From Norwalk Ohio to the world- the new stomach flu is here- and an influenza update

From Norwalk Ohio to the world-

The new stomach flu is here-

 and an influenza update

One thing is far from new- stomach flu in the winter.

Background on the stomach flu viruses

Every year for probably many hundreds or thousands of years, certain viruses appear across the country to cause vomiting, diarrhea, and fever, that is, stomach flu, every January, February, and March.

For most of our lives that virus was rotavirus, but rotavirus immunization in the United States has effectively cut down on the presence of rotavirus.

Sadly, a new virus has fully taken the place of rotavirus, that is the norovirus.  The norovirus is so widespread at exactly the same time as rotavirus once was, that the number of people who get stomach flu and the severity of it is essentially unchanged.

So this winter, like all others, a very large number of our children are suddenly starting to vomit heavily then develop diarrhea, staying sick for a week, and raising concerns about dehydration.

So what does the norovirus have to do with Norwalk, Ohio?  Well, it was first discovered there in 1968.  The virus was completely unknown across the world until this discovery, leading to it being named the Norwalk virus until more was known about it and a category of virus was created and the species name norovirus adopted fairly recently.

The norovirus is now the most prevalent cause of stomach flu in the winter across the US, and most cruise ships!   

What to do if your child gets the stomach flu

It turns out that stomach flu, although an entirely miserable experience, is typically quite harmless.  

The whole illness has to do with gut viruses landing in your stomach, causing the stomach, then the intestines, then the colon to get inflamed as it burns along the whole tube of the gut.

Landing in the stomach leads to stomach inflammation, and therefore, vomiting.  That usually starts the illness and lasts 1-3 days.  Once the virus passes to the intestine and colon, diarrhea appears and lasts until the whole intestine is healed, which usually takes 5-14 days.  Fever may or may not be present.

The inflammation of stomach flu tends to be relatively minor.  It causes all this trouble, but does no lasting damage to the gut or stomach.

So the key risk your child with stomach flu is really not the germ, but the risk of dehydration.  This does not actually happen in the vast majority of cases, but it can.  The greatest risk is during the heavy vomiting period.  If there is not much vomiting, diarrhea tends not to cause dehydration since your child can simply drink to keep from getting dry.  Heavy vomiting however can keep drinking from working.

One way around  this is to use the strategy of limiting drinking to small sips that get absorbed before they can hit the stomach and be vomited.  This works if you limit drinking to one teaspoon every 5 minutes.  Eight hours of this provides 16 ounces of fluid with no vomiting of what is swallowed.

Of course, sometimes the vomiting and diarrhea is so intense that no strategy can keep up, and dehydration occurs.  How do you know if this has happened?  Here are the signs:

• No or little urination
• Dry cracked lips
• Sunken eyes
• And, wilted lack of energy.

The good news is that no matter what, it is easy to reverse dehydration- it just involves adding water by drinking or by IV.  If drinking fails we turn to the ER for IV hydration.

FOOTNOTE ON INFLUENZA

The latest data from the CDC show that the influenza virus epidemic of 2014-2015 is following the track of the epidemic of 2012-2013 to a remarkable degree, making it a very typical epidemic.   As such it is waning as spring approaches, and we anticipate influenza infections will become infrequent as February arrives and proceeds.

Also, thankfully, the number of childhood deaths is much smaller than in prior epidemics of influenza virus.

All in all, despite all the excitement in the news, this appears to be a very average, typical winter of influenza caused colds and flus and is on the wane.

To your health,

Dr. Arthur Lavin

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