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  • Writer's pictureMorgan Rose, CNM, WHNP-BC, IBCLC

Norovirus and Shigella: Navigating the Stomach Bug Battle in Schools and Daycares

We acknowledge and empathize with parents who have received distressing news from daycare or school that their child has contracted the stomach flu. Unfortunately, despite reaching a peak in February, cases of Norovirus, a viral infection affecting the stomach, are still circulating. Furthermore, Shigella bacterial infections are also increasing, compounding the challenges for parents.

According to a study published in the Journal Pediatrics in 2022, Norovirus and Shigella are the primary culprits behind acute gastroenteritis outbreaks in schools and childcare facilities. The study sheds light on the prevalence of these infectious agents and highlights the need for effective measures to prevent and control outbreaks in these settings.

To curb the spread of Norovirus and Shigella, some school districts recommend that sick children stay home for 48 hours after their symptoms have ceased, resulting in more missed school or daycare days. Although both illnesses exhibit similar symptoms, such as diarrhea, vomiting, low-grade fever, cramping, and nausea, classified under general terms such as 'stomach flu' or 'stomach bug,' it is crucial to differentiate between a viral or bacterial infection and determine the appropriate course of action. Experts guide how to distinguish between Norovirus and Shigella infections and when to seek antibiotic support.

Distinguishing between Norovirus and Shigella can be confusing. Shigellosis is a bacterial infection caused by the Shigella spp bacterium, while a group of single-stranded RNA viruses causes Norovirus.

Norovirus and Shigella share similar symptoms, such as nausea, cramping, diarrhea, and vomiting. A stool sample is the most reliable method to identify the type of infection. However, doctors may diagnose the illness based on the patient's symptoms, duration, and the prevalence of either infection in the region.

Children with Norovirus typically experience vomiting, while adults may experience diarrhea more often, according to Roger Seheult, MD, a quadruple board-certified doctor in internal medicine, pulmonary diseases, critical care medicine, and sleep medication and medical advisor for Intrivo. Here are the common symptoms associated with Norovirus:

  • Diarrhea

  • Vomiting

  • Nausea

  • Stomach pain

In addition to the typical symptoms of nausea, cramping, diarrhea, and vomiting, Norovirus may also rarely cause fever, headache, and body aches. In children, Shigellosis watery diarrhea is the usual symptom.

Shigellosis may also manifest with the following symptoms:

  • Diarrhea containing blood or mucus

  • Abdominal cramps

  • Fever

  • Loss of appetite

  • Nausea and vomiting

  • Painful bowel movements

  • Tenesmus is the sensation of needing to defecate even if the bowels are empty.

Although there are only minor differences in symptoms between Norovirus and Shigella, a few notable distinctions exist:

  • Shigella infection may be more likely to present with a fever.

  • Norovirus usually begins with vomiting, and diarrhea may follow, or both may appear simultaneously, according to Dr. Marci Drees, Chief Infection Prevention Officer at ChristianaCare, as reported by ABC6 News.

  • Dr. Drees states that Shigella infection typically presents mainly as diarrhea, with vomiting being less common.

  • Norovirus generally lasts one to three days, while Shigellosis may persist for five to seven days.

  • Both Norovirus and Shigella can remain in the stool for days or even weeks after symptoms subside, despite Shigella being able to persist for a more extended period.

According to a study in Pediatrics conducted between 2009 and 2019, there were 4,633 outbreaks of Norovirus and Shigella, but the actual number may be higher due to many unreported cases. Of these outbreaks, about 51% were caused by Norovirus, and approximately 16% by Shigella spp.

Regarding outbreak settings, the study found that viral outbreaks accounted for approximately 65% of school outbreaks and 37% of childcare settings. In comparison, bacterial outbreaks accounted for 10% of schools and 41% of childcare settings. Therefore, the study authors recommend focusing on preventive measures such as handwashing, cleaning and disinfecting with effective products, and excluding ill children and staff.

At home, it is recommended to bleach common surfaces and bathroom fixtures regularly, wash soiled laundry and linens in hot water, and practice frequent handwashing to prevent the spread of infections among family members. If a family member is sick, they should avoid preparing food for others, and if that's not possible, they should wash their hands thoroughly for at least 30 seconds with soap and hot water. Hand sanitizer is not effective in preventing Norovirus, and using soap and water is the best option for either illness.

Reference: Pediatrics. (2022). Norovirus and Shigella Outbreaks in Child Care Settings and Schools: United States, 2016-2018. Pediatrics, e2021046311.


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