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Stomach flu: Dr. Romesh shares what you need to know

January 07, 2020

If your family’s holiday break included a bout of the stomach flu you’re not alone. Our chief of general pediatrics and father of two boys ages 10 and 12, Dr. N. Romesh Wijesooriya, provides some insight into what causes it and what parents need to know.

What is gastroenteritis?

Though it is commonly referred to as the “stomach flu” and has some similar symptoms to the respiratory flu, gastroenteritis is not actually a type of “flu”. Gastroenteritis is an inflammation of the lining of the intestines caused by a virus, bacteria or parasites. Symptoms of gastroenteritis include diarrhea, stomach pain, vomiting, headache, fever and chills.

Gastroenteritis is most commonly caused by a virus. There are hundreds of different kinds of viruses that can cause gastroenteritis but the most common types are rotavirus and norovirus. Rotavirus is the world’s most common cause of diarrhea in infants and young children. Norovirus is the most common cause of serious gastroenteritis and also foodborne disease outbreaks in the United States.

Are rotavirus and norovirus contagious?

According to the CDC, rotavirus spreads easily among infants and young children. Children can spread the virus both before and after they become sick with diarrhea and are most likely to pass the virus from their body into the environment when they are sick and during the first 3 days after they recover. There are two vaccines that can be given to infants to help prevent rotavirus. Talk to your child’s doctor or health care provider about the vaccines.

Both the CDC and the Virginia Department of Health consider norovirus a highly contagious virus. Norovirus disease usually begins 12-48 hours after exposure, but can appear as early as 10 hours after exposure. Individuals are most contagious when they are sick and during the first few days after recovering. There is no vaccination to prevent norovirus infection although the CDC reports that research is being conducted in this area. Because there are many strains of norovirus, people who have been sick with norovirus can get it again throughout their lifetime.

How does gastroenteritis spread?

Individuals become infected with rotavirus or norovirus by accidentally getting stool (feces) or vomit from infected people in their mouth. This usually happens by:

  • Eating food or drinking liquids that are contaminated with the virus
  • Touching surfaces or objects contaminated with the virus then putting your fingers in your mouth
  • Having contact with someone who is infected with the virus (for example, caring for or sharing food or utensils with someone with the virus)

Other viruses that cause gastroenteritis infection are also likely to spread in this way.

Although it is NOT as common, different types of bacteria can also cause gastroenteritis. Salmonella is one of the most common bacterial causes of gastroenteritis in the United States and it is usually spread by undercooked poultry, eggs or poultry juices. (This is often referred to as “food poisoning.”) Another bacteria, shigella, is often passed around in day care centers. It typically is spread from person to person and common sources of infection are contaminated food and drinking water. Parasites in contaminated swimming pools or drinking water can also cause gastroenteritis. However, this is very rare in the United States.

How is gastroenteritis treated?

There is no specific medication for gastroenteritis. Supportive care is the name of the game. With the exception of certain infections in young infants and individuals who have compromised immune systems, gastroenteritis cannot be treated with antibiotics. Check with your doctor before giving your child any medicine for gastroenteritis. Drugs used to control diarrhea and vomiting are NOT usually given to children younger than 5.

Treatment of gastroenteritis primarily focuses on preventing dehydration and trying to keep your child as comfortable as possible while the body fights off the infection.

Gastroenteritis and dehydration

The most common problem associated with gastroenteritis is dehydration (a condition that occurs when the body does not have enough water or fluids to carry out normal day-to-day functions). This can happen if individuals do not drink enough fluids to replace what they lose through vomiting and diarrhea. Dehydration is most common in babies, young children, the elderly and people with weak immune systems. Signs of dehydration include dry skin and a dry mouth, feeling lightheaded, being really thirsty and not peeing as much. Children can get dehydrated quickly, so it’s important that you watch closely  and call your doctor if you see any of these symptoms. If you have a baby, look for fewer, drier diapers as a sign of dehydration. If your infant or child has not had a wet diaper in 8 hours you should contact your pediatrician.

Preventing dehydration

“If your child has no signs of dehydration you should encourage them to continue their usual diet plus drink adequate fluids,” said Wijesooriya. “If they do not want to eat, offer them a commercial oral rehydration solution like Pedialyte in small amounts until their appetite returns. If your child is showing signs of mild to moderate dehydration (no urine output for 8 hours, dry and sticky lips/mouth, no tears when crying or sunken eyes) contact your pediatrician immediately to discuss next steps.”

For children over age 1, the American Academy of Pediatrics recommends clear liquids (like Pedialyte) in small amounts ranging from 2 teaspoons to 2 tablespoons, every 15 minutes as a method to help prevent dehydration. The AAP has different recommendations for preventing dehydration in infants under age 1 and under 6 months of age.

What are tips for preventing gastroenteritis?

The CDC recommends the following to help stop the spread of viruses that cause gastroenteritis infection:

  • Wash your hands carefully with soap and water especially after using the toilet and changing diapers, and always before eating, preparing or handling food. (Note: Noroviruses can be found in your vomit or stool even before you start feeling sick. The virus can stay in your stool for 2 weeks or more after you feel better. So, it is important to continue washing your hands often during this time.)
  • Alcohol-based hand sanitizers can be used in addition to hand washing, but they should not be used as a substitute for washing with soap and water.
  • Carefully wash fruits and vegetables before preparing and eating them.
  • Food that might be contaminated with norovirus or other viruses should be thrown out.
  • Keep sick infants and children out of areas where food is being handled and prepared.
  • Do not prepare food for others or provide health care while you are sick and for at least 3 days after symptoms stop.
  • After a bout of throwing up or diarrhea occurs, immediately clean and disinfect contaminated surfaces.
  • Immediately remove and wash clothes or linens that may be contaminated with vomit or stool (feces).
  • Handle soiled items carefully, wear rubber or disposable gloves while handling soiled items and wash your hands after, and wash the items with detergent at the maximum available cycle length then machine dry them.


Resources
What is gastroenteritis: NIHWEBMD
Are rotavirus and norovirus contagious: CDC – NorovirusCDC- RotavirusVDH
How does gastroenteritis spread: WEBMD
How is gastroenteritis treated: WEBMD
Gastroenteritis and dehydration: NIH
Preventing dehydration: KidsHealth
Tips for preventing gastroenteritis: CDC

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