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Viral

National Digestive Information Clearinghouse

What is viral gastroenteritis? What are the symptoms of Viral gastroenteritis is of the viral gastroenteritis? lining of the , , and The main symptoms of viral gastroenteritis . Several different can U.S. Department are of Health and cause viral gastroenteritis, which is highly Human Services contagious and extremely common. Viral • watery gastroenteritis causes millions of cases of • NATIONAL diarrhea each year. INSTITUTES Other symptoms include OF HEALTH Anyone can get viral gastroenteritis and most people recover without any complications, • unless they become dehydrated. • • chills • Symptoms usually appear within 12 to 48 hours after exposure to a gastroenteritis- causing and last for 1 to 3 days. Some viruses cause symptoms that last longer. Stomach What are the complications of viral gastroenteritis? is the most common complica- tion of viral gastroenteritis. When someone does not enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. When dehydrated, the body does not have enough fluids to keep the proper balance of important salts or minerals, known as . Infants, young children, older adults, and people with Small Large weak immune systems have the greatest risk intestine intestine of becoming dehydrated.

Viral gastroenteritis is inflammation of the lining of the stomach, small intestine, and large intestine. The signs of dehydration in adults are What causes viral • � excessive thirst gastroenteritis? • � infrequent Four types of viruses cause most cases of viral gastroenteritis. • � dark-colored urine • � dry skin Rotavirus is the leading cause of gastroen- • � lethargy, dizziness, or faintness teritis among infants and young children. Signs of dehydration in babies and young Rotavirus are most common in children are infants 3 to 15 months old. Symptoms usu- ally appear 1 to 3 days after exposure. Rota- • � dry mouth and tongue virus typically causes vomiting and watery • � lack of tears when crying diarrhea for 3 to 7 days, along with fever and • � no wet diapers for 3 hours or more abdominal pain. Rotavirus can also infect adults who are in close contact with infected • � high fever children, but the symptoms in adults are • � unusually cranky or drowsy behavior milder. • � sunken eyes, cheeks, or soft spot in the Caliciviruses skull Caliciviruses cause in people of Also, when people are dehydrated, their skin all ages. is the most common does not flatten back to normal right away calicivirus and the most common cause of after being gently pinched and released. viral gastroenteritis in adults. Norovirus is usually responsible for of viral People should talk with a health care gastroenteritis. Norovirus outbreaks occur provider if they have all year but are more frequent from October • � blood in their stool, which may indicate to April. People infected with norovirus typi- a bacterial infection cally experience , vomiting, diarrhea, abdominal , fatigue, headache, and � • symptoms that are severe or last more muscle aches. The symptoms usually appear than a few days 1 to 2 days after exposure to the virus and • � symptoms of dehydration last for 1 to 3 days. Severe dehydration may require intrave- nous fluids and hospitalization. Untreated severe dehydration can cause serious health problems such as organ damage, , or coma—a sleeplike state in which a person is not conscious.

2 � Viral Gastroenteritis Adenovirus How is viral gastroenteritis Adenovirus mainly infects children younger transmitted? than 2 years old. Of the 49 types of adeno- Viral gastroenteritis is transmitted from viruses, one strain affects the gastrointes- person to person. Viruses are present in the tinal tract, causing vomiting and diarrhea. stool and vomit of people who are infected. Symptoms typically appear 8 to 10 days after Infected people may contaminate surfaces, exposure and last 5 to 12 days. Adenovirus objects, , and with viruses, espe- infections occur year-round. cially if they do not their hands thor- oughly after using the bathroom. When an infected person with unwashed hands shakes Astrovirus primarily infects infants and hands with or touches another person, the young children, but adults may also be virus can spread. When an infected person infected. This virus causes vomiting and vomits, the virus can become airborne. watery diarrhea. Symptoms usually appear 3 to 4 days after exposure and last 2 to People may be infected with viruses by 7 days. The symptoms are milder than the • � touching contaminated surfaces or symptoms of norovirus or rotavirus infec- objects and then touching their mouths tions. Infections occur year-round, but the virus is most active during the winter months. • � sharing food, drink, or eating utensils with infected people • � eating that are contaminated with the virus, such as from contami- Viral gastroenteritis is often mistakenly nated called “stomach flu,” but it is not caused by the virus. Some forms of • � swallowing airborne particles that con- gastroenteritis are caused by tain viruses or parasites rather than viruses. For Norovirus is especially contagious. Norovi- information about bacterial infections, rus can survive for months on surfaces that see the Bacteria and are not thoroughly disinfected with a bleach fact sheet from the National Institute solution. Hard surfaces should be cleaned of and Digestive and Kidney with a mixture of 2 cups of bleach and Diseases (NIDDK). 1 gallon of .

3 � Viral Gastroenteritis Infected people who do not have symptoms How is viral gastroenteritis can still transmit viruses. Viruses may be present in the stool up to 2 weeks after a treated? person recovers from gastroenteritis. Most cases of viral gastroenteritis resolve over time without specific treatment. Antibi- Outbreaks of viral gastroenteritis can occur otics are not effective against viral infections. in households, childcare settings, schools, The primary goal of treatment is to reduce nursing homes, cruise ships, camps, dormi- symptoms and prevent complications. tories, restaurants, and other places where people gather in groups. People who suspect Over-the-counter medicines such as loper- they were exposed to a virus in one of these amide (Imodium) and subsalicylate settings may want to contact a local health (Pepto-Bismol) can help relieve symptoms department that tracks viral gastroenteritis in adults. These medicines are not recom- outbreaks. mended for children. Eating, Diet, and Nutrition How is viral gastroenteritis The following steps may help relieve the diagnosed? symptoms of viral gastroenteritis in adults: Viral gastroenteritis is usually diagnosed • � drinking plenty of liquids such as fruit based on symptoms alone. People who have juices, sports drinks, caffeine-free soft symptoms that are severe or last for more drinks, and broths to replace fluids and than a few days may want to see a health electrolytes care provider for additional tests. A health care provider may ask for a stool sample • � sipping small amounts of clear liquids or to test for rotavirus or norovirus or to rule sucking on ice chips if vomiting is still a out bacteria or parasites as the cause of the problem gastroenteritis. • � gradually reintroducing food, starting During an of viral gastroenteritis, with bland, easy-to-digest foods such health care providers or public health offi- as , potatoes, toast or bread, cereal, cials may test stool samples to find out which lean meat, applesauce, and bananas virus is responsible for the outbreak. • � avoiding fatty foods, sugary foods, dairy products, caffeine, and alcohol until recovery is complete • � getting plenty of rest

4 � Viral Gastroenteritis Children present special concerns. Because The U.S. Food and Drug Administration has of their smaller body size, infants and chil- approved two vaccines to protect children dren are likely to become dehydrated more from rotavirus infections: , quickly from diarrhea and vomiting. The live, oral, pentavalent (RotaTeq); and rotavi- following steps may help relieve symptoms of rus vaccine, live, oral (Rotarix). RotaTeq is viral gastroenteritis and prevent dehydration given to infants in three doses at 2, 4, and in children: 6 months of age. Rotarix is given in two doses. The first dose is given when the infant • � giving oral rehydration solutions such is 6 weeks old, and the second is given at as , Naturalyte, Infalyte, and least 4 weeks later but before the infant is CeraLyte 24 weeks old. • � giving food as soon as the child is Parents of infants should discuss rotavirus hungry � vaccination with a health care provider. • � giving infants breast or full For more information, parents can visit the strength formula, as usual, along with Centers for Control and Prevention oral rehydration solutions rotavirus vaccination webpage at www.cdc. Older adults and adults with weak immune gov/vaccines/vpd-vac/rotavirus. systems should also drink oral rehydration In the past, rotavirus infections were most solutions to prevent dehydration. common from November to April in the United States. However, recently wide- How can viral gastroenteritis spread vaccination slowed the of the virus, delaying rotavirus activity until be prevented? late February. Overall rates of infection have People can reduce their chances of getting or also been lower than in previous years. spreading viral gastroenteritis if they • � wash their hands thoroughly with soap and warm water for 20 seconds after using the bathroom or changing diapers and before eating or handling food • � disinfect contaminated surfaces such as countertops and baby changing tables with a mixture of 2 cups of household bleach and 1 gallon of water • � avoid foods and drinks that might be contaminated

5 � Viral Gastroenteritis Points to Remember • � Children with viral gastroenteritis should be given oral rehydration solu- • � Viral gastroenteritis is inflammation tions to prevent dehydration. of the lining of the stomach, small intestine, and large intestine. Several • � People can reduce their chances of get- different viruses can cause viral gastro- ting or spreading viral gastroenteritis if , which is highly contagious and they wash their hands thoroughly with extremely common. soap and warm water for 20 seconds after using the bathroom or changing • � The main symptoms of viral gastroen- diapers and before eating or handling teritis are watery diarrhea and vomiting. food, disinfect contaminated surfaces, • � Dehydration is the most common com- and avoid foods or liquids that might be plication of viral gastroenteritis. contaminated. • � When someone does not drink enough fluids to replace those that are lost Hope through Research through vomiting and diarrhea, dehy- The NIDDK’s Division of Digestive Diseases dration can result. Signs of dehydration and Nutrition supports basic and clinical in adults are excessive thirst, infrequent research into gastrointestinal diseases, urination, dark-colored urine, dry skin, including viral gastroenteritis. and lethargy, dizziness, or faintness. Researchers are investigating • � Infants, young children, older adults, and people with weak immune systems • � diagnostic tests for virus strains have the greatest risk of becoming • � new vaccines for rotavirus and norovirus dehydrated. • � the use of to treat • � Viral gastroenteritis is transmitted from gastroenteritis person to person. Participants in clinical trials can play a more • � Diagnosis of viral gastroenteritis is usu- active role in their own health care, gain ally based on symptoms alone. access to new research treatments before • � Most cases of viral gastroenteritis they are widely available, and help others by resolve over time without specific contributing to medical research. For infor- treatment. are not effec- mation about current studies, visit tive against viral infections. The pri- www.ClinicalTrials.gov. mary goal of treatment is to reduce symptoms. • � Adults with viral gastroenteritis should drink plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes.

6 � Viral Gastroenteritis For More Information You may also find additional information about this Centers for Disease Control and Prevention topic by visiting MedlinePlus at www..gov. This publication may contain information about 1600 Clifton Road medications. When prepared, this publication Atlanta, GA 30333 included the most current information available. Phone: 1–800–CDC–INFO For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll- (1–800–232–4636) free at 1–888–INFO–FDA (1–888–463–6332) or visit Fax: 404–371–5488 www.fda.gov. Consult your health care provider for Email: [email protected] more information. Internet: www.cdc.gov

Acknowledgments The U.S. Government does not endorse or favor any specific commercial product or company. Trade, Publications produced by the Clearinghouse proprietary, or company names appearing in this are carefully reviewed by both NIDDK sci- document are used only because they are considered necessary in the context of the information provided. entists and outside experts. This publication If a product is not mentioned, the omission does not was originally reviewed by Mary K. Estes, mean or imply that the product is unsatisfactory. Ph.D., and Robert Atmar, M.D., Baylor Col- lege of Medicine.

7 Viral Gastroenteritis National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892–3570 Phone: 1–800–891–5389 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: [email protected] Internet: www.digestive.niddk.nih.gov The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at www.digestive.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIH Publication No. 11–5103 April 2011

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