Norovirus

What is norovirus?

Noroviruses are a group of viruses that can cause infection of the gut (intestines), called gastroenteritis. Viruses are types of germs smaller than bacteria. Gastroenteritis usually causes symptoms of being sick (vomiting) and diarrhoea, similar to stomach flu. Norovirus is the newer name given to the group of viruses that used to be known as Norwalk-like viruses and Norwalk virus. Noroviruses are also known as small round-structured viruses (SRSVs).

How is norovirus spread?

A norovirus present in the gut (intestines) of an infected person can pass out in their diarrhoea. It is easily spread from an infected person to another by close contact. This is usually because of the virus being present on the infected person's hands after they have been to the toilet. Objects touched by the infected person can also allow transmission of the virus through contaminated surfaces. The virus can be passed on if the infected person prepares food and someone ingests the contaminated food, or if someone drinks contaminated water.

Outbreaks of norovirus that affect many people can occur. For example, in hospitals, nursing homes, on cruise ships and in schools.

It usually takes 24-48 hours after first contact with norovirus before symptoms develop. This period is known as the incubation period for the virus.

How long is norovirus contagious?

Norovirus is most contagious from the point at which symptoms start until 48 hours after all symptoms have ended, but it may be slightly infectious for a short period of time before symptoms start and later than 48 hours after they have ended.

How do you catch norovirus?

Norovirus is the most common virus causing infection of the gut (gastroenteritis) in adults in the UK. However, norovirus infection can occur in anyone of any age. You can get norovirus infection more than once because your body is not able to maintain immunity to norovirus infection for a long time once you have had it.

Norovirus symptoms

Norovirus presents with feeling sick (nausea) or being sick (vomiting) and diarrhoea which tends to be watery. . Sometimes there are other symptoms such as:

• A high temperature (fever).
• A headache.
• Aching muscles in your arms and legs.

The symptoms tend to be relatively mild and short-lived, often only lasting one to two days. However, in a few people symptoms can last longer.

If symptoms are severe, lack of fluid in the body (dehydration) can occur. You should consult a doctor quickly if you suspect that you or your child are becoming dehydrated. Mild dehydration is common and is usually easily reversed by drinking lots of water to replace the fluids.

For more information about symptoms, including signs of dehydration, see the separate leaflets called Diarrhoea and Acute Diarrhoea in Children.

How is norovirus diagnosed?

A sample of your stool (faeces) may be sent to the laboratory for testing during an outbreak of infection of the gut (gastroenteritis). This is to help identify the type and source of the infection. However, in most cases testing is not necessary because the treatment is usually the same for many causes of gastroenteritis.

When should I seek medical advice for norovirus?

Norovirus in children

Most young children who have infection of the gut (gastroenteritis), including gastroenteritis caused by norovirus infection, have mild symptoms which will get better within a few days. The important thing is to ensure that your child has plenty to drink. In many cases, you do not need to seek medical advice. However, you should seek medical advice in the following cases (or if there are any other symptoms that you are concerned about):

• If your child is under the age of 6 months.
• If your child has an underlying medical condition (for example, heart or kidney problems, diabetes, history of premature birth).
• If your child has a high temperature (fever).
• If you suspect lack of fluid in the body (dehydration) is developing (see earlier).
• If your child appears drowsy or confused.
• If your child is being sick (vomiting) a lot and unable to keep fluids down.
• If there is blood in their diarrhoea or vomit.
• If your child has severe tummy (abdominal) pain.
• If your child has a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, use of immunosuppressant drugs or HIV infection which is not under control with treatment.
• Norovirus infections caught abroad.
• If your child has severe symptoms, or if you feel that their condition is becoming worse.
• If your child's symptoms are not settling - for example, vomiting for more than a few days, or diarrhoea that does not start to settle after 5-7 days.

Norovirus in adults

Again, most adults who have gastroenteritis, including gastroenteritis caused by norovirus infection, have mild symptoms which will get better within a few days. The important thing is to ensure that you have plenty to drink. In many cases, you do not need to seek medical advice. However, you should seek medical advice in the following cases (or if there are any other symptoms that you are concerned about):

• If you suspect that you are becoming dehydrated.
• If you are vomiting a lot and unable to keep fluids down.
• If you have blood in your diarrhoea or vomit.
• If you have severe abdominal pain.
• If you have severe symptoms, or if you feel that your condition is becoming worse.
• If you have a continuing high fever.
• If your symptoms are not settling - for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days.
• Norovirus infections caught abroad.
• If you are elderly or have an underlying health problem such as diabetes, epilepsy, inflammatory bowel disease, kidney disease.
• If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, immunosuppressant drugs or HIV infection which is not under control with treatment.
• If you are pregnant.

Norovirus treatment

There is no specific medication to treat norovirus. The aim is to make sure that you or your child have plenty of fluids to avoid lack of fluid in the body (dehydration) until their immune system has the time to clear the infection. Children with norovirus can usually be cared for at home. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop. For further information see the separate leaflets called Diarrhoea and Acute Diarrhoea in Children.

Medication for norovirus

Antibiotic medicines are not needed to treat norovirus. It is a viral infection so antibiotics will not be effective. See the separate leaflet called Diarrhoea Medicine for further information.

Is norovirus dangerous?

Complications of norovirus infection are not very common. If they do occur, they can include the following:

Lack of fluid (dehydration) and salt (electrolyte) imbalance in your body.

This is the most common complication. It occurs if the water and salts that are lost in your stools (faeces), or when you have been sick (vomited), are not replaced by you drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild and will soon recover as you drink. Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, kidney failure may also develop.

Lactose intolerance

Lactose intolerance can sometimes occur for a period of time after norovirus infection. It is known as secondary or acquired lactose intolerance. Your gut (intestinal) lining can be damaged by the episode of infection of the gut (gastroenteritis). This leads to lack of an enzyme called lactase that is needed to help the body digest the milk sugar lactose. Lactose intolerance leads to bloating, tummy (abdominal) pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the intestinal lining heals.

Irritable bowel syndrome

IBS is sometimes triggered by a bout of gastroenteritis.

Persistent diarrhoeal syndromes

This may develop but is rare.

Reduced effectiveness of some medicines

During an episode of gastroenteritis, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the vomiting and diarrhoea mean that reduced amounts of the medicines are taken up (absorbed) into your body. Examples of such medicines are medicines for epilepsy, diabetes and contraception. Speak with your doctor or practice nurse if you are unsure of what to do if you are taking other medicines and have gastroenteritis.

Certain patients will have a list of 'sick day rules' from their GP or consultant - this includes patients with adrenal insufficiency and those taking some medications. It is important to follow this advice if you fall into one of these groups.

How to prevent the spread of norovirus

If you or your child have norovirus infection, the following are recommended to prevent the spread of infection to others:

• Washing your hands thoroughly after going to the toilet. Ideally, use liquid soap and water but any soap is better than none. Dry properly after washing. If your child wears nappies, be especially careful to wash your hands after changing nappies and before preparing, serving, or eating food.
• If a potty has to be used, wear gloves when you handle it, dispose of the contents into a toilet, then wash the potty with hot water and detergent and leave it to dry.
• Don't share towels and flannels.
• Don't prepare or serve food for others.
• If clothing or bedding is soiled, first remove any stools (faeces) into the toilet. Then wash in a separate wash at as high a temperature as possible.
• Regularly clean the toilets that you use, with disinfectant such as a bleach-based household cleaner. Wipe the flush handle, toilet seat, taps, door handles, surfaces or objects with hot water and detergent at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time).
• Stay at home and off work, school, college, etc until until at least 48 hours after the last episode of diarrhoea or being sick (vomiting). Avoid contact with other people as far as possible during this time.
• Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leave the food-handling area. For most, no other measures are needed, other than staying away from work until at least 48 hours after the last episode of diarrhoea or vomiting. In the UK there is no need for a report from your GP to say that you are fit to return to work. If your employer wants such an assessment, they should commission it themselves from an occupational health physician.

Norovirus prevention

The advice given in the previous section is mainly aimed at preventing you or your child from spreading norovirus infection of the gut (gastroenteritis) to other people if you are infected. However, in general, good hygiene is essential to prevent the spread of many infections to others and to reduce your chance of picking up infections from others.

Handwashing or using an alcohol-based hand sanitiser is the most important thing that you and your child can do. In particular, always wash your hands and dry them thoroughly and teach children to wash and dry theirs:

• After going to the toilet (and after changing nappies or helping an older child to go to the toilet).
• Before preparing or touching food or drinks.
• Before eating.

If you smoke, you should also wash your hands before smoking. The simple measure of washing hands regularly and properly is known to make a big difference to the chance of developing norovirus.