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http://www.boston.com/dailyglobe2/007/metro/Norwalk_stomach_virus_hits_area_hard+ .shtml Norwalk stomach virus hits area hard 186 cases reported at one care center By Stephen Smith, Globe Staff, 1/7/2003 Public-health authorities in Boston are tracking more than 700 cases of Norwalk virus, an unusually extensive outbreak of the same condition that recently afflicted cruise-ship passengers with roiling stomachs and aching heads. In the past six weeks, the Boston Public Health Commission has investigated 17 separate outbreaks of Norwalk, with 186 people falling ill at one long-term care center alone. Typically, the agency would expect fewer than five clusters in a comparable period. The experience in Boston mirrors a spike across the state - and in New York City - of an illness whose onset is marked by diarrhea, vomiting, and nausea. ''We'd almost call it an epidemic level,'' said John Auerbach, executive director of the Boston Public Health Commission. ''You can't miss it because it has such horrible symptoms. It comes and goes in about 48 hours, but people who have it say it's the worst 48 hours of their life.'' Norwalk - named for the small city southwest of Cleveland where the virus was first identified more than three decades ago - rarely causes death or serious illness, despite its unpleasantness. And while the clusters of cases identified so far have been restricted chiefly to nursing homes, rehabilitation centers, and hospitals, disease trackers said yesterday they believe the virus is also striking many members of the general public across the state. The 700 cases reported in Boston likely are only a narrow snapshot of the illness being caused this winter by Norwalk. Most individual cases are never reported to health authorities, who predicted yesterday that the virus will continue to circulate through the winter. ''I think it's probably fair to extrapolate that there's more Norwalk disease occurring in the community as a whole right now and not just in the nursing-home population,'' said Dr. Bela Matyas, medical director of the epidemiology program at the Massachusetts Department of Public Health. While the agency does not keep a specific tally of cases, Matyas said his investigators have noticed an increase in reports of the viral illness. Norwalk is spread person-to- person, through a handshake or even a caring pat on the shoulder. The cascade of infection most often begins when people don't wash their hands after using the toilet. ''This is a completely preventable disease,'' Matyas said. ''If you observe people's behavior in public bathrooms, it's frightening how many people come out of a stall and don't wash their hands.'' A hearty microbe, the virus has forced the closure of hospital wards and schools in North America and the United Kingdom in recent months, and New York health authorities are investigating whether patients hospitalized with stomach ailments are cases of Norwalk. Health authorities in Boston first became concerned in late November when a spate of Norwalk cases was reported - the same time period when hundreds of people aboard cruise ships came down with classic symptoms of the viral illness. Federal infectious- disease specialists speculated at the time that the bouts of illness on cruise ships were likely reflecting the march of the virus through North America, and the cases in Massachusetts and elsewhere in the Northeast appear to confirm those suspicions. Of the 17 outbreaks identified in Boston, three have been in hospitals, but those cases were confined to health-care workers and did not require that wards be closed or other drastic measures, said Dr. Anita Barry, director of communicable disease control at the Boston Public Health Commission. Public-health nurses were dispatched to the nursing homes and other chronic-care facilities reporting outbreaks of illness, where they attempted to figure out how the outbreaks began and how they could be stopped. At the chronic-care facility with the 186 cases - neither city nor state health authorities would disclose the name of any of the facilities, citing patient confidentiality - residents and workers started falling ill in mid- December, with the virus rampaging for seven days. ''One thing this speaks to is the ease of transmission of these Norwalk viruses,'' Barry said. ''You don't need a lot of virus particles to get yourself sick.'' Sometimes, the virus is spread through food, when someone who's infected prepares a meal, causing it to be tainted. But disease investigators have no evidence implicating sullied food in the recent outbreaks. For most people stricken with Norwalk, treatment is limited to downing ample fluids, taking aspirin, and swallowing anti-nausea medications. People can be hospitalized if they become dehydrated. ''Any diarrhea or vomiting or nausea illness could potentially get serious in a very frail or elderly or seriously ill person,'' said Dr. Ron Walls, chairman of the department of emergency medicine at Brigham and Women's Hospital. ''But for most people, it lasts a couple of days and then it just goes away on its own.'' Explanations for the outbreak vary, with disease specialists suggesting that it may indicate new strains of the virus in circulation as well as increased awareness of its existence. Paul Maxwell and his girlfriend became all too aware of Norwalk on New Year's Eve. They'd gone to the Roxy nightclub in Boston's theater district to welcome the dawn of 2003. But Maxwell's girlfriend wound up marking the holiday in their room at the hotel that houses the nightclub. ''All of a sudden, it just happened - no warning, nothing,'' Maxwell said. ''She didn't know what hit her. You don't know whether you're coming or going. All you know is you are really down.'' Stephen Smith can be reached at [EMAIL PROTECTED] This story ran on page A1 of the Boston Globe on 1/7/2003. © Copyright 2002 Globe Newspaper Company. A<:>E<:>R ~~~~~~~~~~~~~~~~~~~~ Forwarded for your information. The text and intent of the article has to stand on its own merits. 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