NORO virus how it is spread, some ideas

[1234]

My daughter thru hiked the AT last year. She hiked in a small bubble. About half her group got the NORO virus, she did not. The group talked about the virus and what to do to not get it, yet still half did. I asked what her thoughts were on who did and who did not. 1st she washed her hands and rinsed in pumped water. Same for cooking utensils. She got sick years ago from contaminated cookware so she learned this lesson. She did not share food. She did not share other things you put in your mouth that burn. Just before Erwin while camping at a stream one night people started puking. They first went to the stream to clean up. They skipped shelters and camped prior to or after a shelter at a stream as did many others. The group broke up as the sick stayed behind. Thinking back things she noticed. Those who treated water from streams did not let the Aqua react for 5 min, they waited at most 1 min and when it turned yellow they poured it into their bottle. The water is always cold, they started using it 15 min later not waiting a full 30 for cold water. Some said well I am also boiling it, but in fact it they merely brought it to a boil and used it. Seeing what her group did and how they used the streams, she thinks the streams are the source of contamination along with all the campsites and shelters. It is spread by contact. 50% of her group had become sources for spreading the virus. She thinks the simple act of washing your hands and utensils in purified water and not sharing items and food was why she did not contact the virus. Watch people, watch their habits, you will soon pick out the ones that will get sick and the ones who "may" not. The virus will be out there this year also. Pay attention to the directions on purifying water, pay attention to what you use untreated water for. Pay attention to where you camp, as the night before someone may have been sick in the very spot you are camped.

[Pedaling Fool]

My first question is how do they know they had been infected with the norovirus? The symptoms displayed can be linked to hundreds of little thingys. That's the thing about self diagnosis, you really can't do it on your own; it takes technology to determine what infects you.

Also, I'm skeptical about infection via water source on the trail. The thing about getting infected by little things is that it is so, so easy, but especially easy to get infected by the norovirus.

I agree that the way her friends were treating water was bad, but then again I don't treat water, so who am I to say :)



See here, an article that puts it in perspective, a little, of how easy it is to get infected. http://www.realclearscience.com/blog...norovirus.html (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."





Maybe they were infected by norovirus or maybe something else. I don't worry too much about these things; I see getting sick as getting healthy. Seems like we're too concerned with isolating ourselves from these little thingys too much. Just get infected and get it over with :D

[Don H]

As you hike along the trail you will come across places where there are common hand holds, places where nearly everyone will grab on to. A tree, a limb maybe a rock outcropping. I've always though these places could also be a source. Maybe not the main source.

I think sharing food, drink and sleeping in shelters is the main cause.

[lonehiker]

Water only has to be brought to a boil.

[Kraken Skullz]

Noro is one of those things that is EVERYWHERE. Unfortunately when on the trail, folks don't have the amenities that they are used to and cleanliness takes a back seat to simplicity and weight. The instructions on the water purification systems are there for a reason and if hikers are in groups it only increases the risk that someone will be a carrier for noro or rhinovirus. One of the reasons I am leary of staying in shelters is the even more increased risk of someone passing through recently that was a carrier or still contagious with one of the above mentioned two viruses. My advice, Take Hand Sanitizer and use it anytime you "get the call from nature" and before handling food.

[bfayer]

.. My advice, Take Hand Sanitizer and use it anytime you "get the call from nature" and before handling food.

Just need to point out that alcohol based hand sanitizer does not kill Noro. Bleach or Hydrogen Peroxide does. You can get Hydrogen Peroxide wipes, but you need to keep them sealed and out of the sun for them to remain effective (same for bleach)

[The Cleaner]

It's not the water or shelter unless there is fresh vomit or feces there. It starts via feces to mouth contact, such as not washing your hands after doing #2. Not many places to wash up after you go. Use TP and wash as soon as possible and do not wash in the water supply source at a shelter....

[1234]

My first question is how do they know they had been infected with the noro virus? Well lots of folks said "I am skipping the shelters" they did but they all camped in the same spots. The noro was confirmed as being on the trail again. Several people started puking all night long on the same night, thus they must have picked up the virus from same place. They puked in the stream they wiped off the puke in the stream, they stayed there for days puking. I can only guess that the stream is contaminated. Noro is not everywhere it gets spread where people are in large numbers like daycare, schools, ships, and hostels. The noro is not just another simple virus you have a day or 2 and you are back to normal. It has gotten stronger putting some people in the hospital or being laid out for up to 2 weeks or more. I am glad someone said alcohol was useless, because relying on hand sanitizer that is alcohol based will not keep you safe as it does kill noro virus. Soap and water does. Amazing. Back to basics. To kill germs water needs to boil for 10 min I could not find how long it took for boiling water to kill noro. If someone can answer this please do.

[Kraken Skullz]

Hand sanitizer DOES help prevent the spread of viruses of most kinds. Obviously if you have soap and water that is preferred but most people don't stop and find a clean water source and bust out the camp soap every time that they go hiking.

See the link below for more info. Pretty sure the CDC knows more about this than we do.

http://www.cdc.gov/norovirus/preventing-infection.html

[lonehiker]

Quote: To kill germs water needs to boil for 10 min

Once again, this is a false statement. Water only has to come to a boil.

[Kraken Skullz]

True. Also, by the time the water is at a rolling boil, it has already been at a temp where any bacteria, protozoa and viruses have been killed or sterilized. Either way, wash your hands when possible, when you can't take whatever precautions you can if you think you are in a high risk area.

[Miner]

From my observations, many hikers don't actually bring their water to a boil. I know I rarely do. A few bubbles forming on the bottom of the pot is usually all that is necessary to rehydrate their food.

When testing different alcohol stoves on my patio (which is the only time I have a thermometer), I've found that the water rarely gets over 180F for how I actually rehydrate food in the back country.

[4eyedbuzzard]

No need to boil. 180° F will outright kill pretty much all enteric pathogens. For comparison, milk is pasteurized at 160° for 15 seconds, which reduces pathogen populations to such small levels where they won't cause illness.

[Pedaling Fool]

It's a good thing to have good hygiene practices, but when dealing with something as contagious as norovirus (or any number of other diseases) I wouldn't worry/overanalyze how to prevent it. Who knows maybe you'll be lucky enough to get sick with a strain that boosts your immune system ;)


http://io9.com/5730895/swine-flu-gives-its-survivors-supercharged-immunity-could-create-universal-flu-vaccine

[CarlZ993]

I missed the 2013 noro epidemic on the AT (saw people sick from Hot Springs to Waynesboro VA). Don't know how. I almost always slept in the shelters. I did use alcohol gel like it was going out of style (even after I learned that it was often ineffective). I didn't share any food. Used alcohol gel after writing in shelter logs. Used Aquamira for water purification (followed the instructions).

I spoke to a guy from the Health Department in Erwin (after he had interviewed someone w/ Noro). He told me that you don't gain an immunity from the disease after you catch it. He told me that you are still contagious for a few days after you no longer show symptoms.

I've never had giardia before. I understand that malady also causes diarrhea as well. I don't know how you can tell the difference between the two viruses.

Noro was a nasty virus on the trail. I hope it isn't as bad for the 2014 thru-hikers. Word for the wise, pack extra TP at all time. You never know if & when it will hit.

[ChuckT]

Bfayer - are you sure about hydrogen peroxide? I heard an ER doctor say that peroxide is nearly useless. His take was that it may be better than nothing but not much more than that.

Sent from my SAMSUNG-SM-N900A using Tapatalk

[4eyedbuzzard]

Hand sanitizer marketed as anti-viral, typically containing benzethonium or benzalkonium chloride is considered effective. The plain old alcohol stuff isn't.

[bfayer]

Bfayer - are you sure about hydrogen peroxide?

Yes.

http://www.epa.gov/pesticides/antimicrobials/list_g_norovirus.pdf

[winger]

I missed the 2013 noro epidemic on the AT (saw people sick from Hot Springs to Waynesboro VA). Don't know how. I almost always slept in the shelters. I did use alcohol gel like it was going out of style (even after I learned that it was often ineffective). I didn't share any food. Used alcohol gel after writing in shelter logs. Used Aquamira for water purification (followed the instructions).

I spoke to a guy from the Health Department in Erwin (after he had interviewed someone w/ Noro). He told me that you don't gain an immunity from the disease after you catch it. He told me that you are still contagious for a few days after you no longer show symptoms.

I've never had giardia before. I understand that malady also causes diarrhea as well. I don't know how you can tell the difference between the two viruses.

Noro was a nasty virus on the trail. I hope it isn't as bad for the 2014 thru-hikers. Word for the wise, pack extra TP at all time. You never know if & when it will hit.


Giardiasis isn't a virus it's a Protozoa, it's symptoms are much more prolonged than Norovirus.

[Prime Time]

Remember the primary way of spreading Norovirus is transmission of feces or vomit from an infected person. You're not likely to contract Norovirus in a stream or spring, but it's possible and anyway you should boil your cooking water (rolling boil, not "fish eyes") anyway for other nasty things that could be there like giardia. Just as importantly, since most of us eat out of the pan we boil our water in, this will help make it more sanitized. Dip your spork/utensils in the water briefly while it's boiling to help make sure they are clean also.

During outbreaks, avoid shelters, shelter areas, and above all privies! Don't share your food or your cookware/utensils or accept any from anyone! Passing the virus from your hands to your mouth is by far the most likely way to get infected!

Carry a disinfecting soap through the outbreak area and beyond for at least a couple of weeks and use it instead of or in addition to hand sanitizer. Good old alcohol sanitizer is still good for other general bacteria. Norovirus isn't the only thing that can get you out there!

When in town, be extra cautious of surfaces which may come in contact with lot's of hikers (bars tops, tabletops) and avoid hiker hostels in the outbreak areas.

Don't panic, but don't be stupid either. Know how the virus is spread, then apply some common sense to minimize your chances of infection.

[HikerMom58]

Remember the primary way of spreading Norovirus is transmission of feces or vomit from an infected person. You're not likely to contract Norovirus in a stream or spring, but it's possible and anyway you should boil your cooking water (rolling boil, not "fish eyes") anyway for other nasty things that could be there like giardia. Just as importantly, since most of us eat out of the pan we boil our water in, this will help make it more sanitized. Dip your spork/utensils in the water briefly while it's boiling to help make sure they are clean also.

During outbreaks, avoid shelters, shelter areas, and above all privies! Don't share your food or your cookware/utensils or accept any from anyone! Passing the virus from your hands to your mouth is by far the most likely way to get infected!

Carry a disinfecting soap through the outbreak area and beyond for at least a couple of weeks and use it instead of or in addition to hand sanitizer. Good old alcohol sanitizer is still good for other general bacteria. Norovirus isn't the only thing that can get you out there!

When in town, be extra cautious of surfaces which may come in contact with lot's of hikers (bars tops, tabletops) and avoid hiker hostels in the outbreak areas.

Don't panic, but don't be stupid either. Know how the virus is spread, then apply some common sense to minimize your chances of infection.

Good post Prime Time! Let's hope this year will be better than last year. Stay away Noro!

[4eyedbuzzard]

you should boil your cooking water (rolling boil, not "fish eyes") anyway for other nasty things that could be there like giardia. . .
Don't panic, but don't be stupid either. Know how the virus is spread, then apply some common sense to minimize your chances of infection.Giardia is actually a very temperature sensitive organism and the cysts cannot live long in temps above 130°F according to EPA. It is killed at roughly 170°F if held at or above that temp for 10 minutes. At 185°F or above it is killed within a minute, as are most other things. Heating water to an actual rolling boil is unnecessary as most enteric pathogens are killed at much lower temperatures, and the ones that aren't killed (e.g. Clostridium botulinum) at those temps would require a pressure cooker to heat the water above 212 °F boiling point. Note that the energy required to achieve a rolling boil doesn't make the water any hotter than it was just before it boiled - it serves only to create and then maintain the phase state change from liquid to gas (steam). I would hope this would put at ease most alcohol stove users, who rarely get their water to a rolling boil.

[Prime Time]

Giardia is actually a very temperature sensitive organism and the cysts cannot live long in temps above 130°F according to EPA. It is killed at roughly 170°F if held at or above that temp for 10 minutes. At 185°F or above it is killed within a minute, as are most other things. Heating water to an actual rolling boil is unnecessary as most enteric pathogens are killed at much lower temperatures, and the ones that aren't killed (e.g. Clostridium botulinum) at those temps would require a pressure cooker to heat the water above 212 °F boiling point. Note that the energy required to achieve a rolling boil doesn't make the water any hotter than it was just before it boiled - it serves only to create and then maintain the phase state change from liquid to gas (steam). I would hope this would put at ease most alcohol stove users, who rarely get their water to a rolling boil.
I'm just quoting the CDC which recommends bringing water to "a full rolling boil for 1 full minute" to kill Giardia. Maybe they're just being safe, but disease control is what they do so I guess If I'm gonna post something here, so will I.

[DocMahns]

Bfayer - are you sure about hydrogen peroxide? I heard an ER doctor say that peroxide is nearly useless. His take was that it may be better than nothing but not much more than that.

Sent from my SAMSUNG-SM-N900A using Tapatalk

The reason why the medical community is pushing away from hydrogen peroxide is because when you clean a wound using it, it kills good healthy/helpful cells as well as opportunistic pathogens. This can lead to delayed wound healing and increase chance of necrosis. Water and a mild soap encapsulate the bad bacteria and wash them away leaving healthy cells in tact and happy. Most of the time we only use an isotonic saline solution to cleanse wounds with no soap or other detergent.

[bfayer]

The reason why the medical community is pushing away from hydrogen peroxide is because when you clean a wound using it, it kills good healthy/helpful cells as well as opportunistic pathogens. This can lead to delayed wound healing and increase chance of necrosis. Water and a mild soap encapsulate the bad bacteria and wash them away leaving healthy cells in tact and happy. Most of the time we only use an isotonic saline solution to cleanse wounds with no soap or other detergent.

I have no idea, but I will take your word for it. Sounds good anyway :)

I do know all the documentation I have on Noro, says hydrogen peroxide is very effective for cleaning surfaces that may be contaminated with Noro. There are others, but for a hiker, hydrogen peroxide is probably the easiest to deal with. Bleach works well too, but I don't think hikers are going to be washing their hands with bleach everyday.

Hydrogen peroxide wipes are available on Amazon (and other places), and are not expensive. Keep them closed up, and keep them out of the sun.

[Meriadoc]

I spoke to a guy from the Health Department in Erwin (after he had interviewed someone w/ Noro). He told me that you don't gain an immunity from the disease after you catch it. He told me that you are still contagious for a few days after you no longer show symptoms.


Interesting. In 2012 I caught noro in Tennessee along with the bubble. I flip flopped and on my way south ran into the bubble again. Some kind person had brought noro up to Maine too! I caught it a second time. The second time was much easier than the first. I thought it might have been some leftover immunity. But there are so many factors that go into it that I didn't know. It's too bad that there is no immunity gained - that would have been cool.

Oh, and from what I read on noro, you can be contagious for two weeks after the symptoms resolve.
Went and pulled up a source for that: http://www.cdc.gov/norovirus/about/transmission.html
And there I found the following statement:
"Being infected with one type of norovirus may not protect you against other types." That certainly implies that limited immunity is gained.

[4eyedbuzzard]

I'm just quoting the CDC which recommends bringing water to "a full rolling boil for 1 full minute" to kill Giardia. Maybe they're just being safe, but disease control is what they do so I guess If I'm gonna post something here, so will I.I understand that you are just quoting CDC's (pretty predictable) answer to any question on water purity - boil it. I imagine they are overly conservative as heating water too much isn't going to have a negative health outcome, they aren't the one's carrying or paying for the fuel, nor spending the time doing it, and some in the general public would likely have problems figuring out temperature and/or time. But the reality of what actually needs to be done, of which CDC is well aware as medical/scientific professionals, is far from what they recommend people do, as the chart below from the Infectious Diseases Society of America shows. (link to the chart at their site here http://cid.oxfordjournals.org/content/34/3/355/F2.expansion.html )

We don't have unlimited sources of energy (fuel) in the backcountry to waste just to create rolling boils and steam to prove we've reached beyond a certain temperature. If CDC made similarly conservative suggestions on such things as sleeping bag temperature ratings, clothing, first aid kit supplies, etc, we might be lucky to leave the trailhead with a pack weight under 50 lbs.

I just wanted to post this so you and/or others here don't think I pull this stuff out of my ***. If you can get water to that pre-boil temp with lots of fish-eyes, it's going to kill everything.

26059

[Heeler59]

Quote: To kill germs water needs to boil for 10 min

Once again, this is a false statement. Water only has to come to a boil.


This is true, water only has to come to a boil. Please read the CDC information. It is the most up to date, and the most accurate. Norovirus is spread in close quarters person to person, usually contaminated food or equipment. It is not coming from water obtained from a running stream.

[1234]

This is true, water only has to come to a boil. Please read the CDC information. It is the most up to date, and the most accurate. Norovirus is spread in close quarters person to person, usually contaminated food or equipment. It is not coming from water obtained from a running stream.
If you are going to quote someone please quote, " To kill germs water needs to boil for 10 min I could not find how long it took for boiling water to kill noro. If someone can answer this please do." I have checked all the links and charts and still have no answer, one chart did have 10 min boil AT 100 degrees C or 212degrees for 10 min to kill one type of virus. Per the chart different germs, virus's and protozoa took different temperatures for different length of time to be killed. NORO was not on the chart. So we have no real answer, we only now know that it is a possibility that it may be killed at a lower temp than a boil.

[1234]

correction "vibrio cholerac takes 100 degrees C for 10 sec" to be killed.

[1234]

quote right off the CDC web page: Norovirus outbreaks have also been caused by contaminated water from wells and recreational settings, such as pools. http://www.cdc.gov/norovirus/trends-outbreaks.html Foods that are commonly involved in outbreaks of norovirus illness are—


leafy greens (such as lettuce),
fresh fruits, and
shellfish (such as oysters).

But, any food that is served raw or handled after being cooked can get contaminated.
To search for foodborne outbreaks caused by norovirus, go to the Foodborne Outbreak Online Database (FOOD) (http://wwwn.cdc.gov/foodborneoutbreaks/Default.aspx).

[1234]

I do not want to lose focus here, I do not want to see another outbreak this year. Best prevention it knowledge. Number one thing everything leads back to is WASH your hands completely with soap and water. If you have hospital grade disinfectant wipes by all means use them. After you use the "rest room" or woods, Wash, prior to putting food into your mouth, wash. It really is that simple. Avoiding shelters will not keep you safe from infection, cleanliness will.

[4eyedbuzzard]

If you are going to quote someone please quote, " To kill germs water needs to boil for 10 min I could not find how long it took for boiling water to kill noro. If someone can answer this please do." I have checked all the links and charts and still have no answer, one chart did have 10 min boil AT 100 degrees C or 212degrees for 10 min to kill one type of virus. Per the chart different germs, virus's and protozoa took different temperatures for different length of time to be killed. NORO was not on the chart. So we have no real answer, we only now know that it is a possibility that it may be killed at a lower temp than a boil.There are literally dozens of different "Norwalk like" virus strains, which are all regularly lumped together and called norovirus. It isn't just one distinct "critter". They are all enteric (intestinal) viruses.

[Heeler59]

I do not want to lose focus here, I do not want to see another outbreak this year. Best prevention it knowledge. Number one thing everything leads back to is WASH your hands completely with soap and water. If you have hospital grade disinfectant wipes by all means use them. After you use the "rest room" or woods, Wash, prior to putting food into your mouth, wash. It really is that simple. Avoiding shelters will not keep you safe from infection, cleanliness will.

I'm not sure what you mean by "hospital grade disinfectant wipes". I am a hospitalist PA, and the only disinfectant wipes we use in this environment are intended for inanimate surfaces, and the label clearly says not to use on human skin. They are very toxic, thus they kill all kinds of germs very well. Yes, your best bet for killing viruses is soap and water and scrubbing, EtOH gel won't get it all.

[rocketsocks]

There are literally dozens of different "Norwalk like" virus strains, which are all regularly lumped together and called norovirus. It isn't just one distinct "critter". They are all enteric (intestinal) viruses.I wouldn't want any of them. So I treat my water, and use the approved 2 ply squares for bottom floggin...do you really want to get these critters in your gut.

26064260652606726066

[Feral Bill]

I don't see how careful cleanup after you own BM would make a difference. You are not spreading pathogens to yourself. You could keep from passing on something to another person, of course. Still, I clean up, and boil extra water for a mealtime hand wash. I guess if I was with a group showing symptoms, I would go elsewhere, fast.

[4eyedbuzzard]

I don't see how careful cleanup after you own BM would make a difference. You are not spreading pathogens to yourself. You could keep from passing on something to another person, of course. Still, I clean up, and boil extra water for a mealtime hand wash. I guess if I was with a group showing symptoms, I would go elsewhere, fast.You wash your hands before eating (or really any other time) to protect yourself. You wash them after wiping to protect the herd.

[Kraken Skullz]

Seeing some of the comments it appears this is a pretty big worry on the AT. Any others that we should be worried about this time of year?

[4eyedbuzzard]

Seeing some of the comments it appears this is a pretty big worry on the AT. Any others that we should be worried about this time of year?Getting sick sucks, but generally everybody recovers in a couple of days. Getting a tick borne disease like Lyme, or falling and breaking bones is a lot worse. There are bigger health hazards on the AT than Noroviruses.

[winger]

Getting sick sucks, but generally everybody recovers in a couple of days. Getting a tick borne disease like Lyme, or falling and breaking bones is a lot worse. There are bigger health hazards on the AT than Noroviruses.

There may be more serious diseases, such as Lyme, but there are few illnesses, as quickly devastating as Norovirus. Does anyone wish to be pooping and puking for 24-48 hrs away from home and its conveniences? Norovirus, is spread quickly and from person to person. Lyme is spread by tick. There is a far lower incidence of Lyme compared to Norovirus. Everyone needs to practice basic hygiene and avoidance.

[4eyedbuzzard]

There may be more serious diseases, such as Lyme, but there are few illnesses, as quickly devastating as Norovirus. Does anyone wish to be pooping and puking for 24-48 hrs away from home and its conveniences? Norovirus, is spread quickly and from person to person. Lyme is spread by tick. There is a far lower incidence of Lyme compared to Norovirus. Everyone needs to practice basic hygiene and avoidance.I have nowhere said that people shouldn't practice proper hygiene. Kraken Sullz asked if there were any other worries. I responded. And whether you like it or not, from a personal medical standpoint noro is nowhere near as devastating a disease or injury as contracting Lyme or other tick borne diseases, or injuring a joint or breaking a limb. It is a bigger public health issue, due to how widespread it is. 20 million people in the US get some sort of norovirus infection each year. Unless there is an underlying medical condition though, virtual all recover within a few days. Not so with Lyme and other tick born diseases, which can lead to years of suffering. Joint injuries, broken bones, etc, can also negatively affect people for years. Sorry, but there's just no comparison in severity.

[MuddyWaters]

Thinking back things she noticed. Those who treated water from streams did not let the Aqua react for 5 min, they waited at most 1 min and when it turned yellow they poured it into their bottle. The water is always cold, they started using it 15 min later not waiting a full 30 for cold water.


ClO2 treatment protocol is based on deactivating giardia. Bacteria and viruses are ridiculously simple by comparison.

Treatment is by "CT" This is concentration (ppm) x time( minutes).
Typical solution concentration of 4ppm is achieved when following directions. 1mg/liter = 1 ppm. 4 ppm for 30 minutes would be 120 mg-min/L

Giardia is deactivated (not killed, sterilized) 1000 fold in only about 5 minutes .


26076



the CT time for norovirus is < 0.5 mg-min/liter for a 4 log (10,000 x reduction) at 5 C. Easily achievable no matter what you do. Even less at room temp.

[rocketsocks]

..........................

[lemon b]

Usually from the hands through the eyes. Gets on the hand touch the eyes and the bug is in the system.

[Mando12]

In 2012 I got (self diagnosed) norovirus in Hot Springs. I felt good when I arrived in the AM but was sick by the evening. It was rough for a few days, but I was fortunate to be in town. Real hand washing on the trail doesn't happen all that often. It was my practice to avoid shaking hands with new friends, because we were all less than clean. I started wondering about the shelter logs because it was something that almost everyone touched. Interesting that the outbreak happened again in 2013 in the same area.