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mountain squid
12-21-2013, 19:47
We (TEHCC Trail Maintainers) recently had a partnership meeting with ATC (Southern Region) and local Forest Service. During the meeting ATC brought up the 2013 Norovirus outbreak. Between Hot Springs, NC and Erwin, TN (approximately) many hikers became very sick. Prior to the 2014 hiker season, I thought it would be a good idea to post some precautions/reminders/information about norovirus.

From ATC's website at Appalachiantrail.org (http://www.appalachiantrail.org/hiking/hiking-basics/health-safety):

This highly contagious virus causes your stomach and/or intestines to become inflamed, which leads to stomach pain, nausea, and diarrhea. Norovirus is transmitted by contact with an infected person, contaminated food or water, or contaminated surfaces. The virus has a 12-48 hour incubation period and lasts 24-60 hours. Infected hikers may be contagious for 3 days to 2 weeks after recovery. Outbreaks occur more often where people share facilities for sleeping, dining, showering, and toileting; the virus can spread rapidly in crowded shelters and hostels; sanitation is key for avoiding and spreading norovirus. Take the following steps to prevent contracting and spreading the illness:

* Do not eat out of the same food bag (think trail mix), share utensils, or drink from other hikers’ water bottles.
* Wash your hands with biodegradable soap (200' from water sources) before eating or preparing food and after toileting.
* Be aware that alcohol-based hand sanitizer may be ineffective against norovirus.
* Treat water by boiling (rolling boil for 1 minute minimum), or by chemical disinfection with iodine, chlorine, or chlorine dioxide. Most filters do not remove viruses, but a combination of filtration and chemical disinfection is effective against a broad range of pathogens.
* Bury human waste 8’’ deep in soil and at least 200 feet away from natural water. Follow Leave No Trace (http://www.appalachiantrail.org/hiking/hiking-basics/leave-no-trace-practices) guidelines for disposing of human waste.
* Noroviruses are found in the stool or vomit of infected people and on surfaces that have been touched by ill people. Outbreaks are more likely in areas with multiple people in small spaces like shelters and hostels.
* Norovirus can stay on surfaces and objects and still infect people after days or weeks.

What to do if you get norovirus:

* Drink plenty of fluids and wash hands often
* Seek medical treatment if you become dehydrated or illness lasts more than a few days (norovirus usually last 1-3 days)
* Limit contact with others and avoid preparing food and drinks for others for 2-3 days after recovery
* Report outbreaks of any illness to the local health department

From Center for Disease Control's website:

The best way to help prevent norovirus is to practice proper hand washing and general cleanliness.

For more detailed information about norovirus, please visit CDC (http://www.cdc.gov/norovirus/)'s website (there is alot of good info there).


I understand from Laurie Potteiger at ATC that they are having discussions with the CDC and state health departments now about additional steps to help prevent the spread of norovirus on the Trail. Check back for possible updates in the coming weeks.

Stay well out there next year!

See you on the trail,
mt squid

CarlZ993
12-21-2013, 20:42
Good info for the 2014ers. Hope they have less of a problem w/ the 'hiker plague' than us unlucky 13ers.

leaftye
12-21-2013, 21:16
Good for know for hikers going through this area. Chemical or UV water treatment will be more effective in this area.

bfayer
12-21-2013, 22:05
Good for know for hikers going through this area. Chemical or UV water treatment will be more effective in this area.

I don't disagree at all, I just want to point out that I don't think there was any evidence that the noro was being spread by water sources. I suspect it had much more to do with personal hygiene and human to human/human to surface contact.

So I agree with you completely, but if someone worries about water but not other sources of noro they are not doing much to prevent catching it.

By the way Hydrogen peroxide wipes kill noro as well if not better than bleach and are not hard to find. They can be repackaged into a zip lock bag.

I hope the class of 14 can avoid a repeat of last year.

4eyedbuzzard
12-21-2013, 22:39
"Hey guys, I'm back and feeling better!"
One of the bigger problems is that not only can the virus can live for weeks on clothing and other surfaces but that people can still be contagious weeks after "recovering".

cliffdiver
12-22-2013, 00:33
I remember being in the Smokies when I first heard about a serious outbreak and that shelters would be closed due to norovirus. I stopped sharing food/drink and became quite religious about cleaning my hands whenever possible. None of my group or I ever caught it, thankfully.

My suspicions were always towards a few of the hostels in the NC/TN/VA area, but that was my personal opinion. The stories told to me were dissimilar in that there seemed to be no ground zero or obvious cause at work, so in the end, I just hiked and tried not to worry about it too much.

Siarl
12-22-2013, 03:58
Good hand-washing technique is one of the best things to prevent acquiring any germs or virus'. There's another technique that hikers can implement but it may be difficult for some to do. We pride ourselves on our ability to be courteous and kind to those we meet on the trail. This may lead many to participate in communal cooking, sharing water bottles, shaking hands, hugs, etc. It may seem a very discourteous thing to do and even down right rude sometimes. But you should refrain from doing so. I worked in the medical field and it makes sense. AT hikers save, scrounge, do without, wait what may seem like for-friggin'-ever and almost go crazy with anticipation in order to prepare for that momentous day to begin the hike. Don't fret about being rude in order to stay healthy. If the other hiker is considerate, they will understand. And there is always a gracious way to say things without being rude about it. In a hospital setting, good health practices are the priority. Washing hands is mandatory. I also imagine that it doesn't help that the first few months of the hike is spent in frigid temps that makes taking a shower or bath outside not so tempting. I like the idea of the hydrogen peroxide wipes. Great idea.

fehchet
12-22-2013, 06:09
I always sleep in my tent and avoid physical contact including hand shaking. Elbow to elbow maybe. Wash hands often. And don't eat food offered. Trail magic is a decision at the time.

The Cleaner
12-22-2013, 10:38
Good for know for hikers going through this area. Chemical or UV water treatment will be more effective in this area. On a shelter check day trip last April, there was a sick hiker at Jerry's Cabin shelter. While waiting for a SAR evac, I drank untreated water from the piped spring there and cleaned up litter in the shelter. I also brought a spray bottle w/50/50% bleach and water and spayed the shelter and privy. Many hikers passed by, most not going near the shelter and treating the great water there. IMO hostels and hotel rooms which may have been crowded with those waiting for snowy conditions to improve were among the likely places to be infected with NORO. I made several similar trips and never got sick....

ChinMusic
12-22-2013, 13:44
On a shelter check day trip last April, there was a sick hiker at Jerry's Cabin shelter. While waiting for a SAR evac, I drank untreated water from the piped spring there and cleaned up litter in the shelter. I also brought a spray bottle w/50/50% bleach and water and spayed the shelter and privy. Many hikers passed by, most not going near the shelter and treating the great water there. IMO hostels and hotel rooms which may have been crowded with those waiting for snowy conditions to improve were among the likely places to be infected with NORO. I made several similar trips and never got sick....
I noticed that locals in general were not getting sick. 10-K for example was shuttling sick hikers all the time. It is quite possible that the locals had already been challenged by this virus in the past and had some acquired immunity.

Robin2013AT
12-22-2013, 20:01
HikerMom emailed me on the trail (right before Gatlinburg) re: Chin Music's reports of what was happening with the Noro outbreak just up the trail a bit. I was able to avoid all shelters and hostels (except one and BOY were there alot sick people there!). I never got sick. I think good hand washing and hygiene from a heightened awareness is important. You will probably read about Noro on WB as soon as it happens (and other trail issues) so it is worth looking in now and again as you can.

swamp dawg
12-22-2013, 21:06
Thanks for the info. I will follow the guidelines you posted along with a little common sense. Did the virus seem to appear in early or late spring? I talked to a lot of hikers at Trail Days that had the curse. Thanks for all you do for the trail over the years, can't wait for spring...swamp dawg

bfayer
12-22-2013, 21:06
... You will probably read about Noro on WB as soon as it happens (and other trail issues) so it is worth looking in now and again as you can.

But the sad part is as soon as someone posts that people are getting sick, someone will jump in and say they are exaggerating and there is no proof any more people are getting sick than normal and that people always get sick and only lab tests can prove it's noro, etc. etc. ad infinitum...

The bottom line is if everyone waits until enough people get sick, or waits until a lab confirms the cause, before they start preventive measures it will be too late. There is a reason modern cultures have developed the hygiene practices they have, all hikers need to do is follow the advice of their grandmother or second grade teacher and their chances of getting sick will be significantly reduced.

By the way I think some thanks should go out to a few folks that tried to get the word out when it started this last year. There were several but Blissful and HikerMom are two that come to mind. Thanks guys! You took grief you should not have had to take.

Lauriep
12-23-2013, 14:06
Thanks for posting this, Squid, and raising awareness of the threat of norovirus on the Trail and actions hikers can take to reduce their chance of exposure and transmission.

The direct link on ATC's page with information about norovirus is www.appalachiantrail.org/hiking/hiking-basics/health-safety#sanitation (http://www.appalachiantrail.org/hiking/hiking-basics/health-safety#sanitation). This page also has a very helpful link to the CDC page on treating water in the backcountry, with a chart that rates the effectiveness of various water treatment methods www.cdc.gov/healthywater/drinking/travel/backcountry_water_treatment.html (http://www.cdc.gov/healthywater/drinking/travel/backcountry_water_treatment.html).

Buzzy84
12-23-2013, 17:55
Thanks for the heads up everyone. I did here about this watching hitched hike's youtube and a few others this year.. Sounds horrible.. Lots of good pointers here some of which i practice every day at home like washing hands regularly etc.. But i'm assuming it will be a little harder out on the trail. Is there certain brands of soap that you can use in streams and stuff?

ChinMusic
12-23-2013, 18:09
Re avoiding Noro: If your bubble is hit hard like mine was last year it is almost impossible to avoid. While it is easy to avoid contact with others it is impossible to avoid touching things that they touch. We all travel down the same narrow corridor. We all touch the same rocks, the same trees for hand holds, etc.

I recognized what the virus was very early on. I knew what to avoid and did my best. I did not stay in shelters, use privies, share food, or even shake hands. I was in no-touch mode from just north of Hemlock Hollow forward. I saw numerous hikers just laying next to the trail, unable to advance. It was a mess.

I got into Erwin and was in the process of patting myself on the back when it hit. The bad new is, avoiding Noro is very hard. Those that didn't get it in that bubble either had some previous immunity or were just lucky. The good news is that Noro is not the Black Death. You will recover in a day or two and live to tell your story.

bfayer
12-23-2013, 18:10
Thanks for the heads up everyone. I did here about this watching hitched hike's youtube and a few others this year.. Sounds horrible.. Lots of good pointers here some of which i practice every day at home like washing hands regularly etc.. But i'm assuming it will be a little harder out on the trail. Is there certain brands of soap that you can use in streams and stuff?

You don't wash your hands in the streams, you scoop water in your pot, take it away from the stream (or spring) and wash away from other people source of drinking water.

Dr. Bonner's is a good choice, but any of the biodegradable trail soaps work just as well.

It really isn't much harder to wash, but the privies and water sources are usually not near each other. What happens is you get to a shelter, make a trip to the spring and get back to the shelter with only enough water to make dinner and tea, you don't want to make an extra trip down to the spring just to get water to wash up with after you use the privy or before you eat.

I carry a folding bucket for just this reason. But I am a weekend section hiker and don't have to carry it for 5 months :)

I fully understand why thru hikers are not going to carry an extra way to carry water for 2000+ miles.

Buzzy84
12-23-2013, 18:59
You don't wash your hands in the streams, you scoop water in your pot, take it away from the stream (or spring) and wash away from other people source of drinking water.

Dr. Bonner's is a good choice, but any of the biodegradable trail soaps work just as well.

It really isn't much harder to wash, but the privies and water sources are usually not near each other. What happens is you get to a shelter, make a trip to the spring and get back to the shelter with only enough water to make dinner and tea, you don't want to make an extra trip down to the spring just to get water to wash up with after you use the privy or before you eat.

I carry a folding bucket for just this reason. But I am a weekend section hiker and don't have to carry it for 5 months :)

I fully understand why thru hikers are not going to carry an extra way to carry water for 2000+ miles.


Ya good point.. I wasn't thinking of washing in drinking water but ya, who knows if someones gonna drink out of that certain stream. Better off to do what you suggest.. Thanks

Theosus
12-23-2013, 19:14
I always sleep in my tent and avoid physical contact including hand shaking. Elbow to elbow maybe. Wash hands often. And don't eat food offered. Trail magic is a decision at the time.

Yeah I hate hand shaking any time, and even more in an environment like the AT. They say 85% of men don't wash their hands after peeing, so if you come up to me in a restaurant and I'm about to eat, I'm not shaking your hand, period. on the AT or other trail? Forget it. I like bowing. We should bow like the Japanese...

bfayer
12-23-2013, 19:19
Ya good point.. I wasn't thinking of washing in drinking water but ya, who knows if someones gonna drink out of that certain stream. Better off to do what you suggest.. Thanks

I actually should have said you "shouldn't" wash up in streams and springs, unfortunately the reality is people do it all the time, along with washing dishes, washing clothes, and disposing of all sorts of unwanted materials and liquids.

If at all possible always get water right out of the pipe at a spring and not the pool :)

Buzzy84
12-23-2013, 19:27
I actually should have said you "shouldn't" wash up in streams and springs, unfortunately the reality is people do it all the time, along with washing dishes, washing clothes, and disposing of all sorts of unwanted materials and liquids.

If at all possible always get water right out of the pipe at a spring and not the pool :)

Right I hear ya.

Starchild
12-23-2013, 21:20
We all travel down the same narrow corridor. We all touch the same rocks, the same trees for hand holds, etc.

Along with using the same water sources. And that may be more of the reason locals don't seem to have come down with it as much as thru's (your above post). They are not sharing these things, i.e. they are bringing their own water on day hikes, especial when they know that this is going around. So I'm not so sure it is because they have developed some local immunity.

Starchild
12-23-2013, 21:23
I actually should have said you "shouldn't" wash up in streams and springs, unfortunately the reality is people do it all the time,

Also what happens when they get sick for a bit of time and run out of TP? Where do they have, in that condition, to clean themselves? Hopefully there will be a place they can reach downstream of where most collect water. It's a rough situation.

mountain squid
12-24-2013, 12:52
Great tips, info and links everyone! It is also helpful to hear experiences from last years hikers. Keep the advice and helpful tips coming!

See you on the trail,
mt squid

squeezebox
12-24-2013, 18:22
An excellent point someone made that the filters, Sawyer etc, will not filter virus so aqua mur if possible
More likely it's person to person. Or person to surface, washing pots with soap or heating to dry would not hurt.
Wash your hands, wash your hands, wash your hands

ChinMusic
12-24-2013, 18:57
Along with using the same water sources. And that may be more of the reason locals don't seem to have come down with it as much as thru's (your above post). They are not sharing these things, i.e. they are bringing their own water on day hikes, especial when they know that this is going around. So I'm not so sure it is because they have developed some local immunity.

Norovirus may have been plucked out of a local water source. That would explain why this area seems to be ground zero for so many years. It is certainly not spread via water though. Those of us that treat with chemical or UV wouild kill the virus. I am confident my water was virus-free and still got sick.

Colter
12-25-2013, 14:30
I don't disagree at all, I just want to point out that I don't think there was any evidence that the noro was being spread by water sources...

I doubt any cases were proven to come from a specific source such as "an infected person, contaminated food or water, or contaminated surface," yet it is known that they are all ways the virus can be spread.

As I frequently point out, treating water vs washing hands is a false choice.

METHODS:

In a prospective surveillance study, 334 persons who hiked the Appalachian Trail for at least 7 days (mean [+/- SD] length of hike, 140 +/- 60 days) in 1997 were interviewed. At the end of their hike, subjects completed a questionnaire on injuries, illnesses, water purification methods, and hygiene practices...

CONCLUSION: Diarrhea is the most common illness limiting long-distance hikers. Hikers should purify water routinely, avoiding using untreated surface water. The risk of gastrointestinal illness can also be reduced by maintaining personal hygiene practices and cleaning cookware. (http://www.ncbi.nlm.nih.gov/pubmed/12681456)

Sly
12-25-2013, 14:59
On a shelter check day trip last April, there was a sick hiker at Jerry's Cabin shelter. While waiting for a SAR evac, I drank untreated water from the piped spring there and cleaned up litter in the shelter. I also brought a spray bottle w/50/50% bleach and water and spayed the shelter and privy.

Just bleach and water isn't as effective as adding a little TSP or dish detergent which acts as a wetting agent.

Cro-Mag
12-26-2013, 11:10
Great advice everyone! Please keep in mind that while most hikers got sick between Hot Springs and Erwin, there were many people sick much earlier on. My hiker buddy got sick at the shelter right after the NOC. She got sick on her sleeping bag, in a full shelter, in freezing temps...what other option did we have but to share a tent and a sleeping bag. Needless to say, I got sick 4 days later at the Fontana Hilton. This was late March, if anyone wanted to know.

All I can say about the virus is that one second you're feeling good, the next second you're feeling kind of strange and the next second you are covering the fallen leaves with the force of a fire hose from your stomach. I was physically sick for about 12 hours, but it took me 5 days to get back to strength. Just keep that in mind if you are near a town. You might not be hiking the same miles you were a few days ago and you do not want to run out of food.

The Cleaner
12-26-2013, 13:16
IMO lots of hikers do no wash their cooking pots, cups or spoons enough or correctly when they do. Probably #1 reason for not even cooking in pots. Many use freezer bag or freeze dried foods or just go no stove. One needs to heat a little water, add some extra cold water and your choice camp soap ( I use Dr. Bronner's). Scrub with something then rinse with boiling water. This last step is rarely done because you need to heat more water and most thru hikers just can't (or won't) do this because of fuel usage. I've seen some eat a freeze dried dinner, then lick their spoon clean and put it away. Several years ago I saw a young woman with 3 dogs, cook something in a pot then when she finished eating she let her dogs lick the pot "clean". Then she wiped it with a used bandana and put them away. Seems like it's just too much trouble to do something right and many hikers their main concern is making miles. It's all HYOH these days, so do as you want, but no matter how you get sick it's no fun and could be one reason some ended their hike sooner than planned...

ChinMusic
12-26-2013, 13:30
All I can say about the virus is that one second you're feeling good, the next second you're feeling kind of strange and the next second you are covering the fallen leaves with the force of a fire hose from your stomach. I was physically sick for about 12 hours, but it took me 5 days to get back to strength. Just keep that in mind if you are near a town. You might not be hiking the same miles you were a few days ago and you do not want to run out of food.
Hit me that fast too. I was lucky to be in a motel room in Erwin when it hit. It would have been horrible in the field. I took a couple days off and got back to normal miles a couple days later.

Hot Flash
12-26-2013, 14:25
By the way Hydrogen peroxide wipes kill noro as well if not better than bleach and are not hard to find. They can be repackaged into a zip lock bag.


Just remember that once H2O2 is exposed to air, it rapidly loses effectiveness. It has about a 30-day shelf life once the packet or bottle is opened.

theinfamousj
12-27-2013, 01:54
Also what happens when they get sick for a bit of time and run out of TP? Where do they have, in that condition, to clean themselves?

Leaves... Plenty of those around.

Moss.

Smooth rocks.

Snow if it is that time of year.

These are all things I have wiped with.

Sent from my SGH-I777 using Tapatalk

HikerMom58
01-02-2014, 22:10
Bump.... Class of 2014 is interested in staying informed on this subject on their FB page. :>)

Slo-go'en
01-03-2014, 02:04
There is apparently a "super bug" version of the Norovirus going around this winter. ABC had a news story about it earlier in December. Pretty scary stuff, pray it doesn't show up on the trail!

theinfamousj
01-03-2014, 03:33
Just (well, yesterday) got over super bug norovirus and asked myself if I could have hiked with it. Answer: easy zero of tent already pitched.

From what my med professional tells me, the designation of super bug comes from being very contagious, but not very difficult. Had symptoms for less than 12 hours. When I had e. Coli food poisoning, it was a full 24.

YMMV.

Source of Contact: Durham, NC, on or around Christmas.

Sent from my SGH-I777 using Tapatalk

squeezebox
01-03-2014, 03:52
Isolation !! sleep in your tent , not the shelter. don't use the privy, get someone to collect water for you, don't foul the water source. If you are out in the woods, where I would think there are more germs than at home, jammed together in a shelter, it's a reason to be cleaner than at home. Wash everything you touch, including yourself.

mhaddon
01-09-2014, 01:19
Just (well, yesterday) got over super bug norovirus and asked myself if I could have hiked with it. Answer: easy zero of tent already pitched.

From what my med professional tells me, the designation of super bug comes from being very contagious, but not very difficult. Had symptoms for less than 12 hours. When I had e. Coli food poisoning, it was a full 24.

YMMV.

Source of Contact: Durham, NC, on or around Christmas.

Sent from my SGH-I777 using Tapatalk

You did better than I did. I had a mild fever and aches with mine. So bad it took me three days to get my strength back. Now then, I had my four kids get it first so I was tired by the time it hit. I'm pretty sure that's why it takes longer to recover when your body is already worn down from the miles... something to keep in mind about recovering when it hits and you've been perfectly health vs. worn down. And it didn't seem to last long, but would be brutal outside the comforts of home. I think it's better to take it serious than to blow it off as something that is easy to get over in a day.

Pedaling Fool
01-29-2014, 18:09
Just some FYI about norovirus http://www.livescience.com/42944-what-is-norovirus.html

squeezebox
01-29-2014, 18:59
Spraying down the shelters and privys with 10% bleach water would be a good thing to do

Brently
01-30-2014, 15:51
I wonder if I'll be immune this time around since I got in in '12 right after Erwin? I've heard hydrogen peroxide wipes will kill the virus, since your typical antibacterial's don't .

ChinMusic
01-30-2014, 16:01
I wonder if I'll be immune this time around since I got in in '12 right after Erwin?

Based on what I have read about the limited immunity one may acquire, you are not 100% protected. My educated guess, and only a guess, is that you have pretty good immunity to this strain of norovirus. If your body is challenged again with it you will probably skate by. IMO this is why someone like 10-K, who shuttled countless sick hikers last year, did not come down with symptoms. His body had previously been challenged by the virus.

HikerMom58
01-30-2014, 16:01
I wonder if I'll be immune this time around since I got in in '12 right after Erwin? I've heard hydrogen peroxide wipes will kill the virus, since your typical antibacterial's don't .

I did a quick google search on that and this is what I found. Thanks for mentioning hydrogen peroxide wipes, Brently.

http://www.nbcnews.com/health/norovirus-why-washing-your-hands-isnt-enough-1C8143996

moldy
01-30-2014, 17:46
I have read that you are immune for up to 6 months after you get the virus.

MDSection12
01-30-2014, 18:27
I've been carrying a 5 Hour Energy bottle full of bleach ever since my dog rolled in crap on a weekend hike. I don't take him anymore, for that reason, but the bleach is my emergency 'icky' recovery. Maybe that'd be a good practice for thrus.

beachbunny
01-30-2014, 19:21
I spent last summer in glacier national park,it hit there too

mountain squid
01-30-2014, 20:32
Just some FYI about norovirus http://www.livescience.com/42944-what-is-norovirus.html



I did a quick google search on that and this is what I found. Thanks for mentioning hydrogen peroxide wipes, Brently.

http://www.nbcnews.com/health/norovirus-why-washing-your-hands-isnt-enough-1C8143996Very good articles. Thanks for sharing. Let's hope the recent cruise ship vacationers are not finalizing plans for their next adventure . . . on the AT . . .

See you on the trail,
mt squid

some observations (http://www.whiteblaze.net/forum/showthread.php?14493-observations-from-fs42-(advice-for-first-week-on-trail)&highlight=)

Pedaling Fool
02-03-2014, 10:05
Here's another article I just read, not much info, but this puts it in perspective a little why it's so easy to get infected. http://www.realclearscience.com/blog/2014/02/sit_down_we_need_to_talk_about_norovirus.html

Excerpt:

"They are incredibly infectious. The average person needs to come into contact with just 18 of these little viruses to become sick. Compare that number to say, Salmonella (http://www.msdsonline.com/resources/msds-resources/free-safety-data-sheet-index/salmonella-typhi.aspx), which may require about 100,000 bacterial cells to cause illness. That explains why hundreds of people on cruise ships get sick."

ChinMusic
02-03-2014, 12:24
While hygiene is important, IMO it is not the major factor. Some have made the point that it is the hygiene on the trail that is a major criterion. That would not explain the quick spreading on cruise ships where hygiene would be expected to be a normal levels.

You can do everything right and still get this sucker.

sfdoc
02-03-2014, 12:48
While much good advice has been presented regarding norovirus, I must emphasize that vigorous hand washing is the best defense against this virus which can bring on some serious misery. Another point that perhaps is unknown by many is that the norovirus is a very sticky and highly resistant virus, which is why it spreads so rapidly and thoroughly on cruise ships. What this means is, if you contact it, washing hands doesn't remove it from everything else you touch, not even necessarily your hands: your clothes, equipment, etc. Therefore, extra vigilance must be exercised. Even hot laundering doesn't necessarily solve the problem. Some of the field sanitation practices suggested in other entries leaves no doubt as to how this virus exists and persists on the trail.
Another consideration is the fact of the appearance of the virus after the first 100 moles or so. Hikers have been broken down, both physically and mentally. Immune systems are weakened and therefore susceptible. I suggest taking a good multi-vitamin. Also, we become careless because we are tired. Again, vigorous vigilance regarding our field sanitation practices.
Lastly, the traditional route for contracting norovirus is fecal-oral, perhaps not directly, but that's the route. Again, vigorous field sanitation practices are in order. I hope this works for you.

HikerMom58
02-12-2014, 11:18
I just saw this on CNN. I found it interesting so thought I would share it.

http://www.cnn.com/2014/02/11/health/navy-norovirus/index.html?sr=fb021214navynorovirus1a

Pedaling Fool
02-12-2014, 11:39
I just saw this on CNN. I found it interesting so thought I would share it.

http://www.cnn.com/2014/02/11/health/navy-norovirus/index.html?sr=fb021214navynorovirus1aDon't listen to the BS in this article. I spent 18 of my 23 years in the navy at sea and that article is sprinkled with some truths on a big pile of $hit:)

Yes, we do "field day" (cleaning of things like the galley and berthing compartments) every day, but we still have outbreaks, just like on the trail...no one really knows what they are, it's just a part of life. No one is quarantined:rolleyes:

At best you may get to miss some watches and be sent to your rack, but you better be really sick; most end up standing their watch. You just have to suck it up. It's like Sgt Rock says: "No Sniveling" Go stand your watch, you little bitch -- ok that last part I added:D

HikerMom58
02-12-2014, 12:42
Don't listen to the BS in this article. I spent 18 of my 23 years in the navy at sea and that article is sprinkled with some truths on a big pile of $hit:)

Yes, we do "field day" (cleaning of things like the galley and berthing compartments) every day, but we still have outbreaks, just like on the trail...no one really knows what they are, it's just a part of life. No one is quarantined:rolleyes:

At best you may get to miss some watches and be sent to your rack, but you better be really sick; most end up standing their watch. You just have to suck it up. It's like Sgt Rock says: "No Sniveling" Go stand your watch, you little bitch -- ok that last part I added:D

Funny PF :D... good to know! Thanks for your service, PF.

It grossed me out when they suspected that a sailor's hands may not be clean & right into the ice machine it goes.
That's a gross scenario right there! *Yikes*

The best info on this thread, IMHO, is that hydrogen peroxide kills the virus not alcohol based hand sanitizers.

Son Driven
02-12-2014, 12:53
http://en.wikipedia.org/wiki/Mary_(elephant) What can we do to right the wrongs of the past, so we can break free of the NORO plague?

bfayer
02-12-2014, 12:56
...At best you may get to miss some watches and be sent to your rack, but you better be really sick; most end up standing their watch. You just have to suck it up...

And that is a fact. There are two types of people on ships, Sailors and Riders. The difference between them is not who gets sick, it's who does their job when they are.

mountain squid
02-12-2014, 13:54
"Sweepers, sweepers. Man your brooms. Give the ship a clean sweep down, both fore and aft . . ."


I was in food service (MSC) and never had any major outbreaks. Sanitation is the key. Hot, soapy water everywhere in the galley. When underway, Messing and Berthing inspections were held every day. On board the Belleau Wood (ship similar to the Iwo Jima of the article), the only 'outbreaks' that I recall were when the Marines came onboard and got sick. They had very close quarters and if one got sick it would spread rapidly through their berthing compartment.

We kept things very clean. I was mostly worried during field exercises with the Seabees. Shower facilities were not high on the priority list of getting things done first. It would usually take a few days for them to be built, but we always managed to stay as clean as possible. Sanitation is harder in the field, obviously, and as hikers we know that.

Wash your hands everyone!

See you on the trail,
mt squid

Praha4
02-12-2014, 16:20
no medical data to support this hypothesis, but one hostel in particular that shall remain unnamed, in Erwin, TN, seems to be the epicenter for noravirus, year after year. Maybe this hostel should borrow a page from the cruise ship industry on how to sanitize the place.

bfayer
02-12-2014, 16:24
...Maybe this hostel should borrow a page from the cruise ship industry on how to sanitize the place.

No doubt, the cruise industry has the process down pat :datz

Lauriep
02-22-2014, 16:28
ATC, in partnership with the CDC, National Park Service, and the Tennessee Department of Health, has developed some guidance for hikers on preventing norovirus. The poster is being distributed to hostels and agency partners to post strategically. Should we get any reports of an outbreak, the poster will be distributed more widely. I've cut and pasted the language below and have attached the poster as a PDF.



PREVENT NOROVIRUS (STOMACH BUG) INFECTION

An outbreak of norovirus (stomach bug) occurred on the Appalachian Trail in TN/NC last spring. Help prevent one in 2014!
Proper hygiene—especially hand washing with soap and water—is key to preventing the spread of the disease. (Hand sanitizers may not be effective against norovirus.) Also, be aware that most water filters do not filter viruses.


Please be informed! Read the following information carefully.

Noroviruses (Stomach Bug): can cause people to have gastroenteritis, an inflammation of the stomach and the intestines. This illness often begins suddenly and lasts about 1 to 2 days. Common symptoms: vomiting, diarrhea, and some stomach cramping.
Less common symptoms: low-grade fever, chills, headache, muscle aches, nausea, and tiredness.

How noroviruses (stomach bug) are spread
 Noroviruses are found in the stool or vomit of infected people and on infected surfaces that have been touched by ill people. Outbreaks are more likely in areas with multiple people in small spaces like shelters and hostels.
 By eating food or drinking liquids that are contaminated with norovirus (untreated water sources can be contaminated).
 By touching contaminated surfaces and then touching your mouth, nose, or eyes. Norovirus can stay on surfaces and objects and still infect people after days or weeks.
 By not washing hands after using the bathroom and before eating or preparing food.

Prevent getting and spreading norovirus (stomach bug) through good hygiene practices
 Wash hands with soap and water often, especially after using the bathroom and before handling food or eating. Alcohol-based hand sanitizers are not as effective against norovirus, but may be used if soap and water are not available. Use biodegradable soap at least 200 feet (80 steps) from a water source.
 Boil water (rolling boil for at least 1 minute) or use chemical disinfectant (iodine, chlorine, or chlorine dioxide). Most filters do not remove viruses, but can be used effectively in combination with chemical disinfection against a broad range of pathogens.
 Bury human waste 8 inches deep in soil and at least 200 feet away from natural water if privy not available.
 Avoid sharing water bottles, eating utensils, and other personal items.

What to do if you get norovirus (stomach bug)
 Drink plenty of fluids and wash hands often.
 Seek medical treatment, especially if you become dehydrated or illness lasts more than a few days (norovirus usually last 1-2 days).
 Avoid contamination of common areas (e.g., shelters); consider camping or staying off the A.T. if possible.
 Limit contact with others and avoid preparing food and drinks for others for 2-3 days after recovery.
 Please report date and location of any cases or outbreaks of vomiting and diarrhea on the A.T. or at places used by A.T. hikers (e.g. hostels) to the local health department and ATC at stomachbug@appalachiantrail.org. Your prompt report will help stop potential outbreaks. Thank you!

4eyedbuzzard
02-22-2014, 17:33
I understand and support the ATC's concern and efforts regarding preventing norovirus. But from a scientific standpoint, norovirus cannot survive being heated to temperatures above 65°C (150°F) for more than approximately 15 minutes, or heating it to 80°C (176°F) for 1 minute. Like most illness prevention measures, complete "sterilization" of food/water is never achieved, rather the reduction of pathogens to a level that renders them unlikely to produce illness in a host is. But heating water to a full "rolling boil" is unnecessary. Many alcohol stoves used by hikers never get water to rolling boil. But they do typically heat water to the 180 - 200°F range, which is hot enough to kill virtually all known enteric pathogens including the various noroviruses.
Not listed as a possible means of prevention, was UV treatment, such as a Steripen, which has an UV intensity greater than what lab testing has shown to be needed to be effective against norovirus.

bfayer
02-22-2014, 18:15
Not listed as a possible means of prevention, was UV treatment, such as a Steripen, which has an UV intensity greater than what lab testing has shown to be needed to be effective against norovirus.

Although I trust the Steripen to take care of Noro virus, for folks that don't, and don't like chemicals, the First Need filter does take care of Noro. It's not ultralight, but it works.

Pedaling Fool
02-22-2014, 18:41
If anyone was wondering about a vaccine, they are working on one, but the norovirus has proven to be a worthy opponent for several reasons, nonetheless there was a little progress/success. However, since only ~800 people per year die from it, out of tens-of-millions that are infected, it's probably not high on the priority list ...

http://www.medscape.com/viewarticle/812143

Del Q
02-22-2014, 20:51
I was hiking SOBO from Damascus to Erwin last April, like 80% of the thru hikers I ran into had it or had-had it. Hotel in Erwin, same %

Freaky

mountain squid
02-22-2014, 21:04
 Please report date and location of any cases or outbreaks of vomiting and diarrhea on the A.T. or at places used by A.T. hikers (e.g. hostels) to the local health department and ATC at stomachbug@appalachiantrail.org. Your prompt report will help stop potential outbreaks. Thank you!Thanks for the Update, Laurie! I heard about the poster last night during our Maintainers Dinner Meeting but didn't get too many details. I figured an update would be forthcoming. Thanks Again!

I also wanted to highlight the email address (stomachbug@appalachiantrail.org). Hopefully hikers will annotate it somewhere or at least remember where to find it and will utilize it if someone gets sick this year.

Stay Safe out there everyone and remember to Wash Your Hands!

See you on the trail,
mt squid

some observations (http://www.whiteblaze.net/forum/showthread.php?14493-observations-from-fs42-(advice-for-first-week-on-trail)&highlight=)

Pedaling Fool
02-23-2014, 10:09
What I love about this virus is not only that it takes so very few of them to get inside you to make you sick, or that they have such an indestructible outershell to protect them, but that they can be transmitted thru the air to infect you...that makes me :)

Only because I know there are people out there freaking out over all the creepy crawlies all around us. If we could only have the ability to see them, just for a day; people would be shocked at how :eek:dangerous:eek: an environment we live in...:D

ChuckT
02-23-2014, 10:31
Pedaling Fool you sure know how to ... cheer us up?

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HikerMom58
02-23-2014, 10:45
What I love about this virus is not only that it takes so very few of them to get inside you to make you sick, or that they have such an indestructible outershell to protect them, but that they can be transmitted thru the air to infect you...that makes me :)

Only because I know there are people out there freaking out over all the creepy crawlies all around us. If we could only have the ability to see them, just for a day; people would be shocked at how :eek:dangerous:eek: an environment we live in...:D

This is funny and true.. I love all the emoticons! :D If we knew the half of what's out there (germs) or what has been done to our food. (restaurant food particularly) we'd all be shocked, I'm sure! :eek:

Ignorance is bliss! :D No worries ChuckT.

4eyedbuzzard
02-23-2014, 12:29
Only because I know there are people out there freaking out over all the creepy crawlies all around us. If we could only have the ability to see them, just for a day; people would be shocked at how :eek:dangerous:eek: an environment we live in...:D


This is funny and true.. I love all the emoticons! :D If we knew the half of what's out there (germs) or what has been done to our food. (restaurant food particularly) we'd all be shocked, I'm sure! :eek:

Ignorance is bliss! :D No worries ChuckT.

Isn't it nice to know that we all have trillions of friends, pounds of them, who simply call us "home sweet home". :eek: :p :D

Lauriep
02-24-2014, 20:02
Mtn. Squid,

Thanks for highlighting the email stomachbug@appalachiantrail.org.

The email address can also be found on our Health & Safety page <www.appalachiantrail.org/healthandsafety (http://www.appalachiantrail.org/healthandsafety)> and for a while on our Trail Updates page at <www.appalachiantrail.org/updates (http://www.appalachiantrail.org/updates)>.

If anyone has something to report but forgets the email, you can find it by going to the ATC website and typing "norovirus" into the search button.

Laurie P.
ATC

mountain squid
03-26-2014, 16:55
Hope everyone is keeping their hands clean. Don't forget the email address in case someone does get sick: stomachbug@appalachiantrail.org

(I might quiz you if I see you on the trail . . . . )

See you on the trail,
mt squid

HikerMom58
03-30-2014, 21:10
Second hand info here... Yesterday hikers in Central VA told me that they ran into a female hiker that believes she got sick with the Norovirus. She also told them of one other hiker, she also believes is sick with the virus, hiking behind her.

She was feeling better when they ran into the female hiker, yesterday, just south of Catawba VA.

Also, be careful and check for ticks. :eek: I'll be taking Sunny to the doctor tomorrow for a tick found deeply embedded in her. Not sure that the tick was completely removed so getting it checked out to be sure.

mountain squid
04-27-2014, 17:12
Just a reminder to everyone to keep your hands clean! If you do share your trail mix, POUR it into everyone's hands, including your own.

Stay Healthy!

See you on the trail and at Trail Days,
mt squid

maintenance videos (http://www.youtube.com/user/mountainsquid04/videos)

Lauriep
04-27-2014, 18:12
To reiterate: If you suspect you have or recently have had norovirus on an A.T. hike, please email stomachbug@appalachiantrail.org with as much detail as possible about the symptoms of your illness and your location, as soon as possible. Also notify the local health dept. Please encourage anyone you know who may have had norovirus symptoms to use this email.

We can't do very much with second-hand reports.

More information is available at www.appalachiantrail.org/healthandsafety (http://www.appalachiantrail.org/healthandsafety).

Laurie P.
ATC

Lone Wolf
04-27-2014, 19:33
once again stay out of privies, shelters and hostels

ChinMusic
04-27-2014, 20:38
once again stay out of privies, shelters and hostels
And shuttle driver vehicles.

misterfloyd
04-28-2014, 17:25
Is thier anyone who did not get this virus? What is thier secret? Sooner or later you are going to come into contact with it. Was most of the outbreak during peak season. I will be around those parts in June.

Floyd

mountain squid
04-28-2014, 19:14
I don't believe everyone gets it. Last years outbreak probably was during the peak season for this area.

When you come through in June, pay attention to where you camp and where you do your chores, etc. And wash your hands often!

Check back here, to see if an outbreak does occur this year.

See you on the trail,
mt squid

Lone Wolf
04-28-2014, 19:24
And shuttle driver vehicles.

i don't get it......

ChuckT
04-28-2014, 19:59
Ha we just heard from a friend whose husband is in physical rehab center after a knee replacement. The message was "Do not visit they have a Norovirus outbreak." Whoa!

Sent from my Samsung Note 3 using Tapatalk.

Slo-go'en
04-28-2014, 20:14
I walked through "ground zero" last year not too long after everyone was getting it and I never got it. I used the privys, stayed in hostels and didn't do anything special except maybe use my tent more often then not, but that was mainly because shelter space was still hard to score. There doesn't sound like there has been any wide spread out breaks of the virus this year, on the trail or anywhere else for that matter, while last year it seemed to be all over the place.

Rolls Kanardly
04-28-2014, 21:37
Noro Virus Awareness.
In my trail book for hiking the Appalchian Trail where I keep my notes about things I think are really important to remember, I have the places where the Noro Virus is present. I will add this stretch to my notes and hope I do not catch the virus.
This particular post says Hot Spring, GA to Erwin, TN. is a problem area to be concerned about. While looking at the data this is what I have come up with. It takes about two days to get the virus per the awareness post. It takes about 3 days to recover from the virus and a person may be contagious for up to 14 days after recovery. So that is nineteen days from the first day a person is infected to the last day their are contagious. If a hiker does a modest 10 miles a day on the trail that puts them pretty close to Atlanta for the day they were infected. It appears that the virus is really a problem from the beginning of the hike to Erwin, TN. I think I will be careful far in advance of Hot Springs.
Rolls

Slo-go'en
04-29-2014, 10:41
I have the places where the Noro Virus is present. I will add this stretch to my notes and hope I do not catch the virus. This particular post says Hot Spring, GA to Erwin, TN. is a problem area to be concerned about.

That was last year. The out break also occurred in late March/early April at a time when it was cold and raining a lot so people where spending a lot of time huddled together in shelters and there were a lot of people on the trail.

All it takes is one infected person to show up and start infecting others. There is no way of knowing where or when this might happen.

gravityman
04-29-2014, 14:08
Really surprising. In 05 this was the same stretch (hot springs to Erwin) where a lot of hikers were coming down with it.

CarlZ993
04-29-2014, 15:02
Last year, norovirus was really bad between Hot Springs & Damascus. Erwin TN looked like a hiker hospital ward. Lots of people holed up in individual rooms @ the Super 8 or Holiday Inn Express. For me, this period was 4/10 to 4/25. It seemed to lessen after that. But, a buddy of mine was further ahead of me & he got it really bad in Waynesboro VA. You just don't know.

I used alcohol gel religiously (before eating, after defecation, after reading shelter journals, etc). I didn't shake anyone's hand. I didn't share any food. I stayed in hostels, shelters (mostly), & occasionally in a motel (I didn't tent in this section). I saw a lot of people get sick. Probably most of them. I never did. I guess I was just lucky.

rafe
04-29-2014, 18:48
Really surprising. In 05 this was the same stretch (hot springs to Erwin) where a lot of hikers were coming down with it.

So this has been going on for some time, eh? I thought it was a more recent development.

rafe
04-29-2014, 20:50
Is thier anyone who did not get this virus?

I do almost all of my AT hiking off-season, but I'm one of the lucky ones I guess. Stayed in lots of shelters... but they were mostly empty.

squeezebox
04-29-2014, 22:46
Any chance some of the shelters and privys could be sprayed down with a 10% bleach solution ?
Might Help.

Sarcasm the elf
04-29-2014, 23:04
I used alcohol gel religiously (before eating, after defecation, after reading shelter journals, etc). I didn't shake anyone's hand. I didn't share any food. I stayed in hostels, shelters (mostly), & occasionally in a motel (I didn't tent in this section). I saw a lot of people get sick. Probably most of them. I never did. I guess I was just lucky.

Unfortunately, alcohol based hand sanitizer is not effective against the Norovirus. If you google "Norovirus, alcohol" you will find a number of studies that has looked into this. Here are a couple of quick links:

http://well.blogs.nytimes.com/2013/01/14/really-the-claim-hand-sanitizer-stops-norovirus-spread/?_php=true&_type=blogs&_r=0

http://www.ncbi.nlm.nih.gov/pubmed/19933337

http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html#alcohol

That said, your decision not to shake hands or share food was probably very effective at reducing your exposure.

Sara
05-06-2014, 18:34
A couple a guys got sick somewhere between Hot Springs and Erwin. They reported it and are feeling better now. I saw two sick hikers today and they are warning everyone to stay away from them (and they aren't using the shelters) in case they are still contagious.


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mountain squid
05-06-2014, 18:52
Thanks for the update, Sara! I've been asking the hikers as I see them, but haven't heard of any 'outbreaks' thus far. It is good to hear some real time updates. Hopefully this will not spread to other hikers.

See you on the trail,
mt squid

maintenance videos (http://www.youtube.com/user/mountainsquid04/videos)

soulrebel
05-07-2014, 07:52
No surprise that people get sick...For 300 miles I've been picking up trash all over the place and have watched plenty of people take full bathes at the springs. It was common place to see folks taking their sweat rag and pressing it up against the pipe to rinse it out in the spring and then pouring sweaty water above the pipe head and pretty much contaminating everything. I've seen all matter of hikers engaging in the practice. I pretty much got tired of telling people that it wouldn't hurt to step at least a few feet away from the springhead before doing some chores... Multiple bags of trash (aka three 1-gal ziplocs full of trash) left in firepits and random campsites. Dirty TP next to sitting logs and wooden benches... So basically, you can safely assume that most springs have runoff from the nether region of hundreds of hikers... I've unmet many people that can't even reply verbally to a "hello, How ya doin?" in the woods... Me and hiking buddy had three people in a row fail to say hello on our way to Erwin the other day... Insane

ericmcdaniel
05-07-2014, 22:26
My girlfriend and I got sick starting on May 5th (vomiting, diarrhea) starting around mile 416 just south of Hampton, TN. It lasted basically 24 hours with lingering feelings of "Bleh" (probably from dehydration). We stayed at a nearby hostel where we basically quarantined ourselves for a couple of days in an otherwise unused bunkhouse far from the rest of the hostel, and we didn't share the bathrooms or anything else that others were using. Would love to know where it came from so I could thank them for the "birthday present." :p


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Pedaling Fool
05-08-2014, 08:48
Sickness is a natural event and it's our job to embrace it so that we become stonger and make stronger progeny;)

The upside to killing half of Europe http://www.realclearscience.com/journal_club/2014/05/08/black_death_the_upside_to_killing_half_of_europe.h tml


Excerpt:

"Because so many people died, it was widely assumed that the Black Death killed indiscriminately. But that's not true. Elderly people and those who were in poor health to begin with were much likelier to die. To be sure, the plague kills healthy people, too. But, as with most infectious diseases, healthy people have a better chance at surviving. Ironically, the Europeans who made it through the Black Death inherited a much better world. Food prices dropped, labor wages increased, and there was a boost in the standard of living. ........

As shown, the survival curve for post-Black Death Londoners was greatly improved compared to the pre-Black Death survival curve. A much greater fraction of the population survived to middle age and beyond.

Once again, the adage, "What doesn't kill you makes you stronger," turns out to be accurate."




What's pathetic about this fascination with the norovirus is that it just sidelines you for a day or so, yet people talk of it as it's the Black Death.

mountain squid
05-09-2014, 19:35
My girlfriend and I got sick starting on May 5th (vomiting, diarrhea) starting around mile 416 just south of Hampton, TN.Oh No! Sorry you got sick. Hopefully you are better now. I also hope you remembered to send an email to stomachbug@appalachiantrail.org.

See you on the trail,
mt squid

ericmcdaniel
05-09-2014, 20:26
Didn't know about that, but we will now! -Wanderbus


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Sara
05-10-2014, 10:53
I'm in Hampton and a hiker I was staying with at a hostel got ill last night. He was throwing up every two hours. He is heading into Elizabethtown for medical aid and a hotel stay for recovery today.


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ChinMusic
05-10-2014, 11:11
We've been doing some Trail Magic between hikes. Elk Garden, VA 623 and The Captains so far. I'm trying to keep the hikers from touching common items such as the ketchup bottle for example. My wife handles the condiments. I think most of the hikers understand what we are trying to avoid. IMO Trail Magic, with multiple hikers touching the same items, could easily be a source of spreading something like Noro.

I do have Clorox Wipes available for use and wipe everything down when setting up. The last thing I want to do is see a hiker get sick.

Jeff
05-10-2014, 14:00
Chin...you are doing all the right things.

Any plans for TM in New England this summer? You know you want to visit Fenway again!!