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Expert Ansers: Norovirus in Alabama

Marilyn Bulloch headshot graphic

March 10, 2023

AUBURN, Alabama – With the arrival of spring break travel season, travelers should be aware of increasing cases of norovirus in Alabama and around the country. Infectious disease experts from the Alabama Department of Public Health, the Centers for Disease Control and Prevention and Auburn University, including the Harrison College of Pharmacy’s Dr. Marilyn Bulloch, want to warn people and provide tips as they travel during this season.

Bulloch, an associate clinical professor in the Harrison College of Pharmacy’s Department of Pharmacy Practice, received her Doctor of Pharmacy from Rutgers University in 2007 and completed residencies at the University of Alabama at Birmingham and the Charleston (South Carolina) Area Medical Center. Her research interests include acute care pharmacotherapy, infectious diseases, internal medicine and medication use in older adults. She has spoken at the national, regional and local level on a variety of medicine related topics, including influenza and other concerning viral infections. She also has been published in numerous medical and pharmacy journals.

What is norovirus and its symptoms?

  Norovirus is a highly contagious virus that causes gastrointestinal symptoms. People who are infected shed the virus—and it only takes a few of the tiny, resilient particles of the virus to make a person very sick. There are so many different versions or strains of the norovirus that it is difficult to be fully immune to it. Even if you do develop immunity to a specific strain, scientists don’t know how long that immunity lasts.

The most common symptoms are nausea, vomiting and occasional diarrhea. Patients may also have terrible stomach pain as well. Some describe the cramping that can occur as “intense” and often one of the worst parts of the illness. It’s often mistaken for food poisoning on the first day of symptoms, but where food poisoning usually goes away after a day or so, norovirus symptoms continue for several days. One of the reasons the “infection” part may not be initially suspected is that if a person develops a fever, it is usually pretty low, lower than what normally is even considered a true fever.

It’s not a general “stomach bug” either like some other infections may cause, and you are miserable for several days. Because people have so much vomiting and diarrhea, it is not unusual for them to develop associated symptoms like fatigue or headaches. Sometimes patients complain of muscle aches.

Why are we seeing an increase in cases right now?

Norovirus is one of those viruses where outbreaks occur every so often. I think people are more hypervigilant about outbreaks of any pathogen after the COVID-19 pandemic, but norovirus outbreaks are not necessarily a new or rare thing. Actually, there is a “season” when outbreaks are more common; the “season” runs from about November to April, but they have occurred at other times in the year in the past. There have been some studies that indicate the virus thrives more in cooler temperatures, which would explain why we do see more cases in the winter.

How is norovirus spread?

Unlike flu or COVID-19, norovirus is not spread through the air or respiratory droplets. You have to come into direct contact with someone who has the virus, including up to about two days after symptoms go away. You can also catch it by sharing food or utensils with a sick person. Most people are not going to share anything with someone with gastrointestinal symptoms, but there are other, less-assuming ways you can catch it, mostly related to touching a contaminated surface and touching your face. It can be something simple like a door knob or a toilet handle.

Perhaps less commonly, you can get it from food grown or harvested in contaminated water.  Technically, this could include food grown in an area that uses this contaminated water for irrigation, but it is realistically probably more of an issue with foods, such as oysters and other shellfish that are harvested in water that has unknowingly been contaminated.

Since we are talking about spring break and travel, it is worth pointing out that community pools could be a potential source of infection. If the water gets contaminated from a swimmer, it can be spread if there is not enough chlorine in the pool. Hot tubs may still be a risk, too. The virus can survive at temperatures as high as 145 degree Fahrenheit.

Am I more susceptible when I am traveling?

People are more relaxed when they travel: they eat out at restaurants, or they may share food. You hope that someone who is preparing or serving food will not be sick, or recently sick, but it’s always a possibility. In fact, the virus can be transmitted even before symptoms develop, so you could come into contact with people who don’t know they have the virus.

We are also around more strangers when we travel, so there are more opportunities to catch many infections. As mentioned before, pools and other shared water sources can be a potential source of infection, and it is important to make sure that if you are going to swim in a shared pool, that you know the pool is cleaned and chemically treated the way that it should be. The CDC has a surveillance system—the National Respiratory and Enteric Virus Surveillance System—which tracks viruses, like norovirus. Positive tests for the virus are on an upward trend across the United States. I don’t know that going to any particular place in the country is “safer” than others.

What are some precautions people can take?

Wash your hands with soap and water after touching anything in public. Since 2020, people have gotten a lot better at hand hygiene, and hand sanitizer is more readily available. However, the sanitizers do not work as well with these types of viruses. People may think that they are being safe and hygienic, but without soap and water, they may not have reduced their risk.

Avoid sharing food with anyone, if possible, and definitely do not share food with anyone who has been sick recently, because they could still be contagious. Make sure all utensils are cleaned really well. You could avoid certain foods with a higher risk of transmission like shellfish. If you do eat them, make sure they are thoroughly cooked and not raw, or even steamed, as steaming doesn’t heat the food up enough to kill the virus.

If you do get sick, stay home and stay hydrated. Dehydration is a big risk because of the nausea and diarrhea. It is the dehydration that often causes additional symptoms or complications.

If someone does get norovirus, what should they do?

The virus should run its course in about three days. If people stay hydrated, they should not require any medicine, and there is not an antiviral that can be taken for this infection. However, if the vomiting or diarrhea is very severe, people may want to call their primary care physician and see if they need a medication to ease the vomiting or diarrhea so that they do not become so dehydrated or depleted of electrolytes that it causes problems.


About the Harrison College of Pharmacy

Auburn University’s Harrison College of Pharmacy is ranked among the top 25 percent of all pharmacy programs in the United States, according to U.S. News & World Report. Fully accredited by the Accreditation Council for Pharmacy Education (ACPE), the College offers doctoral degrees in pharmacy (Pharm.D.) and pharmaceutical sciences (Ph.D.) while also offering a master’s in pharmaceutical sciences. The College's commitment to world-class scholarship and interdisciplinary research speaks to Auburn's overarching Carnegie R1 designation that places Auburn among the top 100 doctoral research universities in the nation. For more information about the College, please call 334.844.8348 or visit http://pharmacy.auburn.edu.

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Last Updated: March 13, 2023