One health problem of Thai children that worries parents is diarrhea or inflammatory bowel disease, which originates from various causes including viral infections, bacterial infections, drug allergies, food allergies, infections in other body systems, as well as surgical emergencies such as appendicitis and intussusception. However, the main cause of diarrhea in Thai children that caused a severe outbreak in early 2018 was Norovirus infection.
Getting to Know Norovirus… The Cause of “Diarrhea” in Children Worldwide
Norovirus, formerly known as Norwalk-like virus, is one of the leading causes of diarrhea outbreaks worldwide. This virus enters the body through consuming contaminated food or water, contact with contaminated surfaces such as plates, spoons, or even children sucking their fingers. Children infected with Norovirus may have symptoms of gastroenteritis alone or both gastritis and enteritis.
If Your Child Has These Symptoms, Do Not Take It Lightly
Children infected will present with vomiting or watery diarrhea, with symptoms occurring suddenly within 24-48 hours after infection, leading to dehydration that may require hospitalization. Additionally, children may have these symptoms:
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- Nausea and quite severe vomiting
- Watery diarrhea
- Abdominal pain, usually not localized or cramping in the abdomen
- May have low-grade fever, some cases have high fever of 38-39 degrees Celsius
- Headache, fatigue, body aches
Severe Symptoms Like These, See a Doctor Immediately
1. Passing large amounts of watery stool along with vomiting, unable to eat, leading to moderate to severe dehydration
2. Passing stool with mucus and blood along with high fever
3. Passing watery stool and/or mucus and blood, along with risk factors for bloodstream infection such as low urine output, altered consciousness (lethargy, restlessness), cold extremities, rapid and weak pulse, etc.
4. Abdominal pain with tenderness on palpation or rigid abdomen, vomiting bile-stained fluid, should consider surgical diseases such as appendicitis, intussusception, or intestinal obstruction
Norovirus Testing… Available Only in Some Hospitals
These symptoms indicate severe illness, severe dehydration, or the need to consider other diseases including surgical causes, which require physical examination by a doctor, additional laboratory tests, and urgent treatment. The doctor will collect stool samples for laboratory testing to detect Norovirus, a special lab test not available in all hospitals.
Treatment Guidelines… When Infected with Norovirus
Currently, there is no specific antiviral medication for this virus. Treatment is supportive care, and most cases improve within 3-7 days.
Cases with Mild Symptoms and No Severe Dehydration
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- Provide oral rehydration solution (ORS) by sipping frequently. If the patient begins to show mild dehydration, oral rehydration solution should be given at 30 – 90 milliliters per kilogram of body weight, sipped in small amounts over 3 – 4 hours to replace lost fluids and electrolytes. To prevent dehydration and electrolyte loss, give 10 milliliters of ORS per kilogram of body weight each time after vomiting or diarrhea.
- Eat soft foods in small amounts but frequently
- Give symptomatic treatment such as antiemetics and pain relievers for abdominal pain
- No need for antibiotics except in cases of severe bacterial infection, infants under 6 months infected with Nontyphoidal salmonella, or immunocompromised patients
Cases with Severe Symptoms or Severe Dehydration
Those with severe symptoms will have severe vomiting or diarrhea, very poor oral intake, or severe dehydration which may cause danger from fluid and electrolyte loss leading to shock and low blood pressure. If these symptoms occur, hospitalization is required for intravenous fluids, symptomatic treatment, and close monitoring. Special care is needed for:
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- Children under 6 months old, young children, or the elderly
- Patients with underlying diseases
- Patients with severe symptoms, vomiting more than 4 times per day or diarrhea more than 8 times per day
Currently, there is no vaccine for Norovirus, but infection can be prevented by maintaining hygiene, eating freshly cooked food, using serving spoons, and washing hands before eating and after using the restroom, which helps reduce infection and transmission.
