbreaks? According to estimates from the CDC, norovirus costs the United States approximately $2 billion annually in healthcare expenses and lost productivity. This underscores the importance of effective prevention and control measures at both individual and community levels.

Norovirus in Healthcare Settings

Healthcare facilities face unique challenges when it comes to norovirus. The close proximity of patients, the vulnerability of many individuals in these settings, and the potential for rapid spread make norovirus outbreaks particularly concerning in hospitals and long-term care facilities. Strict infection control measures, including proper hand hygiene, patient isolation, and environmental cleaning, are crucial in these settings to prevent and control outbreaks.

Ongoing Research and Future Perspectives on Norovirus

The scientific community continues to study norovirus to develop better prevention and treatment strategies. Current areas of research include:

• Vaccine Development: Efforts are underway to create an effective norovirus vaccine, which could significantly reduce the global burden of the disease.
• Antiviral Treatments: Researchers are exploring potential antiviral drugs that could directly target the virus and reduce symptom severity and duration.
• Improved Diagnostic Tools: Developing faster, more accurate diagnostic tests could help in early detection and management of outbreaks.
• Understanding Virus Evolution: Studying how norovirus strains evolve over time can help in predicting and preparing for future outbreaks.

What progress has been made in norovirus vaccine development? Several vaccine candidates are currently in various stages of clinical trials. While challenges remain, particularly due to the virus’s ability to mutate rapidly, researchers are optimistic about developing an effective vaccine in the coming years. Such a vaccine could potentially prevent millions of cases annually and significantly reduce the economic burden of norovirus outbreaks.

The Role of Global Surveillance

Global surveillance networks play a crucial role in monitoring norovirus strains and tracking outbreaks. Organizations like the NoroNet, a collaborative network of laboratories worldwide, work together to share data on norovirus genotypes and emerging strains. This information is vital for understanding the virus’s evolution, predicting potential outbreaks, and informing public health strategies.

As research progresses and our understanding of norovirus deepens, we can hope for more effective prevention and treatment options in the future. In the meantime, awareness, proper hygiene practices, and prompt management of symptoms remain our best defenses against this ubiquitous and troublesome virus.

Have the Stomach Flu? 4 Ways to Treat Symptoms at Home

There’s almost nothing worse than being bent over a toilet throwing up. And, sadly, it can be hard to know what caused you to be there in the first place. Kelli Miller, ANP, UnityPoint Health, lists the symptoms of the stomach flu and how long it lasts, plus ways to feel better, so you can get out of the bathroom and get back to normal.

Stomach Flu Symptoms

Miller says it’s easy to get confused about the difference between influenza, or “the flu,” and gastroenteritis, better known as “the stomach flu.” The stomach flu is caused by a number of viruses, mainly norovirus, which accounts for more than 50 percent of all cases, and others, like rotavirus. Bacteria, such salmonella and E. coli, can also be to blame. Getting the flu shot does not prevent you from getting the stomach flu, but it does prevent you from getting influenza.

“Stomach flu symptoms include stomach pain, nausea, vomiting and diarrhea,” Miller says. “A low-grade fever, chills and muscle aches aren’t uncommon to experience as well. Symptoms can start as little as 12 hours after exposure.”

These symptoms can last anywhere from one to 14 days, and unfortunately, the stomach flu is extremely contagious.

“The stomach flu is spread by the fecal-oral route, which means the viruses from infected feces or vomit find their way into our mouths from either touching a contaminated surface and then touching your face or eating/drinking contaminated foods and/or water. Compared to other viruses, noroviruses can live for days on household surfaces, which is why they spread easily,” Miller says.

Stomach Flu vs. Food Poisoning

Miller says the clinical symptoms of the stomach flu and food poisoning overlap quite a bit, as you can have vomiting, diarrhea, abdominal discomfort and fever with either one. She says the easiest way to determine the cause of your discomfort is to look back at your recent history.

“If your symptoms are caused by food poisoning, they tend to occur within hours after eating something. If you can recall eating something questionable, or if others who ate the same thing as you and have similar symptoms, you probably have food poisoning. If you are the only one who got sick, you more than likely picked up a viral illness,” Miller says. 

Stomach Flu vs. COVID-19

To make matters even more confusing, some people with COVID-19 (about 20% according to studies) experience stomach issues including nausea, vomiting and/or diarrhea. Most people with those symptoms usually report developing them in the first couple of days and then go on to experience other respiratory or cold-like symptoms like fever, headache, cough and fatigue.

If you experience nausea, vomiting and/or diarrhea, keep an eye out for other symptoms that may follow. If you notice a progression in the illness, talk with your doctor about getting tested for COVID-19. Remember, if you’re feeling sick, stay home and continue to wash your hands frequently.

How to Treat the Stomach Flu at Home

Miller says there’s often no specific medical treatment for viral gastroenteritis. Antibiotics aren’t effective against viruses and overusing them can contribute to the development of antibiotic-resistant strains of bacteria. She recommends treating the stomach flu with the following self-care steps:

• Keep drinking the right fluids. You’ll need to drink enough fluids to prevent dehydration. In addition to water, older children and adults can drink sports drinks, like Gatorade, Power Aid, while babies and young children can have an oral rehydration solution, such as Pedialyte. If your child is vomiting, you can try to give your child a few teaspoons of fluid every few minutes. Babies who breastfeed can continue to breastfeed. But, you should avoid drinks with increased sugar content, such as juices or sodas, which can make diarrhea worse.
• Eat the right foods. If you don’t have an appetite, you should resort to drinking only liquids for a short period of time. Boiled starches (potatoes, noodles, rice, wheat and oats) and plain cereals with salt are recommended, if you have watery diarrhea. You may also try crackers, bananas, soup and boiled vegetables.
• Avoid heavy foods. On the other hand, you should avoid certain foods until you are feeling better. These include dairy products, caffeine, alcohol, nicotine and fatty or highly-seasoned foods.
• Get plenty of rest. The illness or dehydration can make you feel tired.

“Adults under 65 years old with a new bout of diarrhea, with no fever or blood in bowel movements, can take medicine to stop diarrhea, such as loparmide (Imodium) or bismuth subsalicyclate (Pepto Bismal) for one to two days, if they’re not allergic to these medications. Children and adults over the age of 65 should check with their health care provider before taking any over-the-counter medicines,” Miller says.

As contagious as it is, keeping your family from catching the stomach flu can be tricky. Miller offers these tips to protect against the viral infections that cause gastroenteritis:

• Immunize little ones. Infants can be immunized with the rotavirus vaccine. This is offered at 2, 4 and 6 months old during well-child visits.
• Simply wash your hands. Wash your hands often to stop the spread of germs. Hand sanitizer works after being in public as well.
• Give your home the once-over. Use household cleaning products to disinfect surfaces and objects, like countertops, doorknobs, handles, sinks, toilets, computer keyboards and phones.
• Separate your laundry loads. Wash laundry of those recovering from the stomach flu in different loads than the rest of your family.
• Keep your distance. Try to keep your children, especially newborns, away from anyone who is sick. If someone in your family is sick, stay home and do not go to work, school or day care. You should be symptom-free for 48 hours before returning.

When the Stomach Flu Requires a Doctor

While most stomach illnesses pass on their own, there are cases when medical attention is necessary. Miller recommends watching for signs of severe dehydration:

• Increased thirst
• Dry mouth
• Headache
• Confusion
• Increased heart rate over 100 beats per minute
• Increased breathing rate
• Dizziness, including when standing from a sitting or laying position
• Passing out
• Fatigue
• Dark yellow or amber colored urine
• No urination within the past six to eight hours (during the day)

In addition to severe dehydration, Miller also says the following are causes for concern, and if you experience these, contact your provider:

• Bloody stool/rectal bleeding or blood in vomit
• Vomiting for more than 24 hours
• Fever greater than 104 degrees
• Weight loss
• Severe abdominal pain
• Prolonged symptoms lasting more than a week
• Are currently pregnant

Lastly, call your baby’s doctor right away if your baby:

• Has vomiting lasting several hours
• Hasn’t had a wet diaper in six hours
• Has bloody stools or severe diarrhea
• Has a sunken soft spot (fontanel) on the top of his or her head
• Has a dry mouth or cries without tears
• Is unusually sleepy, drowsy or unresponsive

If any of these symptoms are present, evaluation by a health care professional is needed right away, and IV hydration may need to be administered or possible admission to the hospital.

Norovirus

Category: Infections and Parasites

Topic: Viral Infections

Noroviruses are a group of viruses that can cause gastroenteritis (inflammation of the stomach and intestines) with diarrhoea, stomach pain and vomiting. Common names used for gastroenteritis due to Norovirus are ‘gastric flu’ or ‘stomach flu’, ‘winter vomiting’ and ‘viral gastro’.

Noroviruses are found in the faeces or vomit of infected people. People can become infected with the virus in several ways, including:

• eating food or drinking liquids that are contaminated with Norovirus
• touching surfaces or objects contaminated with Norovirus, and then placing their hand in their mouth
• small airborne particles from projectile vomiting
• having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing foods or eating utensils with someone who is ill).

Anyone can become infected with these viruses. There are many different strains of Norovirus, which makes it difficult for a person’s body to develop long-lasting immunity.

Norovirus illness can recur throughout a person’s lifetime.

People working in day-care centres or nursing homes should pay special attention to children or residents who have Norovirus illness. This virus is very contagious and can spread rapidly throughout such environments.

Signs and Symptoms: 

Symptoms of Norovirus illness usually begin about 24 to 48 hours after ingestion of the virus, but they can appear as early as 12 hours after exposure.

The symptoms of norovirus illness usually include nausea, vomiting, diarrhoea, and some stomach cramping. Sometimes people also have a low-grade fever, chills, headache, muscle aches, and a general sense of tiredness. The illness often begins suddenly and the infected person may feel very sick. The illness is usually brief, with symptoms lasting only about 1 or 2 days, but can last longer. In general, children experience more vomiting than adults.

Treatment: 

Currently, there is no antiviral medication that works against norovirus and there is no vaccine to prevent infection. Norovirus infection cannot be treated with antibiotics. This is because antibiotics work to fight bacteria and not viruses.

Norovirus illness is usually brief in healthy individuals. When people are ill with vomiting and diarrhoea, they should rest and drink plenty of fluids to prevent dehydration. Dehydration is the most serious health effect that can result from Norovirus infection, and it is a particular concern in young children, the elderly, and people with weakened immune systems.

Prevention: 

Noroviruses are very contagious and can spread easily from person to person. Both faeces and vomit are infectious. Particular care should be taken with young children in nappies who may have diarrhoea.

People infected with Norovirus are contagious from the moment they begin feeling ill. If your job involves handling food or beverages or you are a childcare or health care worker you must not return to work until 48 hours after recovery (i.e. until 48 hours after you last vomited or 48 hours after your bowel motions return to normal), as this is generally regarded as the period when people are infectious.

The virus can be present in faeces at low levels for several weeks after recovery, so it is important for people to continue to use good handwashing and other hygienic practices.

People infected with Norovirus should not prepare food while they have symptoms and for 48 hours after they recover from their illness. Food that may have been contaminated by an ill person should be disposed of properly.

You can decrease your chance of coming in contact with noroviruses by following these preventive steps:

• frequently wash your hands, especially after toilet visits, changing nappies and before eating or preparing food
• carefully wash fruits and vegetables, and steam oysters before eating them
• flush or discard any vomit or faeces in the toilet and make sure that the surrounding area is kept clean
• use a detergent and warm water to wipe down the area where vomit was present so that no evidence of vomit is visible
• thoroughly clean and disinfect contaminated surfaces immediately after an episode of illness using detergent and water followed by a bleach-based household cleaner
• immediately remove and wash clothing or linens that may be contaminated with virus (use a hot cycle in the washing machine).

Health outcome: 

Anyone can become infected with these viruses. There are many different strains of Norovirus, which makes it difficult for a person’s body to develop long-lasting immunity. In addition, because of differences in genetic factors, some people are more likely to become infected and develop more severe illness than others.

Norovirus disease is usually not serious, although people may feel very sick and vomit many times a day. Most people get better within 1 or 2 days, and they have no long-term health effects related to their illness.

Sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhoea. These people can become dehydrated and may need special medical attention. This problem with dehydration is usually only seen among the very young, the elderly, and people with weakened immune systems. There is no evidence to suggest that an infected person can become a long-term carrier of Norovirus.

Other resources: 

• Clean Up for Gastroenteritis Outbreak Prevention (PDF 716KB)

Help and assistance: 

For further information, please contact your local doctor, community health centre or nearest public health unit, or contact the Queensland Health information line 13HEALTH (13 432584).

If you are in an emergency situation, call 000

Diarrhea due to coronavirus infection

Those infected with coronavirus often “suffer in the stomach” when there may not be other manifestations of covid. Gastroenterologist Victoria Malozemova explained how the virus enters the gastrointestinal tract, whether it is possible to check what it has damaged, and then fix it all.

– Victoria Anatolyevna, Rospotrebnadzor reported that the gastrointestinal tract, like the upper respiratory tract, is the entrance gate for the coronavirus. How does it pass through a natural powerful barrier to harmful microorganisms – the stomach?

— On the mucosa of the gastrointestinal tract, as well as on the bronchi, there are specific receptors that are sensitive to coronavirus, this is already an established fact. They are found in the stomach, duodenum, and rectum. Nature has created barriers in our body that protect against the effects of foreign agents such as viruses and bacteria. For example, protective immunoglobulins work on the oral mucosa, then, getting into the stomach, the virus meets with gastric juice, which is a rather aggressive acidic environment.

Our defense mechanism can be weakened due to chronic diseases (not only of the gastrointestinal tract), against the background of taking drugs that reduce the protective barrier of the mucous membranes, against the background of stress, chronic fatigue, malnutrition.

For example, in patients with chronic stomach diseases, the acidity of the gastric juice decreases, which leads to a weakening of the defense against the penetration of viruses.

In gastroenterology, this is called a hypoacid or anacid state. The virus binds to receptors on the gastrointestinal mucosa and causes increased epithelial permeability syndrome: normally, our epithelial cells in the mucosa are connected by tight junctions, they prevent the penetration of dangerous substances and particles. The virus breaks these contacts, and the sensitivity of the mucosa changes – the work of the stomach and intestines is disturbed.

— How does “gastric covid” manifest itself?

– The leading symptom in this situation is diarrhea, followed by bloating, cramps, nausea and vomiting in prevalence. Both we in the hospital and our colleagues in the country and abroad are seeing that diarrhea is becoming one of the leading symptoms of covid. We have had patients with severe diarrhea that is difficult to treat, they have had a colonoscopy (visual examination of the bowel with an endoscope) to see what is going on. We found erosive and ulcerative lesions of the stomach and intestines, which are caused by the virus. In some, they may become the first manifestation of the disease, in others they occur later, in others they become a consequence of exposure to drugs used in treatment.

— And if a person suffers from irritable bowel syndrome (IBS), how can he understand why he is vilifying: because of his chronic illness or because of infection with the coronavirus?

– Only for PCR testing for coronavirus. But in the hospital, we see such exacerbations caused by the coronavirus. I mean, it’s all connected. There are also combinations of coronavirus with other serious autoimmune intestinal diseases: ulcerative colitis (NUC), Crohn’s disease.

— Why are changes most often detected during and after covid in the duodenum?

— Because the duodenum is part of the small intestine, and, as I said, there are many receptors in it that the coronavirus can contact. A complete examination of the intestine is rarely done – a colonoscopy is sent in extreme cases, and a duodenal 12 can be examined for FGDS. But if we see erosive changes in the duodenum with coronavirus, we can assume that there are also such changes in the entire intestine.

— Is it true that when the manifestations of the disease begin with the gastrointestinal tract, then there is a great chance that it will proceed relatively easily – without a threat to life.

– True, if the virus involved only the intestines in the pathological process. The problem is that most often the liver suffers in parallel. Her defeat is usually manifested by nausea, bitterness in the mouth, vomiting of bile. But often with a coronavirus infection, it happens that these symptoms are absent, and we see the lesion by laboratory parameters.

— Is that why those who undergo medical examination after suffering COVID are prescribed a biochemical blood test for the so-called liver indicators — ALT and AST? Why are they examined six months after the illness?

— When a patient is admitted to the hospital, a complete biochemical study is performed, including liver parameters. And when they are discharged, we check them again and prescribe the necessary medications. And in outpatient treatment, this study is not included in the clinical recommendations, so it is carried out if the patient has specific complaints. To be honest, I would recommend doing such a study either during the period of illness, or immediately after receiving a negative test.

The liver is a kind of blood depot, in which it is filtered, as it were, all viral particles that enter the blood pass through it. In addition, in the liver there is an extensive network of capillaries that the virus and its toxins infect (this is a feature of the coronavirus, we do not see such changes in the liver with ordinary SARS or influenza). And the analysis of liver parameters demonstrates how intense the process of intoxication caused by the coronavirus is. And if they are not normal, then the inflammatory process continues against the background of toxicological effects.

— What to do if the indicators exceed the norm?

– There are agents that protect the mucosa and promote its healing when there are ulcers or erosions. And there are medications recommended to correct liver values. Usually, if a person sees a doctor on time and fulfills his appointments, the condition will normalize, but this may not happen quickly.

– How to understand if the stomach hurts because the coronavirus has broken it, or because of taking medications that are prescribed for covid?

– If this is a treatment for mild to moderate coronavirus, then the treatment regimens do not include antibacterial drugs or others that can lead to diarrhea and other symptoms. Therefore, we can say for sure that these are manifestations of the coronavirus influence. And if pneumonia joins, which cannot be dealt with immediately, antibiotics and other medicines are prescribed. Then we really cannot determine what is primary, but this is not important – the symptoms indicate that the gastrointestinal tract is suffering, there is drug-induced liver damage, and we prescribe complex therapy.

Interviewed by correspondent Irina Baglikova, Fontanka.ru.

Source: https://www.fontanka.ru/2021/09/29/70163474/?fbclid=IwAR0-3wOTYLHBgaHhJLvI5qSGw5MaZOK_Myss9T-JBNOAfCkVcnK9t6SIB_o

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Enteroviral infections – is a group of diseases caused by several types of viruses. The disease is caused by Coxsackieviruses, polioviruses and ECHO (ECHO).

After an enterovirus infection, persistent lifelong immunity is formed, however, it is serospecific. This means that immunity is formed only to the serological type of virus that the child has had and does not protect him from other varieties of these viruses. Therefore, a child can get sick with an enterovirus infection several times in his life. Also, this feature does not allow the development of a vaccine to protect our children from this disease. The disease has a seasonality: outbreaks of the disease are most often observed in the summer-autumn period.

Causes of infection with enterovirus infection.

Infection occurs in several ways. Viruses can enter the environment from a sick child or from a child who is a carrier of the virus. Virus carriers do not have any manifestations of the disease, but the viruses are in the intestines and are excreted into the environment with feces. This condition can be observed in children who have been ill after a clinical recovery, or in children in whom the virus has entered the body, but could not cause the disease due to the strong immunity of the child. The virus carrier can persist for 5 months.

Once in the environment, viruses can persist for quite a long time, as they tolerate adverse effects well. Viruses are well preserved in water and soil; when frozen, they can survive for several years; heated to 45ºС die in 45-60 seconds).

How enterovirus infection is transmitted.

The transmission mechanism can be airborne (when sneezing and coughing with droplets of saliva from a sick child to a healthy one) and fecal-oral if personal hygiene is not observed. Most often, infection occurs through water, when drinking raw (not boiled) water. It is also possible to infect children through toys if children take them in their mouths. Most often, children aged 3 to 10 years are ill. In children who are breastfed, there is immunity in the body received from the mother through breast milk, however, this immunity is not stable and quickly disappears after the cessation of breastfeeding.

Symptoms of enterovirus infection.

Viruses enter the body through the mouth or upper respiratory tract. Once in the child’s body, the viruses migrate to the lymph nodes, where they settle and begin to multiply. The further development of the disease is associated with many factors, such as virulence (the ability of the virus to resist the protective properties of the body), tropism (the tendency to infect individual tissues and organs) of the virus, and the state of the child’s immunity.

Enteroviral infections have both similar manifestations and different ones, depending on the species and serotype. The incubation period (the period from the virus entering the child’s body until the first clinical signs appear) is the same for all enterovirus infections – from 1 to 10 days (usually 2-5 days).

The disease begins acutely – with an increase in body temperature to 38-39º C. The temperature most often lasts 3-5 days, after which it drops to normal numbers. Very often, the temperature has a wave-like course: the temperature stays for 2-3 days, after which it decreases and stays at normal levels for 2-3 days, then rises again for 1-2 days and finally returns to normal. When the temperature rises, the child feels weakness, drowsiness, headache, nausea, and vomiting may occur. With a decrease in body temperature, all these symptoms disappear, but with a repeated increase, they may return. The cervical and submandibular lymph nodes also increase, as viruses multiply in them.

Depending on which organs are most affected, there are several forms of enterovirus infection. Enteroviruses can affect: the central and peripheral nervous systems, oropharyngeal mucosa, eye mucosa, skin, muscles, heart, intestinal mucosa, liver; in boys, testicular damage is possible.

When the mucous membrane of the oropharynx is affected, enterovirus angina develops. It is manifested by an increase in body temperature, general intoxication (weakness, headache, drowsiness) and the presence of a vesicular rash in the form of bubbles filled with liquid on the mucous membrane of the oropharynx and tonsils. These bubbles burst, in their place ulcers are formed, filled with white bloom. After recovery, no traces remain at the site of the sores.

When the eyes are affected, conjunctivitis develops. It can be one- or two-sided. It manifests itself in the form of photophobia, lacrimation, redness and swelling of the eyes. There may be hemorrhages in the conjunctiva of the eye.

With muscle damage, myositis develops – muscle pain. Pain appears on the background of an increase in temperature. Soreness is observed in the chest, arms and legs. The appearance of pain in the muscles, as well as temperature, can be undulating. When the body temperature decreases, the pain decreases or disappears completely.

With damage to the intestinal mucosa (enteritis), there is a liquid stool. Stools of normal color (yellow or brown), liquid, without pathological (mucus, blood) impurities. The appearance of loose stools can be both against the background of an increase in temperature, and isolated (without an increase in body temperature).

Enteroviral infections can affect various parts of the heart. So, if the muscle layer is damaged, myocarditis develops, if the inner layer is damaged with capture of the heart valves, endocarditis develops, if the outer shell of the heart is damaged, pericarditis develops. The child may experience: increased fatigue, weakness, palpitations, drop in blood pressure, rhythm disturbances (blockade, extrasystoles), pain behind the sternum.

With damage to the nervous system, encephalitis, meningitis can develop. The child has: severe headache, nausea, vomiting, fever, convulsions, paresis and paralysis, loss of consciousness.

With liver damage, acute hepatitis develops. It is characterized by an increase in the liver, a feeling of heaviness in the right hypochondrium, pain in this place. Perhaps the appearance of nausea, heartburn, weakness, fever.

When the skin is damaged, exanthema may appear – hyperemia (red coloration) of the skin, most often on the upper half of the body (head, chest, arms), does not rise above the level of the skin, appears simultaneously.

Boys may have inflammation in the testicles with the development of morchitis. Most often, this condition develops 2-3 weeks after the onset of the disease with other manifestations (tonsillitis, loose stools, and others). The disease passes quite quickly and does not bear any consequences, however, in rare cases, the development of aspermia (lack of sperm) in adulthood is possible.

There are also congenital forms of enterovirus infection, when viruses enter the child’s body through the placenta from the mother. Usually, this condition has a benign course and is cured on its own, however, in some cases, an enterovirus infection can cause an abortion (miscarriage) and the development of a sudden death syndrome in a child (the death of a child occurs against the background of complete health).

Very rarely, damage to the kidneys, pancreas, lungs is possible. The defeat of various organs and systems can be observed both isolated and combined.

Treatment of enterovirus infection

There is no specific treatment for enterovirus infection. Treatment is carried out at home, hospitalization is indicated in the presence of damage to the nervous system, heart, high temperature, which cannot be reduced for a long time when using antipyretics. The child is shown bed rest for the entire period of fever.

Meals should be light, rich in proteins. A sufficient amount of liquid is needed: boiled water, mineral water without gases, compotes, juices, fruit drinks.

Treatment is carried out symptomatically, depending on the manifestations of the infection – tonsillitis, conjunctivitis, myositis, loose stools, heart damage, encephalitis, meningitis, hepatitis, exanthema, orchitis. In some cases (tonsillitis, diarrhea, conjunctivitis …) bacterial complications are prevented.

Children are isolated for the entire period of the disease. In the children’s team may be after the disappearance of all symptoms of the disease.

Prevention of enterovirus infection.

For prevention, it is necessary to observe the rules of personal hygiene: wash hands after going to the toilet, walking on the street, drinking only boiled water or water from a factory bottle, it is unacceptable to use water from an open source (river, lake) to drink a child.