2014 Norovirus Awareness

[mountain squid]

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:

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 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'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]

Good info for the 2014ers. Hope they have less of a problem w/ the 'hiker plague' than us unlucky 13ers.

[leaftye]

Good for know for hikers going through this area. Chemical or UV water treatment will be more effective in this area.

[bfayer]

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]

"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]

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]

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]

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]

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]

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]

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]

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]

... 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]

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. 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.

[Buzzy84]

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]

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]

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]

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]

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]

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