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Few things can spoil a getaway in the sun like a sudden GI bug. Acute gastrointestinal infectious illnesses, spread by food and water or hand contact, take many forms. These infections are divided into pre-formed toxin syndromes or infections that are bacterial, viral, or parasitic in origin.   

Ingestion of a pre-formed bacterial toxin—like the one produced by Clostridia, Bacillus cereus (found in reheated Chinese rice) or the toxin produced by Staphylococcus aureus—may cause patients to become violently ill, with vomiting, diarrhea, cramping, fever, and neurological symptoms, usually within a window of hours to a day after ingesting the pre-formed toxin. Fish and seafood (especially raw) are frequent culprits in this category.  Many pre-formed toxins are inactivated with heat. Avoiding uncooked foods known to harbor bacteria that produce these toxins, especially seafood, will reduce the likelihood of illness from a pre-formed toxin.

Viral infections of the gut, such as Rotavirus in children or Norovirus, usually take one to three days to cause symptoms.  You can decrease infections from these viruses by meticulous hand-washing and/or use of alcohol- or chlorine-based cleansers. These viruses are spread by the fecal-oral route. Supportive treatment includes lots of fluids containing sugar and electrolytes (Gatorade, Pedialyte), antidiarrheals (Pepto-Bismol, Imodium), and a BRAT (Bananas, rice, applesauce, and toast) diet. In severe cases, hospitalization for intravenous fluids may be needed.

Norovirus is a viral pathogen that deserves special mention because of its prevalence; it affects hundreds of millions of people each year. Its name derives from Norwalk, Ohio, where an elementary school suffered a large outbreak in 1968. Fortunately, it is almost always self-limiting and non–life-threatening, but it may decimate the vacations of hundreds of people in one fell swoop. And unfortunately, unlike the case with other viral infections, one is not left with long-term immunity to this virus.

Norovirus spreads like wildfire in contained places such as cruise ships and sleepaway camps through the fecal-oral route—either by hand contact or by contaminated food and water.  One infected food-handler with poor hand hygiene can infect hundreds of people.  Stairway banisters and self-serve buffet lines have been documented to harbor this virus and pose a risk for spreading it.  When you’re on a cruise ship, use the hand disinfectants provided by the staff, and use them frequently. With this particular bug, chlorine-based cleansers seem to be more effective than alcohol-based solvents. More information on Norovirus can be found at

Studies have been done focusing on cruise-ship hygiene. This study, reported in the Clinical infectious Diseases Journal, examined 56 vessels over three years. Names are usually withheld in these studies, however, since cruise lines would likely not otherwise allow the study.  Overall, the major cruise lines are tuned in to the problem and do educate their staff aggressively on safe food-handling procedures.  

One outbreak can be extremely costly to a cruise line in refunds and negative press.  I recently took a cruise and found squirt-bottle-bearing staff at every corner, especially near the dining areas, offering this wise advice: “Washy washy happy happy!”

 10706_loresNorovirus. (Source: Centers for Disease Control and Prevention.)

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