Norovirus: A Must-Read For Every Traveller

Montezuma’s Revenge, Bali Belly, stomach flu. Call it what you like, gastro and vomiting is highly contagious and rampant in winter. Here’s what every traveller needs to know.

Bernard O'Riordan

The dreaded stomach bug – medically known as Norovirus – can strike anyone, anywhere and at anytime. Whether you’re a backpacker or a luxury traveller, young or old, the virus doesn’t discriminate.

When it hits, the attacks are often swift and brutal with bouts of nausea, vomiting and diarrhoea that leave you weak and exhausted.

It happened to me on a visit to San Francisco in 2018, where I spent more time on the bathroom floor than I did exploring the streets.

The severe bouts of diarrhoea and nausea struck around 3am and the next several hours became an exhausting bed-to-toilet-to-bed proposition.

It embarrasses me when I think of how I single-handedly destroyed the bathroom linen at that hotel, which shall not be named. But if recent stories are anything to go by, I’m not the only one who has punished the porcelain while travelling.

The winter vomiting bug also swept through the 2018 Pyeongchang Winter Olympics  and caused a sharp jump in hospital admissions across the UK.

About 70 per cent of cases are linked to poor hygiene by food handlers.

In the United States and Britain, about 80 per cent of outbreaks usually occur between November and April, which is why it’s commonly called a “winter vomiting illness”. In Australia and New Zealand, the peak period is usually between May and October.

The reason norovirus comes into its own in winter is because people are indoors, in closer proximity to each other with the heating on, which makes it easier for the virus to spread person to person.

But the truth is, Norovirus can strike unsuspecting travellers at any time of the year.

According to the Center for Disease Control and Prevention (CDCP), norovirus causes between 19 million and 21 million cases of acute gastroenteritis in the US every year, meaning inflammation of the stomach or intestines or both.

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Cruise Ships 

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Judging by the number of onboard outbreaks we hear about each year, cruise ships must surely rank as one of the hot spots for contracting norovirus.

At least 277 people on Royal Caribbean’s Oasis of the Seas were flattened by the virus during a seven day cruise in January 2019, while a year earlier the virus caused havoc on a cruise ship travelling from Costa Rica to San Diego.

And around 16,000 cruise ship passengers fell ill in separate outbreaks in 2016 and 2017 on a Carnival Cruise departing Australia.

Given these horror stories, it’s hardly surprising that 37 per cent of Australians in a recent poll said their biggest fear about cruising was not falling overboard or losing their luggage – it was getting norovirus.

On the face of it, it’s not hard to see why people are afraid of falling ill on a cruise. Close quarters where lots of people are touching the same objects – handrails, buffet utensils, elevator buttons – makes it seem like an obvious breeding ground for germs.

But the truth is, you have a much greater chance of contracting the virus on land (1 in 15) than you do during an onboard outbreak (1 in 5,500), at least according to the CDC.

It’s just when an outbreak does occur onboard, it often affects more people and it’s more newsworthy because it involves conflict and anger, and often class actions.

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Farm To Fork

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About half of all food poisoning cases are caused by Norovirus, with 70 per cent linked to food handlers who have no idea they are infected. Or worse still, food handlers who go to work sick because they can’t afford to take sick leave.

If somebody doesn’t wash their hands thoroughly after going to the bathroom, they can pass the illness on through food they touch.

But the virus can easily find its way to your food at any point from farm to fork due to bacteria lurking in the ground where produce is grown – often caused by animal faeces in the top soil – or contaminated irrigation water.

Some foods are more commonly associated with outbreaks than others, including leafy greens like lettuce and spinach, fresh fruits and oysters. No matter how much you enjoy these foods, sometimes it’s best to avoid them while you are travelling to avoid falling ill.

Most recently, people were warned to avoid eating romaine lettuce in the US after 32 people fell ill across 11 states. (I can almost certainly put my experience in San Francisco down to a dodgy Cobb salad I’d eaten several hours earlier.)

However, any food that is raw or handled after being cooked can become contaminated, particularly when there’s poor hand hygiene.

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Public Transport

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Public transport is an obvious hotspot for picking up nasty bacteria, including e. coli.

A study found that grabbing a handrail on the New York subway, where on average 5.5 million people ride each day,  is like shaking hands with 10,000 people. San Francisco’s BART didn’t fare much better.

A separate study by Weill Cornell Medical College found commonly identified DNA thriving in the subway system.

While many were harmless, they did identify bacteria that causes food poisoning and urinary tract infections.

As any frequent traveller will know, trains, streetcars, buses and taxis are all awash with germs, including highly-contagious strains commonly found in human and animal faeces.

Tourists often become sick by touching surfaces like handrails or doorknobs that have been contaminated, and then put their fingers to their mouth.

That’s why it’s so important to wash your hands regularly with soap when you travel, especially before you eat.

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What Every Traveller Needs To Know 

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What Is Norovirus?

Otherwise known as the winter vomiting bug, Norovirus is a highly contagious and unsavoury bug that usually lasts one to two days. Norovirus has as many as 25 strains and it is very hard to distinguish between them. The global economic burden of norovirus is US$60 billion each year, according to new estimates drawn from studies of the disease and its impact.

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How Is It Spread?

Norovirus is highly contagious and can be spread by coming into close contact with someone who is infected, consuming contaminated food and drink, and touching contaminated surfaces or objects and then touching your mouth. Highly populated places like public transport, cruise ships, nursing homes and schools are popular breeding grounds for the virus.

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What Are The Symptoms?

It takes 12-48 hours for the symptoms to begin. It will take hold of the stomach first, before arriving in the small intestine, which is where most of the damage takes place as the particles that bring on nausea and a sensation of feeling sick multiply. The virus will usually make you feel ill for as long as 48 hours, with symptoms of watery diarrhoea and vomiting as the immune system’s natural defence mechanisms attempt to cleanse the body of the toxins. Other symptoms may include stomach cramps, abdominal pain, tiredness and a fever. Lots of travellers typically suffer diarrhoea, but Norovirus is a whole different ball game, and you’ll know it.

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Is It Deadly?

While you might spend a day or two wishing you were dead, the chances of long-term harm from Norovirus are extremely low if you are otherwise healthy. The people most at risk from Norovirus are babies, the elderly and people with impaired immune systems (those said to be immunocompromised). Those people should seek expert medical advice. Norovirus does cause 800 deaths a year, globally, so it’s no laughing matter.

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What Do I Do If I Get It?

Unfortunately, antibiotics don’t work, so drink plenty of fluids and electrolytes to balance salts in your body and stay hydrated. Taking anti-diarrhoea medicines can ease symptoms, while paracetamol can help with aches and pains. It’s important to get plenty of rest and eat plain foods that won’t upset your stomach, such as bread and rice. With Norovirus you could be spreading the virus to others for up to 21 days, even after your symptoms have eased. So it’s vital to keep up regular hand washing with soap and avoid visiting nursing homes, schools or other places where vulnerable people could become infected.

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How to Avoid Norovirus While Travelling

• Wash your hands regularly with soap and water. Norovirus is not killed with hand sanitiser, so it's vital you practice thorough hand-washing;

• Keep your hands away from your mouth (keeping your hands away from your eyes and nose will help prevent the transmission of cold and flu viruses as well);

• Don’t eat on public transport where bacteria is rampant;

• If you put your bag on the seat or floor, don’t then place it on a surface where food is prepared;

• Resist the urge to eat from a buffet where the food may have stagnated for some time or been touched by many others before you;

• Avoid using in-room ice buckets without plastic inserts. Don't risk the ice unless you know that it was made from clean water.

• Buy an anti-bacterial spray and thoroughly spray your hotel bathroom before use, including door and tap handles.

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(This blog was updated on January 12, 2019)

© 2019 Bernard O’Riordan (Travel Instinct). All Rights Reserved 

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