Family Communications

September is National Preparedness month. There are many ways to prepare for disasters such as a having a family Go Kit and designating a meeting site should you be forced out of your home suddenly. Another important thing to think about and prepare for is Family Communications.
Your family may not be together when disaster strikes, so plan how you will contact one another. Think about how you will communicate in different situations.

Complete a contact card for each adult family member. Have them keep these cards handy in a wallet, purse or briefcase, etc. Additionally, complete contact cards for each child in your family. Put the cards in their backpacks or book bags.

Check with your children’s day care or school. Facilities designed for children should include identification planning as part of their emergency plans.

Family Communication Tips
Identify a contact such as a friend or relative who lives out-of-state. It may be easier to contact a person who is out of the disaster area. That person will act as a “clearing house” for your family members. You can each call your designated person, telling them you are safe and where you are. It may be easier to make a long-distance phone call than to call across town, so an out-of-town contact may be in a better position to communicate among separated family members.

Be sure every member of your family knows the phone number and has a cell phone, coins or a prepaid phone card to call the emergency contact. If you have a cell phone, program your designated person as “ICE” (In Case of Emergency) in your phone. If you are in an accident, emergency personnel will often check your ICE listings in order to get a hold of someone you know. Make sure to tell your family and friends that you’ve listed them as emergency contacts.

Teach family members how to use text messaging. Text messages can often get around network disruptions when a phone call might not be able to get through.

Subscribe to alert services. Many communities now have systems that will send instant text alerts or e-mails to let you know about bad weather, road closings, local emergencies, etc. Sign up by visiting your local Office of Emergency Management web site.
The link to register or add contact information in Stevens County is located on the Stevens County website http://www.co.stevens.mn.us/ – click on the word CodeRED.
Make family communication a priority for your family. Make it a September project!

New Vaccine Requirements for Sept 1, 2014

New Immunization Law for Schools and Child Care takes effect September 1
Make sure your children are ready!

On Sept. 1, 2014, changes to Minnesota’s Immunization Law will take effect. These changes apply to children entering school, child care, and early childhood programs.
The changes were made to be more closely aligned with the current national recommendations, so most children should have already received these vaccines. Medical and conscientious exemptions are still allowed under the law. The vaccines that will be required are:
• Meningitis (meningococcal) – All students entering seventh grade will be required to submit documentation. Students entering eighth through 12th grade must show documentation if the school requests it.
• Tdap – All students entering seventh grade will be required to submit documentation. Students in eighth through 12th grade must show documentation if the school requests it. (This replaces the Td immunization requirement.)
• Hepatitis B – For all children over 2 months old enrolled or enrolling in child care or an early childhood program.
• Hepatitis A – For all children over 12 months old enrolled or enrolling in child care or an early childhood program.
• Kindergarten children must have their final dose of DTaP and polio on or after their fourth birthday.
Health Care Providers need to help their patients prepare for these changes. They need to:
• Give all recommended shots. For example, HPV is not required for school entry, but is recommended for children 11 to 12 years old and should be given at the same time as Tdap and meningococcal vaccines.
• Use every opportunity to vaccinate. Sports or camp physicals, minor injuries, or illnesses appointments can be used to assess and give needed immunizations.
• Call in patients who need vaccines. Use the child and adolescent assessment reports in the Minnesota Immunization Information Connection (MIIC) to identify and call in children who still need to get their shots.

Children who are covered by Medical Assistance/PrimeWest, who are Native American, or who are not insured are eligible for the MN Vaccine for Children Program and may get the vaccines for an administration fee at public health or their doctor’s office.
Please call public health for more info, if your child’s insurance will not pay for these shots. Our phone number is 320-208-6670.

Two ways to be SAFE in 2014

Resolve to be Ready 2014
Roughly half of all Americans make New Year’s resolutions. In 2014, FEMA and local Public Health are encouraging you to Resolve to be Ready for potential emergencies, by committing to make preparedness a year-round family activity. The campaign focuses on “Family Connection” to reinforce the importance of parents including their children in preparedness conversations before disasters strike.
After the holiday festivities end, get a head start on disaster preparations for you and your family with FEMA’s Are You Ready? Guide. This interactive course provides information on specific hazards including steps to not only be reactive but proactive in response to them. The guide also teaches you about evacuation, emergency public shelters, animals in disasters and more.
By taking a few simples steps to prepare in advance, you can minimize the impact an emergency could have on your family or community. For more information about this exciting new campaign visit Ready.gov.
Wishing you a safe and happy New Year!

What Goes Up…
Taking down the Christmas tree may not be as fun as putting it up but keeping a dried-out tree in your home or stored in a garage is a fire hazard! When it comes to tree disposal, do you know your options? After the holidays, don’t throw your Christmas tree in the trash. Real Christmas trees are recyclable. Typically, there are several environmentally sound ways to dispose of your tree. These options include:
• Curbside-pick up for recycling;
• A drop off recycling center; and
• Mulching programs.
Never dispose of your tree by burning it in a fireplace or wood stove. Doing so may result in a chimney fire. Pine and fir trees produce a lot of creosote when burning and may lead to deposits in your chimney. A burning tree is also hard to control and may burn faster than expected.
Safety First.

Football and the Flu

Football season is in full swing. Flu season is just starting.

What do the two have in common? You might be surprised at the correlation or should I say at the metaphorical reference which can be made?

A successful football team practices, does endurance training, does sprints, lifts weights, studies their play book, and practices some more. Based on all their hard work, the team hopes they will have a winning season.

BUT if the team could somehow get and study the play books of their opponents, winning games would be so much easier.

A successful, healthy flu season starts with good and frequent hand washing, covering your cough, discarding tissues in a waste container, eating right, getting enough sleep and staying home when you are sick. Did I mention hand washing?

BUT if you also get a flu shot or the flu mist, it’s like getting your hands on the opposing teams’ play book. You’ve got the best edge you can get. We know the flu vaccine isn’t perfect, but it is perfectly safe and it is the best tool we have to guard against getting influenza.

Getting a flu shot is like getting your hands on the other team’s play book. In conjunction with all the non-pharmaceutical interventions you’ve got a definite edge against catching the flu. Get your flu vaccine and be responsible for your own fight against the opponent-the flu.

Do You Have a Preparedness Barrier?

Consider this question. Are you suffering from one of these Preparedness Barriers?

Apathy: “It won’t happen here.” “I won’t worry about this until a threat is imminent.”
Fatalism: “Whatever I do won’t make a difference in the event of a big disaster.”
Not on My Radar: “I just haven’t thought about that.”
Avoidance: “I don’t like to think about that.”
Lack of Information: “I don’t know how to do this.”
Lack of Resources: “I don’t have the money/time.” “I’m unable to do this.”

Now consider this: The likelihood that you and your family will recover from a disaster or emergency event tomorrow often depends on the planning and preparation done today.

Factors such as number of injuries, communication failures and even road blockages can prevent First Responders from being able to reach you. That is why being prepared is so important. Being responsible for knowing what to do before, during and after a disaster enables you to stay safe during the event and allows first responders to assist those in greatest need.

Data shows 90 percent of disaster survivors are rescued by a neighbor. Talk to your neighbors and plan for how you will work together to ensure everyone stays safe in the event of an emergency.

Americans also travel more than ever before. They travel to areas impacted by hazards they may not be at risk for at home. Knowing what to do before, during and after any emergency is a critical part of being prepared and may make all the difference when seconds count, whether you are at home or traveling.

Learn about potential hazardous events both at home and the places you travel to. Familiarize yourself with the signs of events that come without warning and know the local advance alerts and warnings and how you will receive them. Knowing about the local emergency plans for shelter and evacuation, and local emergency contacts will help you prepare for an event.

Prepare a family communications plan, so your children will know how to contact you in case communications between home and school/college are disrupted. Make an emergency information list of names, phone numbers and locations of family members, doctors, medical insurance and other important resources.

It’s important to have the supplies you need to keep you, your family and your pets comfortable and safe in the immediate aftermath of a disaster. Having a preparedness kit in each of the places you spend most of your time will allow you to grab the essentials quickly, if you need to evacuate or even shelter in place. Places like your home, office, school, and vehicle.

You may need to survive on your own after an emergency. This means having your own food, water and other supplies in sufficient quantity to last for at least 72 hours. Local officials and relief workers will be on the scene after a disaster but they cannot reach everyone immediately. You could get help in hours, but it might take days.

Additionally, basic services such as electricity, gas, water, sewage treatment and telephones may be cut off for days, weeks, or longer. Your supply kit should contain items to help you manage during these outages. Find more information on how to build a kit and the essential supplies you should consider at www.ready.gov/build-a-kit

If you have a child going off to college, give their preparedness safety some thought too. Being prepared will help your college student remain safe and calmly deal with emergency situations. They too can have a disaster readiness kit. This can be as simple as a backpack containing items like a flashlight, a small radio, extra batteries, a solar powered or hand-cranked cell phone charger, energy bars, water and first aid supplies. Advise your student to keep their kit in an easily accessible place, like under the bed or on the top shelf of a closet.

Most colleges have emergency plans. Contact the admissions office to get a copy and confirm your child is registered on the emergency notification system, or check the college website.

September is National Preparedness Month.
Make a plan
Build a Kit
Stay informed
Get involved

Break through your Preparedness Barrier!

Make Your Child’s Shots Less Stressful

Vaccines help protect babies and young children against 14 serious diseases. Even though you are keeping your children safe from diseases, it’s hard to see them cry when they get their shots. You can take some steps before, during and after a vaccine visit to ease the pain and stress of getting shots.

Pack a favorite toy, book, blanket or other comfort item. For older children, be honest-shots can pinch or sting, but not for long. Remind them that shots help keep them from getting sick.

Distract your child with a toy, a story, a song, or something interesting in the room. Make eye contact with your child and smile, talk softly or sing. Hold your child tightly on your lap if you can. After the shots, hug, cuddle and praise your child. For babies, swaddling, breastfeeding or a bottle may offer quick relief.

Read about the shots your child will get in advance. Write down any questions you have about the vaccines, so you’ll remember to ask your healthcare provider before the shots. Bring your child’s vaccine record to the appointment, so it can be updated.

Read the Vaccine Information Sheet that you receive from the shot nurse so you know what to expect afterwards.
For instance, some children have a rash, a slight fever or swelling where a shot was given. These reactions are usually mild and resolve on their own without needing treatment.

If you notice redness, soreness or swelling from the shot, place a clean, cool washcloth on the area. If your child runs a fever, try a cool sponge bath. You can also use a non-aspirin pain reliever if your doctor says it’s OK. Some children eat less, sleep more, or act fussy for a day after they get shots. Make sure your child gets plenty to drink.

If you are worried about anything, call your doctor.
Shots can be stressful, but you can ease your children’s discomfort. Keeping up-to-date on vaccines is the best way to protect against vaccine-preventable diseases. Learn more about childhood vaccines at www.cdc.gov/vaccines/parents or call 1-800-232-4636.
You can also call Stevens Traverse Grant Public Health for more information. The number is 320-208-6670.

MOLD: A Problem in Your Home?

Mold in Homes

Given the amount of rain from recent storms, I thought some tips on how to protect your home and ultimately yourself and your family from mold would be helpful.

You will find more complete information on the Minnesota Department of Health (MDH) website. Go to www.health.state.mn.us click on “Topics,” click on “Environments and Your Health.” Scroll down and click on “Healthy Homes in Minnesota, and then “Mold and Moisture.” There are many other topic areas you may find helpful as well.

So what are the Health Concerns of Mold?
Health effects from exposure to mold can vary greatly depending on the person and the amount of mold in their home. Health symptoms that may occur include coughing, wheezing, nasal and throat conditions. People with asthma or allergies who are sensitive to mold may notice their asthma or allergy symptoms worsen. Individuals with severely weakened immune system who are exposed to moldy environments are at risk of developing serious fungal respiratory infections. However the long term presence of indoor mold growth may eventually become unhealthy for anyone. MDH recommends that people consult a medical professional if they are concerned about the effects of a moldy environment on their health.

Are some molds more hazardous than others?
Many molds can produce potentially harmful substances, whether it’s allergens, mycotoxins, or other compounds. Hence, all indoor mold growth should be removed promptly, no matter what type(s) of mold is present or whether it can produce toxins.

How do I tell if I have a mold problem?
Investigate don’t test. The most practical way to find a mold problem is by using your eyes to look for mold growth and by using your nose to locate the source of a suspicious odor. If you see mold or if there is an earthy or musty smell, you should assume a mold problem exist. Mold often appears as discoloration, staining, or fuzzy growth on the surface of building materials or furnishings. Look for signs of excess moisture or water damage: leaks, standing water, water stains or condensation problems. Search behind and under carpeting, wallpaper, vinyl flooring, sinks, furniture or stored items-especially things placed near outside walls or on cold floors.

MDH does not recommend testing for mold. Instead you should simply assume there is a problem whenever you see mold or smell mold odors.

The following information about mold clean-up is lengthy but thorough. To clean up and remove indoor mold growth, follow steps 1-6 as they apply to your home.

1. Identify and Fix the Moisture Problem – the most important step in solving a mold problem
is to identify and correct the moisture source(s) that allowed the growth in the first place. Common indoor moisture sources include:
Flooding
Condensation (caused by indoor humidity that is too high or surfaces that are too cold)
Roof and plumbing leaks
Firewood stored indoors
Humidifier use
Inadequate venting of kitchen and bath humidity
Improper venting of combustion appliances
Failure to vent clothes dryer exhaust outdoors (including electric dryers)
Clothes line drying indoors

To keep indoor surfaces as dry as possible, try to maintain the home’s relative humidity between 20-40 percent in the winter and less than 60 percent the rest of the year. You can purchase devices to measure relative humidity at some home supply stores. Ventilation, air circulation near cold surfaces, dehumidification, and efforts to minimize the production of moisture in the home are all very important in controlling high humidity that frequently causes mold growth in our cold climate.

2. Begin Drying All Wet Materials – as soon as possible after becoming wet. For severe moisture problems, use fans and dehumidifiers and move wet items away from walls and off floors. Check with equipment rental companies or restoration firms for additional equipment or contracting options.

3. Remove and Dispose of Mold Contaminated Materials – items which have absorbed moisture (porous materials) and have mold growing on them need to be removed, bagged and thrown out. Such materials may include dry wall, insulation, plaster, carpet/carpet pad, ceiling tiles, wood products (other than solid wood), and paper products. Likewise, any such porous materials that have been in contact with sewage should also be thrown away. Non-porous and semi-porous materials with surface mold growth may be saved if they are structurally sound (see step 4).

Take Steps to Protect Yourself – the amount of mold particles in air can increase greatly when mold is disturbed. Consider using protective equipment when handling or working around mold contaminated materials. The following equipment can help minimize exposure to mold:
Rubber gloves
Eye goggles
Outer clothing (long sleeves and long pants) that can be easily removed in the work area and laundered or discarded
At a minimum, you should use an N95 or a N100 type disposable respirator. Where mold growth is very heavy or covers an extensive area or if you are sensitive to airborne contaminants, greater respiratory protection may be more appropriate. More protective options include half-face negative-air respirators with a HEPA filter (i.e., N100, P100).

Take Steps to Protect Others – plan and perform all work to minimize the amount of dust generated. Where possible, consider the following actions to help minimize the spread of mold spores:
Enclose or contain all moldy materials in plastic (bags or sheets) before carrying through the home.
Hang plastic sheeting to separate the work area from the rest of the home.
Cover supply and return vents in the work area.
Place fans in windows of work area to pull contaminated air out of the work area and exhaust it to the outdoors.
Operate an air scrubber, which can be rented at cleaning supply companies.
Remove outer layer of work clothing in the work area and wash separately or bag
Damp clean the entire work area to pick up settled mold spores in dust.

4. Clean Surfaces – surface mold growing on non-porous or semi-porous materials such as hard plastic, concrete, glass, metal, and solid wood can usually be cleaned. Cleaning to remove and capture all mold contamination, is very
important because dead spores and mold particles may cause health problems if they are left in place.
Thoroughly scrub all contaminated surfaces using a stiff brush, hot water and a non-ammonia soap/ detergent or commercial cleaner.
Collect excess cleaning liquid with a wet/dry vacuum, mop or sponge
Rinse area with clean water and collect excess rinse water.

5. Disinfect Surfaces (if desired) – after cleaning has removed all visible mold and other soiling from contaminated surfaces, a disinfectant may be used to kill mold missed by the cleaning. In the case of sewage contamination, disinfection is strongly suggested–contact the Minnesota Department of Health for appropriate advice.
Mix 1/4 to 1/2 cup bleach per gallon of water and apply to surfaces where mold growth was visible before cleaning. Apply the solution with a sponge or by other methods that do not over saturate or flood the surface area.
Collect any run-off of bleach solution with a clean and filtered wet/dry vacuum, sponge or mop. However, do not rinse or wipe the bleach solution off the areas being treated — allow it to dry on the surface.

Always handle bleach with caution. Never mix bleach with ammonia — toxic chlorine gas may result. Bleach can irritate the eyes, nose, throat, and skin. Provide fresh air (for example, open a window or door). Protect skin and eyes from contact with bleach. Test solution on a small area before treatment, since bleach is very corrosive and may damage some materials.

6. Remain on MOLD ALERT – Continue looking for signs of moisture problems or return of mold growth. Be particularly alert to moisture in areas of past growth. If mold returns, repeat cleaning steps and consider using a stronger solution to disinfect the area again. Regrowth may signal that the material should be removed or that moisture is not yet controlled.

When can we rebuild?
Rebuilding and refurnishing must wait until all affected materials have dried completely. It may take several days or weeks for building materials to fully dry and return to prior moisture conditions. A moisture meter may help measure drying progress.

Voluteer! Who, Me?

Minnesota Responds Needs You

If pandemic influenza occurred in West Central Minnesota, would you volunteer to help set up a mass dispensing site?

If a terroristic anthrax attack happened in our community, would you volunteer to help get pills into people within 48 hours?

If a tornado destroyed a neighboring community, would you volunteer to help set up temporary shelter to assist the victims?

If the same tornado displaced pets, would you volunteer to help keep the animals safe until returned to their families?

If you said yes to even one of the four questions…….you are the right person to become a Minnesota Responds Volunteer. MnResponds is a partnership integrating local, regional and statewide volunteers to assist Public Health in emergent incidents, community health events and exercises. MnResponds is part of the nationwide Medical Reserve Corps.

Your community needs you. Volunteers are valuable in many types of emergency responses. Registered and pre-trained volunteers are even more valuable.

When an incident occurs, time is often of the essence. If you are a registered volunteer your skills can be quickly matched up with the work that needs to be done. Pre-registration in MnResponds increases efficiency and volunteers have access to training courses before they are needed. Volunteers are notified when needed. You are not obligated to respond.

All types of people and skills are needed: non-medical people from all walks of life, nursing, healthcare, laboratory, veterinary, behavioral and mental health, office support, clergy and health education to name a few.

Being a volunteer can gain you personal satisfaction, make a difference in your community and prepare you for deployment.

Please consider becoming a MnResponds volunteer. Check it out and enroll at www.mnresponds.org or you can call Stevens Traverse Grant Public Health for more information at 320-208-6670.
Thank you from your
Public Health Preparedness Coordinator

Immunization. Power to Protect.

It’s never too early to think immunizations for your baby. Pregnancy is a great time to learn about the vaccines your baby will need. Educate yourself about shots before the excitement of having a new baby.
There is a list of trusted sources at the end of this article.

The diseases vaccines protect against are very real and can be devastating. We’ve done such a good job of vaccinating children in the past that once-common diseases are seldom seen in the United States. So, it’s understandable that some parents may not have heard of some of the vaccines or the serious diseases they prevent. In fact, some doctors have never seen some of the diseases that vaccines prevent. And yet, many of those diseases are just a plane ride away.

An excellent place to start: Immunize Mom to Immunize Baby. There are certain vaccines pregnant women can get to help keep them healthy. The maternal antibodies passed to babies protect them until they are old enough to get vaccinated. Two vaccines pregnant women should always get are whooping cough (pertussis) and influenza. Getting Tdap (tetanus, diphtheria, pertussis) vaccine during (every) pregnancy makes it less likely a woman will have whooping cough during the time when her baby is most at risk, which is the first new months. 90% of whooping cough deaths are in infants younger than four months. Babies of women who received the flu vaccine during pregnancy are more likely to be born full-term and at a healthy weight. Once a child is old enough to be vaccinated (2 months), it is important to follow the recommended immunization schedule to continue that protection.

Parents need to vaccinate on time, every time. Delaying or skipping immunizations puts children at risk for serious disease. Vaccines are thoroughly tested before they can be recommended and used. They are continually monitored by doctors, researchers and public health officials after licensed and in use. Vaccine manufacturers have refined the process of making vaccine, which means that even though babies get more vaccines today, they actually get fewer antigens than they did decades ago.

Infants are exposed to thousands of germs every day. The antigens in vaccines are just a drop in the bucket compared to what their bodies handle on a daily basis. Some babies may experience side effects of a healthy immune response, such as low-grade fever or fussiness, but vaccines do not cause the severe illness of the disease itself. Severe side effects are extremely rare and study after study conducted over the past ten years has shown that vaccines do not cause autism.

Here are six excellent sources for more information regarding vaccines for pregnant women, infants and children. (Don’t forget teens and adults need vaccinations too.)
*American Academy of Pediatrics: www.aap.org
*Centers for Disease Control and Prevention: www.cdc.gov/vaccines
*Every Child By Two: www.vaccinateyourbaby.org
*National Network for Immunization Information: www.nnii.org
*Vaccine Education Center: www.vaccine.chop.edu
*Immunization Action Coalition: www.vaccineinformation.org

The Minnesota Vaccine for Children program has free vaccine for infants and children, if families qualify. Call Public Health at 320-208-6670, or your clinic, to get more information about vaccines and to see if your child qualifies for MnVFC.

Marcia Schroeder RN
Disease Prevention and Control
Stevens Traverse Grant Public Health

National Infant Immunization Week is April 20-27, 2013. “Immunization. Power to Portect.”

“Nora” (the) Virus

Meet Norovirus – The Perfect Infection
As Sheila’s “guest author” today, let me introduce myself. I’m Nora, officially known as norovirus. People sometimes mislabel me as stomach flu – a pet peeve; and I’m not even related to influenza! If you can’t remember my name, at least call me “acute gastroenteritis”, meaning a heck of a lot of vomiting, diarrhea, and abdominal cramping – my specialty. I’m here today to tell you why I’m the best darned virus that ever lived –from my perspective at least, although maybe not from yours!

Norovirus – the Perfect Design
Let me describe myself. I’m slim and trim at only 30 nanometers (0.03 microns) – svelte even for a virus. Influenza is three times my size! Compared to chunky bacteria like E coli at 1500 nanometers – well, I’m truly microscopic. My physique allows me to slip right through just about any water filtration system out there (only nanofiltration systems block me). Once in your water supply, filters rarely get me out!
I keep my figure because I lack a lipid envelope (lipids are fat, don’t you know?). Without lipids, alcohol based sanitizers and detergents don’t faze me. My peers in the germ family have tricked humans into believing that hand sanitizers replace hand washing. Well, hand sanitize all you want. I only worry when I see a sink and soap coming at me– they mean a long damp trip down the drain! But even then, I often sneak by. 80% of people report washing their hands according to recommendations (at least 20 seconds, all hand surfaces, good lather, and friction from rubbing – the stuff that gets rid of me), but hidden camera studies show only 18% actually do this. Good for me, but not for you!
Did I mention I’m tough? My job skills include high endurance and patience. I contentedly hang out on surfaces for weeks or longer, just waiting for a sucker to come along. Some of my favorite resting spots include anything in the bathroom, doorknobs, soiled linens, counter tops food, and food containers. When I spot a chance, I grab a hand, transfer to a mouth, and voilà – target reached!
I have very few mortal enemies. One is boiling water, and the other is bleach, but even then I put up a good fight. You’ll need 5-25 tablespoons of household bleach per gallon of water (5.25%) to kill me on a surface – even more if the solution sits around for more than a day. No wimpy bleach solutions can take me down! People target me with special bleach based cleaners as well, which seems silly. I freely confess that household bleach kills me, so why spend a bunch of money on something that might not work as well? Oh well – that’s capitalism for you!

Noroviruses are great team players. We’re good at infection; we infiltrate and make you sick with a team of only 10-100 viruses. Our methods are top-secret – in fact, no one has figured out how to grow us in a lab for study. I will reveal that we head for your gut and wreak havoc. First of all, we replicate, replicate, and replicate. In 12-48 hours, we make billions of copies of ourselves – no exaggeration! Then we party hardy. Noro, Norah, Norman, Norma, Noreen, Norris, Norbert, Northcliff (he’s visiting from Australia), and I literally bring you to your knees.
We convince your stomach and intestinal cells to dump large amounts of fluid into your gut, then trigger violent diarrhea and vomiting to get rid of it. We speed up passage from below, while simultaneously slowing down stomach emptying. You accumulate a nauseating volume of fluids and food before spewing out your mouth. It’s all pretty uncomfortable, but hang in there! At least we don’t cause much fever or respiratory symptoms.
Why this torture? It’s just a norovirus plot to take over the world. We dump billions of copies into your emesis and feces. When you “expel”, you help spread our copies around. The more violent your diarrhea or barfing, the more you splatter us around the bathroom (or wherever you may be). We have a special talent in creating small droplets of air bound vomit and virus, which travel quite a ways before settling on a new surface.
One recent success was a girls’ soccer team. While travelling, one girl got sick, was quickly isolated, and then sent home. A few days later, her teammates became ill, although they had no contact with her. Magical, you might say! Actually, there was a bag of snacks in her bathroom. Our aerosolized vomit contaminated the bag, and then just waited until the other girls had a snack attack a few days later.

Norovirus – a Considerate Virus
We try not to make you too sick. If we kill off our victims, who will pass us around? We make you miserable for 24-48 hours, and then move on. We don’t choose our targets – we attack whoever ingests us. Unfortunately, this can mean young children, elderly, or the chronically ill. They can’t handle fluid loss and sometimes need intravenous fluids. But give us credit –we kill very few compared to many viruses! 20% of you actually resist us, although the credit lies in your genetic code. The others can’t keep up with our mastery of disguises (rapid mutations and multiple variations). We infect you again and again.

Norovirus – Our Favorite People
I love people who refuse to stay home when sick. They voluntarily transport my viral team around restaurants, nursing facilities, hospitals, cruise ships, and schools. One sick kid in school (maybe mom lacks child care?) can infect everyone – kids are usually not very clean. A sick food handler can pass us to everyone eating there. Currently, we cause over 50% of food-borne illness in the United States. Pretty good for such a tiny thing – don’t you agree?
I love nurses and aides that spread us around facilities. Dedicated healthcare workers rarely stay home even when throwing up, let alone for 2-3 days after symptoms resolve. Our master plan includes sticking with victims several days after they feel better, just to continue shedding virus with every bathroom trip – pretty clever, eh? If they slack off on hand washing when symptoms improve, we still spread! Sick patients and sick caregivers happily transfer us from room to room. We sickened 265 healthcare workers in just one hospital in 2004.

Norovirus Loves Disasters
I love disasters. Crowded shelters are like Candy Land – everyone living only a few feet apart and sharing limited bathrooms (if they even make it to the bathroom). Hand washing drops off the map midst the worries and cares – and people touch everything! In a mega shelter complex after Hurricane Katrina, we sickened 11,000 victims in 11 days (maybe more – they counted only clinic patients). A textbook example of person to person transmission!
Disasters provide us great access to your food. Cooking kills us, but we love hitching rides on fresh produce, shellfish, and ready-to-eat food. Communal kitchens and food distribution centers can distribute us as well – directly from food to your mouth. Just one volunteer with poor hygiene or sloppy cleaning allows food borne transmission – another favorite strategy!
Contaminated water provides another disaster hang-out. With sanitation off-line, people turn to things like plastic bag and bucket toilets or home-made latrines in the yard. We sneak from sewage disposal to near-by water sources, particularly if flood waters or rains help us along. Once in your water, boiling is the only way to kill us. Filters, disinfectants, and solar disinfection (SODIS) – not effective! Plus, if you rinse produce or dishes with infected water – we’re back on your food – a double whammy! (Side note – did you know we survive in ice cubes? Just another example of our superiority!

Norovirus – Keeping Me Away

If you don’t want to party with us, what can you do? Wash your hands – especially after using the toilet or changing diapers, and always before eating or preparing food. Do it right – hum Happy Birthday, Twinkle Twinkle, or another favorite ditty while scrubbing soap on every hand surface. Don’t touch the faucet or doorknob after washing – I’m waiting to jump back on. Keep a paper towel handy for those things. Hand sanitizers are better than nothing (at least you’ll kill some other germ buddies), but choose soap and water when possible. Always rinse fresh produce – who knows what it was irrigated with?

Norovirus – When You Are Sick
Despite your best efforts, I’ll still get you sooner or later. I’m pretty clever, and all it takes is one careless food preparer. Just keep the fluids up and you’ll be better soon. Young kids get screwed up chemistry with fluid loss, so give them oral rehydration fluids like Pedialyte when available. For adults, the type of fluid doesn’t matter as much – just avoid caffeine, alcohol, and sugary things which make diarrhea worse. Watch for signs of dehydration, like dizziness when standing, dry mouth, and decreased urination. Get thee to a doctor if these occur! I don’t want to kill you. It’s best to avoid medications for diarrhea or nausea unless prescribed by the doctor.
When sick, the best way to block my plan for world domination is isolation. Stick to one bathroom and one bed. Don’t share anything. Wash hands after every bathroom visit, and immediately disinfect contaminated surfaces with strong bleach solutions. Soiled clothing and linens should be washed immediately with detergent, using the longest cycle length and hottest water possible, followed by machine drying – remember, I’m a tough little bug. Wear gloves, and don’t agitate clothes (meaning don’t shake or throw them around, as opposed to getting them upset). This keeps me from flying around the room. When feeling better, go on a bleach cleaning spree.
Keep away from food preparation while sick and for several days afterwards. Don’t be a conscientious employee. Stay home a few more days and let others struggle without you (and me). Productivity will be higher with one sick employee than with many. Attention employers: paid sick days save you money in the long run if it keeps me from getting a foothold in your business!

Norovirus – Preventing Disaster Epidemics
In a disaster setting, drink only boiled or bottled water during diarrhea outbreaks. Use boiled water for hand washing, food preparation, and dish washing. Keep several bottles of bleach in your emergency stores for decontaminating surfaces touched by outsiders (or sick insiders). Try to avoid areas where others congregate during outbreaks.
For disaster workers or volunteers, your personal hygiene can make or break it for literally thousands. Wash your hands frequently. Don’t work during or for several days after diarrheal illness. No one is indispensable enough to warrant spreading my noros around a disaster scene. In shelters, health facilities, and food/water preparation or distribution areas, learn and practice procedures for controlling disease transmission. Shelters should have plans to isolate infected patients with separate sleeping areas and toilets. If written procedures aren’t available, listen for alarm bells in your head – this may not be a safe setting for disaster victims or for you, although my virus compatriots and I will love it.
Have I convinced you that norovirus is the perfect virus – nearly indestructible with a well thought out plan for conquering the world? Watch for us – we’ll be coming to hands near you soon!

Stay safe,
Sheila Sund, M.D.