tag:theconversation.com,2011:/africa/topics/gastroenteritis-4561/articlesGastroenteritis – The Conversation2024-02-15T03:31:18Ztag:theconversation.com,2011:article/2235412024-02-15T03:31:18Z2024-02-15T03:31:18ZHow worried should I be about cryptosporidiosis? Am I safe at the pool?<figure><img src="https://images.theconversation.com/files/575532/original/file-20240214-30-7bq8q2.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C998%2C559&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bright-aqua-blue-swimming-pool-students-2124280826">LBeddoe/Shutterstock</a></span></figcaption></figure><p>You might have heard of something called “<a href="https://www.abc.net.au/news/2024-02-13/nsw-health-alert-cryptosporidiosis-cases/103460468">cryptosporidiosis</a>” recently, closely followed by warnings to stay away from your local swimming pool if you’ve had diarrhoea.</p>
<p>More than 700 cases of this gastrointestinal disease were reported <a href="https://www.health.qld.gov.au/newsroom/doh-media-releases/rapid-increase-in-cryptosporidiosis-cases-hits-queensland">in Queensland</a> in January, which is <a href="https://www.theguardian.com/australia-news/2024/feb/13/avoid-swimming-pools-if-youre-part-of-australias-surge-in-diarrhoea-cases-say-authorities">13 times more</a> than in January last year. Just under 500 cases have been recorded in <a href="https://www.health.nsw.gov.au/news/Pages/20240213_00.aspx">New South Wales</a> this year to-date, while <a href="https://www.health.vic.gov.au/health-advisories/increase-in-cryptosporidiosis-cases-across-victoria">other states</a> have similarly reported an increase in the number of cryptosporidiosis infections in recent months.</p>
<p>Cryptosporidiosis has been listed as a <a href="https://pubmed.ncbi.nlm.nih.gov/12725505/">national notifiable disease</a> in Australia since 2001.
But what exactly is it, and should we be worried?</p>
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Read more:
<a href="https://theconversation.com/what-lies-beneath-the-bugs-lurking-in-your-swimming-pool-51028">What lies beneath: the bugs lurking in your swimming pool</a>
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<h2>What causes cryptosporidiosis, and who is affected?</h2>
<p>Cryptosporidiosis is the disease caused by the parasite <em>Cryptosporidium</em>, of which there are two types that can make us sick. <em>Cryptosporidum hominis</em> only affects humans and is the major cause of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133686/">recent outbreaks in Australia</a>, while <em>Cryptosporidium parvum</em> can also affect animals. </p>
<p>The infection is spread by spores called oocysts in the stools of humans and animals. When ingested, these oocysts migrate and mature in the small bowel. They damage the small bowel lining and <a href="https://www.cdc.gov/parasites/crypto/general-info.html">can lead to diarrhoea</a>, nausea, vomiting, fever and abdominal discomfort. </p>
<p>Most people develop symptoms anywhere from <a href="https://www.health.vic.gov.au/health-advisories/increase-in-cryptosporidiosis-cases-across-victoria">one to 12 days</a> after becoming infected. Usually these symptoms resolve within two weeks, but the illness may last longer and can be severe in those with a weakened immune system. </p>
<p>Children and the elderly tend to be the most commonly affected. Cryptosporidiosis is more prevalent in young children, particularly those <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30283-3/fulltext">under five</a>, but the disease can affect people of any age. </p>
<figure class="align-center ">
<img alt="A 'pool closed' sign in front of a swimming pool." src="https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575739/original/file-20240214-18-g0i5b2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A number of public pools have been closed lately due to cryptosporidiosis outbreaks.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bright-white-sign-local-outdoor-pool-2124260702">LBeddoe/Shutterstock</a></span>
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<h2>So how do we catch it?</h2>
<p>Most major outbreaks of cryptosporidiosis have been due to people drinking contaminated water. The largest recorded outbreak occurred in <a href="https://pubmed.ncbi.nlm.nih.gov/7818640/">Milwaukee in 1993</a> where 403,000 people were believed to have been infected. </p>
<p><em>Cryptosporidium</em> oocysts are very small in size and in Milwaukee they passed through the filtration system of one of the water treatment plants undetected, infecting the city’s water supply. As few as <a href="https://www.sciencedirect.com/science/article/pii/S1286457902016301#BIB26">ten oocysts</a> can cause infection, making it possible for contaminated drinking water to affect a very large number of people.</p>
<p>Four days after infection a person with cryptosporidiosis can shed <a href="https://www.safewater.org/fact-sheets-1/2017/1/23/detailed-cryptosporidium">up to ten billion oocysts</a> into their stool a day, with the shedding persisting for about two weeks. This is why one infected person in a swimming pool can infect the entire pool in a single visit. </p>
<p><em>Cryptosporidium</em> oocysts excreted in the faeces of infected humans and animals can also reach <a href="https://www.safewater.org/fact-sheets-1/2017/1/23/detailed-cryptosporidium">natural bodies of water</a> such as beaches, rivers and lakes directly through sewer pipes or indirectly such as in manure transported with surface runoff after heavy rain. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0043135418308728">One study</a> which modelled <em>Cryptosporidium</em> concentrations in rivers around the world estimated there are anywhere from 100 to one million oocysts in a litre of river water.</p>
<p>In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9133686/">Australia</a>, cryptosporidiosis outbreaks tend to occur during the late spring and early summer periods when there’s an increase in recreational water activities such as swimming in natural water holes, water catchments and public pools. We don’t know exactly why cases have seen such a surge this summer compared to other years, but we know <em>Cryptosporidium</em> is very infectious. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">Explainer: what is gastroenteritis and why can't I get rid of it?</a>
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<p>Oocysts have been found in foods such as <a href="https://www.sciencedirect.com/science/article/pii/S0362028X22052693">fresh vegetables</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/10958471/">seafood</a> but these are not common sources of infection in Australia. </p>
<h2>What about chlorine?</h2>
<p>Contrary to popular belief, chlorine doesn’t kill off all infectious microbes in a swimming pool. <em>Cryptosporidium</em> <a href="https://www.sciencedirect.com/science/article/pii/S1286457902016301#BIB26">oocysts are hardy</a>, thick-walled and resistant to chlorine and acid. They are not destroyed by chlorine at the normal concentrations found in swimming pools. </p>
<p>We also know oocysts can be <a href="https://wwwnc.cdc.gov/eid/article/5/4/99-0425_article">significantly protected</a> from the effects of chlorine in swimming pools by faecal material, so the presence of even small amounts of faecal matter contaminated with <em>Cryptosporidium</em> in a swimming pool would necessitate closure and a thorough decontamination. </p>
<p>Young children and in particular children in nappies are known to increase the potential for disease transmission in recreational water. Proper nappy changing, frequent bathroom breaks and showering before swimming to remove faecal residue are helpful ways to reduce the risk. </p>
<figure class="align-center ">
<img alt="Two children playing in a body of water." src="https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575749/original/file-20240214-26-4wbfib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cryptosporidium can spread in other bodies of water, not just swimming pools.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-summertime-healthy-childhood-concept-two-460928809">Yulia Simonova/Shutterstock</a></span>
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<h2>Some sensible precautions</h2>
<p>Other measures you can take to reduce yours and others’ risk of cryptosporidiosis include: </p>
<ul>
<li><p>avoid swimming in natural waters such as rivers and creeks during and for at least three days after heavy rain</p></li>
<li><p>avoid swimming in beaches for at least one day after heavy rain</p></li>
<li><p>avoid drinking untreated water such as water from rivers or springs. If you need to drink untreated water, boiling it first will kill the <em>Cryptosporidium</em></p></li>
<li><p>avoid swallowing water when swimming if you can</p></li>
<li><p>if you’ve had diarrhoea, avoid swimming for at least two weeks after it has resolved</p></li>
<li><p>avoid sharing towels or linen for at least two weeks after diarrhoea has resolved</p></li>
<li><p>avoid sharing, touching or preparing food that other people may eat for at least 48 hours after diarrhoea has resolved</p></li>
<li><p>wash your hands with soap and water after going to the bathroom or before preparing food (<em>Cryptosporidium</em> is <a href="https://www.cdc.gov/parasites/crypto/resources/childcare_outbreak.pdf">not killed</a> by alcohol gels and sanitisers).</p></li>
</ul>
<p>Not all cases of diarrhoea are due to cryptosporidiosis. There are many other <a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">causes of infectious gastroenteritis</a> and because the vast majority of the time recovery is uneventful you don’t need to see a doctor unless very unwell. If you do suspect you may have cryptosporidiosis you can ask your doctor to refer you for a stool test.</p><img src="https://counter.theconversation.com/content/223541/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The infection is spread by spores called oocysts in the stools of humans and animals.Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982932023-01-25T20:24:10Z2023-01-25T20:24:10ZGot gastro? Here’s why eating bananas helps but drinking flat lemonade might not<figure><img src="https://images.theconversation.com/files/506221/original/file-20230125-366-gqrc32.jpg?ixlib=rb-1.1.0&rect=53%2C44%2C5919%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1591865641966-2e0f86ba2a85?ixlib=rb-4.0.3&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=2070&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Doctors are <a href="https://www.9news.com.au/national/gastroenteritis-sharp-spike-in-gastro-cases-due-to-poor-immunity-gp-warns/9fe43648-b468-4b3b-b3aa-e162e6e6a853">reportedly</a> concerned about a spike in the number of kids with gastroenteritis – when tummy infections can cause nausea, vomiting, diarrhoea, fever, abdominal pain, headache and muscle aches. </p>
<p>Rotavirus is a common cause of gastroenteritis in children and the reported rotavirus rate in New South Wales so far <a href="https://www.health.nsw.gov.au/news/Pages/20230118_00.aspx#:%7E:text=In%20the%20first%20two%20weeks,next%20few%20weeks%20is%20important.">this year</a> is five times what it usually is. </p>
<p>While there’s a lot of gastroenteritis occurring, the good news is the vast majority of cases kids will have an uneventful recovery.</p>
<p>Still, parents and carers get a lot of conflicting advice about the food and drinks kids should consume during recovery from the illness. Let’s look at the evidence. </p>
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Read more:
<a href="https://theconversation.com/gastro-outbreak-how-does-it-spread-and-how-can-we-stop-it-a-gastroenterologist-explains-159329">Gastro outbreak: how does it spread, and how can we stop it? A gastroenterologist explains</a>
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<h2>Old advice: the BRAT diet</h2>
<p>One widely known dietary recommendation when recovering from gastroenteritis is the BRAT diet. This stands for bananas, rice, applesauce and toast. These bland foods and are meant to be gentle on the gut, which is important when a person is recovering from gastroenteritis. </p>
<p>Applesauce is a distinctly American food product and indeed the first mention of this diet was in an <a href="https://www.semanticscholar.org/paper/A-COMPREHENSIVE-PLAN-OF-TREATMENT-FOR-THE-SO-CALLED-Powers/e06fd3236648ac61efbaa9e5b4b2a052dc6c7ed4">American report in 1926</a> on the treatment of “intestinal intoxication” in children. </p>
<p>The BRAT diet was historically recommended but has fallen out of favour over the past couple of decades. There are no clinical trials on the diet itself but evidence to support it came from <a href="https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2015/11/DuroArticle-June-07.pdf">studies</a> that demonstrated how each food in the BRAT diet could help with gastro recovery. </p>
<p>Bananas and apples are rich in a starch called pectin that can form a gel, which <a href="https://pubmed.ncbi.nlm.nih.gov/25809332/">helps</a> to treat diarrhoea. Green banana pulp and flour in particular was found to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627159/">reduce</a> diarrhoea in children. Bananas are also a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355124/">rich source</a> of potassium, which can help to replace potassium lost with diarrhoea. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/1531430/">Rice-based oral rehydration solutions</a> (a drink made from a mixture of water, rice, glucose, sodium, and potassium salts) used to treat gastroenteritis reduce the volume of stools and duration of diarrhoea in patients. A study from <a href="https://www.gastrojournal.org/article/S0016-5085(01)89171-X/pdf">Bangladesh</a> on infants with persistent diarrhoea found a rice-based diet containing green banana or pectin improved stool consistency and reduced the duration more than a diet of rice alone. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="girl eating several colourful icypoles" src="https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506225/original/file-20230125-22-a722qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In general, kids recovering from gastro don’t need a restricted diet.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-eats-colorful-ice-cream-2015084648">Shutterstock</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
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<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">Explainer: what is gastroenteritis and why can't I get rid of it?</a>
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<h2>Magic apples</h2>
<p>The use of apples to treat diarrhoea is thought <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/1176179">to have started</a> in Germany, where a nurse called Sister Frieda Klimsch used the fruit to treat dysentery (a severe form of gastroenteritis) in a hospital. </p>
<p>Another <a href="https://www.jstor.org/stable/3411901">origin story</a> tells of how a doctor in a German prison camp noticed prisoners with dysentery who ate apples from a nearby orchard had shorter and milder illness. The doctor started encouraging them to eat apples to treat diarrhoea. </p>
<p>Eating apple peel was <a href="https://adc.bmj.com/content/archdischild/14/77/43.full.pdf">observed</a> to lead to vomiting in infants in the 1930s and so the peel was removed. <a href="https://www.jstor.org/stable/3411901">Grated apple</a> was used to treat diarrhoea in children around the same period and was helpful in some cases. </p>
<p>Later, applesauce became the recommended form of apple for gastroenteritis recovery in the United States, and features in the BRAT diet. Interestingly, giving <a href="https://pubmed.ncbi.nlm.nih.gov/27131100/">diluted apple juice</a> to children with mild dehydration from gastroenteritis is both safe and effective.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="bowl of applesauce on benchtop" src="https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506222/original/file-20230125-11-5zag6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Applesauce is a distinctly American product, but grated apple works too.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1600984177310-c86c8f8fa9c7?ixlib=rb-4.0.3&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1770&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Why gastro diet advice has changed</h2>
<p>Over the past 20 years or so most health professionals have come to the conclusion the restricted BRAT diet is unhealthy in gastroenteritis recovery because it is low in <a href="https://journals.lww.com/em-news/fulltext/2004/01000/brat_diet__axiom_or_unsubstantiated_myth_.21.aspx">protein, fat, and energy</a>. All these nutrients are necessary for healing.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/2301321/">Studies</a> have <a href="https://academic.oup.com/cid/article/39/4/468/366339">shown</a>, in general, normal eating does not worsen the course of gastroenteritis. So it’s not necessary to restrict your child’s diet. Fasting when recovering from gastroenteritis is not recommended but it’s important to consider the child and ease into the reintroduction of foods. </p>
<p>It turns out fat, lactose and sucrose absorption during diarrhoea <a href="https://academic.oup.com/cid/article/41/Supplement_8/S547/569758">is limited</a> – so it’s sensible to <a href="https://journals.lww.com/em-news/fulltext/2004/01000/brat_diet__axiom_or_unsubstantiated_myth_.21.aspx">avoid fatty foods and foods high in simple sugars</a> (including juices and soft drinks) for moderate to severe diarrhoea as these could worsen symptoms. </p>
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<strong>
Read more:
<a href="https://theconversation.com/diarrhoea-stomach-ache-and-nausea-the-many-ways-covid-19-can-affect-your-gut-145440">Diarrhoea, stomach ache and nausea: the many ways COVID-19 can affect your gut</a>
</strong>
</em>
</p>
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<h2>Flat soft drinks?</h2>
<p>Flat soft drinks such as colas and lemonade warrant a special mention. Some view these drinks as an option to replenish fluids and glucose lost by vomiting and diarrhoea. But research has shown that this may not be a good idea. </p>
<p>One <a href="https://ep.bmj.com/content/93/4/129.2">British study</a> searched the medical literature going back to the 1950s for evidence to support the use of soft drinks in gastroenteritis. They found none. </p>
<p>Then the researchers compared the contents of colas and other sodas with commercially available oral-rehydration solutions containing electrolytes and small amounts of sugar. They found the soft drinks not only contained very low amounts of potassium, sodium and other electrolytes, but in some cases as much as seven times the glucose recommended by the World Health Organization for rehydration. </p>
<p>Carbonated drinks, flat or otherwise, are therefore not considered to provide adequate fluid or electrolytes and are not recommended. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="glass of orange liquid and sachet of powder" src="https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506223/original/file-20230125-18584-lf5yg5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rehydration solutions are more effective than flat soft drinks and have less sugar.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/electrolyte-drink-glass-white-background-1343744714">Shutterstock</a></span>
</figcaption>
</figure>
<h2>So what should you eat and drink during gastroenteritis recovery?</h2>
<p><a href="https://journals.lww.com/em-news/fulltext/2004/01000/brat_diet__axiom_or_unsubstantiated_myth_.21.aspx">Appropriate foods</a> include fruits, vegetables, lean meats, yogurts, as well as complex carbohydrates such as wheat, rice, bread, potatoes, and cereals. </p>
<p>Parents of young children with mild gastroenteritis should keep them hydrated by encouraging fluid intake through water and milk, and discourage fruit juices and carbonated drinks. </p>
<p>For moderate or severe cases the appropriate fluid for oral rehydration is commercially available oral rehydration solution (such a Gastrolyte or Hydralyte). </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281220/">systematic review and meta-analysis of 174 studies</a> concluded the use of a probiotic (<em>Saccharomyces boulardii</em>) and zinc supplementation can help during recovery from gastroenteritis, reducing the duration of diarrhoea as well as stool volume.</p>
<p>If symptoms or <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Dehydration/">dehydration</a> are severe then you should take your child to see a GP or go to the closest hospital emergency department.</p><img src="https://counter.theconversation.com/content/198293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are a lot of tummy bugs about, especially in NSW. But does the old advice of what to eat and drink during recovery still hold true?Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1780272022-02-28T11:05:55Z2022-02-28T11:05:55ZDon’t go wading in flood water if you can help it. It’s a health risk for humans – and dogs too<p>Floods are devastating communities in southeast Queensland and northern New South Wales and have pushed emergency services to their limits. </p>
<p>Flood waters in Northern NSW are already at “<a href="https://www.theguardian.com/environment/2022/feb/28/eastern-australian-states-hit-by-major-flooding-after-rain-bomb-weather-event">unprecedented</a>” levels, and are expected to worsen in coming days. The Australian Defence Force has been deployed to assist with emergency rescues.</p>
<p>In southeast Queensland, floods have <a href="https://www.theguardian.com/australia-news/2022/feb/28/brisbane-flood-2022-bne-river-peak-floods-update-property-flooding-warning-queensland">claimed eight lives</a>, after the equivalent of a year of rainfall fell in a couple of days. </p>
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<p>Some people who are flooded in won’t have the option of avoiding contact with flood water and mud. If this is you, try to wear protective clothing like closed-in shoes or boots and gloves. </p>
<p>Try keep cuts or abrasions away from dirty water, and disinfect and cover any wounds you might have with <a href="https://www.health.qld.gov.au/darlingdowns/healthier-together/healthiertogether-blog/flood-safety">waterproof dressings</a>. Focus on washing your hands with soap afterwards. </p>
<p>But if you’re tempted to wade into flood waters for fun, don’t. It not only risks your immediate safety, it poses a number of health hazards for humans – and dogs aren’t immune.</p>
<p>Health risks from flood water include bacteria and parasites that cause gastroenteritis (gastro), bacteria that infect the skin, physical hazards causing injury, and specific disease-causing pathogens that thrive in mud and water. </p>
<h2>Gastroenteritis</h2>
<p>Many of the organisms (viruses, bacteria and parasites) that cause gastro in humans happily survive for long periods of time in unchlorinated water. </p>
<p>These organisms originate in human faeces (poo) which can leak into drinking water when flood water inundates or damages septic tanks or sewerage pipes. If this occurs, people will be directed to boil their drinking water before use, a so-called “boil water” alert. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/drinking-water-can-be-a-dangerous-cocktail-for-people-in-flood-areas-178028">Drinking water can be a dangerous cocktail for people in flood areas</a>
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<p>Pathogens that cause gastro need to be swallowed, so it’s less likely people will be exposed while walking in water. </p>
<p>But people can easily contaminate food and drinks if they don’t wash their hands thoroughly after contact with flood water. And those who play “flood water sports”, where they are likely to swallow water, are also at risk. </p>
<p>The most common symptoms of gastro are vomiting, diarrhoea and stomach cramps that begin six to 72 hours after infection. It’s usually not possible to tell which microbe has caused the infection without a laboratory test of the person’s stool. So if you have severe symptoms that aren’t getting better, see your GP. </p>
<p>Globally, floods and storms are <a href="https://doi.org/10.1017/s1049023x17006574">associated with increases in gastroenteritis</a>. However, case numbers of gastroenteritis <a href="https://doi-org.ezproxy.library.uq.edu.au/10.1016/S0031-3025(16)32706-4">didn’t increase after the 2011 floods in Queensland</a>.</p>
<h2>Leptospirosis</h2>
<p>Leptospirosis is a potentially life-threatening disease <a href="https://doi.org/10.1371/journal.pntd.0003843">associated with flooding</a> worldwide. It’s caused by infection with bacteria (<em>Leprospira</em>) that <a href="https://www.health.qld.gov.au/cdcg/index/lepto">enter the body</a> through broken skin (wounds) or our mucous membranes (lining of the eyes and mouth).</p>
<p>The bacteria are present throughout the world and <a href="https://doi.org/10.1371/journal.pone.0227055">can survive</a> in mud and soil for weeks if it’s moist and warm. </p>
<p>In urban areas, rats and mice are the main <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/leptospirosis.aspx">carriers</a> of <em>Leptospira</em> and in rural areas, cattle add a further source. </p>
<p><em>Leptospira</em> are washed from soil into flood water with rain, which means anyone walking in water can become infected through cuts and abrasions.</p>
<p>Of particular concern is when the water recedes and the clean-up period begins because the contact with mud is much greater, as is the risk of wounds.</p>
<p>Leptospirosis <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/leptospirosis.aspx">causes</a> a fever and flu-like symptoms initially, and requires prompt diagnosis via a blood test and treatment with antibiotics. Anyone with a prolonged fever who has had contact with mud and flood water should see their GP. </p>
<p>After the floods in 2011, Queensland reported a nearly <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3901-pdf-cnt.htm/$FILE/cdi3901g.pdf">65% increase in the number of cases of leptospirosis</a>, most of which occurred in the weeks after the floods. </p>
<h2>The risk extends to our canine friends</h2>
<p>Leptospirosis is also a risk for suburban dogs and <a href="https://doi.org/10.1111/avj.13148">can be fatal</a>. </p>
<p>While there are no reports of cases of dog leptospirosis associated with floods in Australia, the <a href="https://doi.org/10.1111/avj.13148">emergence of the disease</a> in dogs in Sydney has raised concerns among veterinarians because they don’t understand why it suddenly became a problem. </p>
<figure class="align-center ">
<img alt="Dog plays in mud" src="https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448875/original/file-20220228-25-10fsn66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Try to keep your dog away from the mud after a flood.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/golden-retriever-cooling-down-mud-puddle-400343500">Shutterstock</a></span>
</figcaption>
</figure>
<p>The best advice is to keep the dogs out of flood waters. If you observe listlessness, vomiting and lack of appetite in your dog one to two weeks after exposure to mud or flood water, take them to the vet immediately. </p>
<p>It can be diagnosed with a blood test and treated with antibiotics, in much the same way as for people.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-leptospirosis-and-how-can-it-harm-us-and-our-pets-120221">Explainer: what is leptospirosis and how can it harm us and our pets?</a>
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<h2>Injuries and skin infections</h2>
<p>A <a href="https://doi.org/10.1016/S0031-3025(16)32706-4">common health condition after the 2011 floods in Queensland</a> was cellulitis, a deep bacterial infection of the skin that can occur if a person gets a puncture wound.</p>
<p>Many types of bacteria <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/cellulitis#:%7E:text=Cellulitis%20is%20a%20deep%20infection,break%2C%20including%20trauma%20or%20surgery.">can infect a wound</a> including those normally on human skin such as <em>Staphylococcus aureus</em> (golden staph) and those from the environment, such as <em><a href="https://doi.org/10.1016/S0031-3025(16)32705-2">Aeromonas</a></em>. </p>
<p>The symptoms include an area of skin that is red, painful, swollen, and warm to touch. If someone with these symptoms develops a fever, chills and nausea, it’s important they get medical attention to ensure they don’t develop a bloodstream infection. </p>
<p>Cellulitis is usually treated at home using antibiotics. </p>
<p>When cleaning up after floods, try to avoid getting wounds by using protective equipment, because even minor wounds <a href="https://www.abc.net.au/news/2011-01-15/rudd-treated-for-infection-from-floodwater/1906022">are entry points</a> for bacteria. </p>
<p>If you do sustain skin wounds, quickly clean and disinfect them, and seek medical attention, as you may need a <a href="https://www.healthdirect.gov.au/tetanus">tetanus vaccination</a>. Tetanus is a rare, but fatal, condition in Australia because of widespread vaccination. But it’s important to maintain immunity to tetanus through regular boosters.</p>
<p>Seek medical care if you develop <a href="https://www.publications.qld.gov.au/dataset/public-health-disaster-management-fact-sheets/resource/fb0f503c-67a6-4b15-8a22-783660ee4eab">any infections</a> after exposure to mud or flood water.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-you-need-to-know-about-melioidosis-the-deadly-infection-that-can-spread-after-floods-111813">Here's what you need to know about melioidosis, the deadly infection that can spread after floods</a>
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<img src="https://counter.theconversation.com/content/178027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Reid does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’re tempted to wade into flood waters for fun, don’t. It not only risks your immediate safety, it’s also a threat to your health.Simon Reid, Associate Professor, Communicable Disease Control, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1593292021-04-20T20:10:41Z2021-04-20T20:10:41ZGastro outbreak: how does it spread, and how can we stop it? A gastroenterologist explains<figure><img src="https://images.theconversation.com/files/395915/original/file-20210420-19-1cn1nx6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C673&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>On Monday, Victorian health authorities released figures showing they’d <a href="https://www.theage.com.au/national/victoria/gastro-outbreaks-hit-hundreds-of-victorian-childcare-centres-20210419-p57kcr.html">received 389 reports</a> of “gastro” outbreaks so far in 2021.</p>
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<p>The health department said this was four times higher than the average.</p>
<p>There are many different types of bacteria and viruses that can cause gastroenteritis. But in this instance it’s most likely to be a virus called “<a href="https://www.cdc.gov/norovirus/about/index.html">norovirus</a>”.</p>
<p>It’s a very contagious virus that passes between people quite easily. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851036/">Studies</a> estimate the reproduction number (or R₀) for norovirus in the population to be around 2, but this can go as high as 14 in an outbreak with no intervention. In other words, during an outbreak at a childcare centre without any control measures, one child can potentially infect an average of 14 other children. By contrast, the R₀ for COVID-19 is <a href="https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-28-covid-19-what-we-know-may-2020.pdf?sfvrsn=ed6e286c_2">estimated to be between 2 and 4</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">Explainer: what is gastroenteritis and why can't I get rid of it?</a>
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<h2>How does it spread?</h2>
<p>Over the course of the COVID-19 pandemic, we’ve learned a lot about how the coronavirus spreads. We’ve learned it <a href="https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted">transmits</a> mostly by respiratory droplets, smaller aerosols that can hang in the air that you can then breathe in, and less commonly via surfaces.</p>
<p>But what about gastro? Gastro caused by norovirus spreads primarily via the “foecal-oral route” — basically, when particles from someone’s poo end up in someone else’s mouth. You can also pick up the virus by coming into contact with someone’s vomit.</p>
<p>Most commonly this happens because you touch a surface or a person contaminated with this virus and then touch your mouth. It can spread rapidly in childcare centres because kids often play very physically, and they might not understand proper physical distancing and handwashing in the way adults do.</p>
<p>It can also spread very easily in places like cruise ships.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/cruise-ships-can-be-floating-petri-dishes-of-gastro-bugs-6-ways-to-stay-healthy-at-sea-this-summer-126351">Cruise ships can be floating petri dishes of gastro bugs. 6 ways to stay healthy at sea this summer</a>
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<p>It can take between 12 and 72 hours to develop symptoms after coming into contact with norovirus. Symptoms include vomiting, diarrhoea, stomach pains, and nausea. It generally takes a few days to recover, and isn’t doesn’t usually require serious medical attention. But it might be worth contacting your GP if your symptoms haven’t resolved in three days. Make sure to drink as much water as you can so you don’t get dehydrated.</p>
<p>If you have these symptoms make sure you stay home, and don’t return to work, school or childcare until 48 hours after your symptoms resolve. Returning earlier can mean you spread the virus.</p>
<figure class="align-center ">
<img alt="Children at a childcare facility" src="https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395916/original/file-20210420-13-jgs06p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Gastro caused by norovirus can spread very easily in childcare centres. Thorough handwashing and disinfecting are our best defences against it.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Norovirus is very resistant</h2>
<p>Some of you might be wondering how a virus survives in a state that endured such a long COVID-19 lockdown last year.</p>
<p>Well — norovirus is a very hardy virus. <a href="https://cmr.asm.org/content/28/1/134">Research</a> suggests it’s able to survive long periods on different surfaces and across varied temperatures. It’s often present at low levels across different environments, and in many types of food, <a href="https://www.livescience.com/62485-how-does-norovirus-get-into-oysters.html">for example oysters</a>. It can survive in water for many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3187119/">months</a>. </p>
<p>We can’t really eliminate this virus, but we can mitigate it’s spread.</p>
<h2>How can we stop it?</h2>
<p>The gold standard method is washing your hands thoroughly for 20 seconds with soap and water.</p>
<p>I suspect many of us have become a bit complacent with handwashing and instead are slapping on alcohol-based hand sanitiser when we can, although this is anecdotal.</p>
<p>However, even though hand sanitiser is convenient, it doesn’t <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168661/">work as well</a> against norovirus as thorough handwashing does.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1383985767295246352"}"></div></p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/10772215/">One study</a> even suggests that using both methods simultaneously — washing your hands with soap and water and also applying hand sanitiser — actually increases the number of bacteria on your hands, though the exact way this occurs is unknown.</p>
<p>It’s best to simply wash your hands for 20 seconds. But disinfecting surfaces is also important. If someone in your home or workplace is vomiting due to a gastro type illness, make sure you very quickly disinfect the nearby surfaces. You want to wear gloves and properly disinfect surfaces using hot water with a detergent, or even bleach, both of which can kill norovirus.</p>
<p>Parents, childcare workers and teachers should also teach kids good hygiene and handwashing skills. And, for us grownups, we should follow our own advice.</p>
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<strong>
Read more:
<a href="https://theconversation.com/why-hand-washing-really-is-as-important-as-doctors-say-132840">Why hand-washing really is as important as doctors say</a>
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<img src="https://counter.theconversation.com/content/159329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Washing your hands with soap and water for 20 seconds is the best way to prevent yourself getting sick. And don’t use hand sanitiser.Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/922562018-12-30T20:31:38Z2018-12-30T20:31:38ZHealth Check: when should you throw away leftovers?<figure><img src="https://images.theconversation.com/files/250343/original/file-20181212-110246-1ob9ss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If it's been out longer than four hours, it's best to throw it away.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/putting-casserole-leftovers-into-plastic-containers-511700683?src=ucRLtTrVk2eCHQtIW50Tyw-1-22">By Merrimon Crawford</a></span></figcaption></figure><p>Refrigeration is the <a href="https://royalsociety.org/news/2012/top-20-food-innovations/">most important invention</a> in the history of food. But while commercial and home refrigerators have only been used for the past 100 years or so, people have long used cool natural environments to store foods for extended periods. </p>
<p>Temperature is important for controlling microbial growth. Just as we find food wholesome, bacteria and fungi also enjoy the nutritional benefits of foods. They will consume the food and multiply, eventually “spoiling” the food (think mouldy bread or slimy lettuce). </p>
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Read more:
<a href="https://theconversation.com/how-to-keep-school-lunches-safe-in-the-heat-89868">How to keep school lunches safe in the heat</a>
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<p>If the microbe can cause disease – such as <em>Salmonella</em>, <em>Campylobacter</em>, <em>E. coli</em> or <em>Listeria</em> – you’re at risk of food poisoning. Most disease-causing microbes can grow to dangerous levels even before the food is noticeably spoiled without changing the smell, taste or appearance of the food.</p>
<h2>How to stop bugs growing in our food</h2>
<p>All forms of life require a few basic things to grow: a source of energy, (sugar for us, sunlight for plants), oxygen (for higher forms of life), water and simple chemical building blocks that provide nitrogen, phosphorous and sulphur – and the correct temperature. Water is key, and denying it severely restricts microbial growth. </p>
<p>That’s why salt has long been used as a preservative for perishable foods like meats; salt binds the water and makes it unavailable to microbes. Acid can also be used (via pickling or fermentation), as most microbes don’t like acidic conditions.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250349/original/file-20181212-110256-120h0i3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Don’t delay – put it in the fridge as soon as you can.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/camberley-uk-feb-1st-2017-contents-575253175?src=4FX3155Kq5VX4b8mxC7C8A-1-15">Gary Perkin/Shutterstock</a></span>
</figcaption>
</figure>
<p>Of course, cooking kills the microbes of concern, but they can contaminate and grow in the food afterwards. </p>
<p>If the food can’t be salted or pickled, or you have leftovers of cooked food, you’ll need to store the food at a temperature microbes don’t like. Refrigeration is the most effective and economical option. </p>
<p>Typically, the greater the moisture level, the more perishable the food. That’s why we can store dry foods (such as nuts) in the cupboard but high-moisture foods (such as fresh meat, vegetables) will quickly spoil if unrefrigerated.</p>
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<strong>
Read more:
<a href="https://theconversation.com/food-safety-are-the-sniff-test-the-five-second-rule-and-rare-burgers-safe-92661">Food safety: are the sniff test, the five-second rule and rare burgers safe?</a>
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<h2>How to store food safely</h2>
<p>The “danger zone” is the temperature range between 5°C and 60°C, where most common food poisoning bacteria like to grow. To avoid the danger zone, keep hot foods above 60°C and store foods below 5°C. </p>
<p>The two-hour/four-hour guidelines can also help avoid food poisoning from leftovers. If perishable food has been in the danger zone for:</p>
<ul>
<li>less than two hours, use it immediately or store it appropriately</li>
<li>two to four hours, use it immediately</li>
<li>longer than four hours, discard it.</li>
</ul>
<p>So, if the food has been sitting on the table after a long lunch on a warm day, it’s probably best to discard or consume it soon afterwards. </p>
<p>If the food is OK, store it in small portions, as these will reach the right temperature sooner than larger volumes, before refrigerating or freezing. </p>
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<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-leave-leftovers-to-cool-before-refrigerating-6114">Monday's medical myth: leave leftovers to cool before refrigerating</a>
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<p>Using some common sense, and understanding how microbes grow, can help avoid a nasty case of diarrhoea – or worse. All food business must comply with food safety standards but how we prepare, store and consume food in our homes is equally important in preventing food-borne illness.</p><img src="https://counter.theconversation.com/content/92256/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Enzo Palombo receives funding from Dairy Food Safety Victoria. </span></em></p>Did you forget to put the leftovers away? If it’s only an hour or two, that’s OK, but as the temperature drops under 60 degrees, the risk of bacterial growth – and food poisoning – increases.Enzo Palombo, Professor of Microbiology, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/987692018-08-27T02:32:10Z2018-08-27T02:32:10ZHealth Check: how long are you contagious with gastro?<figure><img src="https://images.theconversation.com/files/232437/original/file-20180817-165964-hrv13m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If this is you, stay away.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>There’s no way you’d want to go to work when you’ve got the telltale signs of gastro: nausea, abdominal cramps, vomiting and diarrhoea. But what about when you’re feeling a bit better? When is it safe to be around colleagues, or send your kids to school or daycare?</p>
<p>The health department recommends staying home from work or school for <a href="https://www.healthdirect.gov.au/gastroenteritis">a minimum of 24 hours</a> after you last vomited or had diarrhoea. But the question of how long someone is <em>contagious</em> after recovering from gastro is a very different question.</p>
<h2>What causes gastro?</h2>
<p>To better understand how long you can be contagious with gastro, we need to look at the various causes.</p>
<p>Viruses are the most common causes of gastro. Rotavirus is the leading cause in infants and young children, whereas norovirus is the leading cause of gastro in adults.</p>
<p>There are around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320479/">1.8 million cases</a> of norovirus infection in Australia each year. This accounts for almost 40% of the total cases of gastro.</p>
<p>Bacterial gastroenteritis is also common and accounts for around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320479/">1.6 million cases</a> a year. Of those cases, 1.1 million come from E. coli infections. Other bacteria that commonly cause gastro include salmonella, shigella and campylobacter. These bacteria are often found in raw or undercooked meat, seafood, and unpasteurised milk.</p>
<p>Parasites such as giardia lamblia, entamoeba histolytica and cryptosporidium account for around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320479/">700,000 cases</a> of gastro per year. Most of the time people recover from parasitic gastroenteritis without incident, but it can cause problems for people with weaker immune systems.</p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-i-feel-a-bit-sick-should-i-stay-home-or-go-to-work-42759">Health Check: I feel a bit sick, should I stay home or go to work?</a>
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</p>
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<h2>Identifying the bug</h2>
<p>Most cases of diarrhoea are mild, and resolve themselves with no need for medical attention. </p>
<p>But some warrant further investigation, particularly among <a href="https://www.racgp.org.au/afp/2012/october/stool-culture/">returned travellers</a>, people who have had diarrhoea for four or five days (or more than one day with a fever), patients with bloody stools, those who have <a href="https://academic.oup.com/cid/article/32/3/331/282348">recently used antibiotics</a>, and patients whose immune systems are compromised.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/232438/original/file-20180817-165967-3eucgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most cases of gastro will resolve on their own.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>The most common test is the stool culture which is used to identify microbes grown from loose or unformed stools. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/15095189">bacterial yield</a> of stool cultures is generally low. But if it does come back with a positive result, it can be potentially important for the patient.</p>
<p>Some organisms that are isolated in stool cultures are notifiable to public health authorities. This is because of their potential to cause serious harm in vulnerable groups such as the elderly, young children, pregnant women and those with weakened immune systems.</p>
<p>The health department <a href="http://www.health.gov.au/casedefinitions">must be notified</a> of gastro cases caused by campylobacter, cryptosporidium, listeria, salmonella, shigella and certain types of E.coli infection. This can help pinpoint outbreaks when they arise and allow for appropriate control measures. </p>
<h2>You might feel better but your poo isn’t</h2>
<p>Gastro bugs are spread via the the faecal-oral route, which means faeces needs to come into contact with the mouth for transmission to occur. </p>
<p>Sometimes this can happen if contaminated faecal material gets into drinking water, or during food preparation. </p>
<p>But more commonly, tiny particles of poo might remain on the hands after going to the toilet. Using toilet paper to wipe when you go to the toilet doesn’t completely prevent the <a href="http://jfoodprotection.org/doi/pdf/10.4315/0362-028X-71.12.2582">contamination of hands</a>, and even more so when the person has diarrhoea.</p>
<p>The particles then make their way to another person’s mouth during food preparation or touching a variety of contaminated surfaces and then putting your fingers in your mouth. </p>
<p>After completely recovering from the symptoms of gastro, infectious organisms can still be shed into stools. Faecal shedding of campylobacter, the E. coli O157 strain, salmonella, shigella, cryptosporidium, entamoeba, and giardia <a href="http://jfoodprotection.org/doi/pdf/10.4315/0362-028X-71.11.2339">can last for many days to weeks</a>. In fact, some people who have recovered from salmonella have <a href="http://jfoodprotection.org/doi/pdf/10.4315/0362-028X-71.11.2339">shed the bacteria</a> into their stools 102 days later.</p>
<p>Parasites can remain alive in the bowel for a long period of time after diarrhoea finishes. Infectious cryptosporidium oocysts can be shed into stools for up to 50 days. <a href="https://www.cdc.gov/MMWR/preview/MMWRhtml/ss5401a2.htm">Giardia oocysts</a> can take even longer to be excreted.</p>
<h2>So, how long should you stay away?</h2>
<p>Much of the current advice on when people can return to work, school or child care after gastro is based on the most common viral gastroenteritis, norovirus, even though few patients will discover the cause of their bug. </p>
<p>For norovirus, the highest rate of viral shedding into stools occurs <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdna-norovirus.htm/$File/norovirus-guidelines.pdf">24 to 48 hours</a> after all symptoms have stopped. The viral shedding rate then starts to quickly decrease. So people can return to work <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdna-norovirus.htm/$File/norovirus-guidelines.pdf">48 hours</a> after symptoms have stopped.</p>
<p>Yes, viral shedding into stools <a href="https://www.ncbi.nlm.nih.gov/pubmed/11280609">can occur for longer</a> than 48 hours. But because norovirus infection is so common and recovery is rapid, it’s not considered practical to demand patients’ stools be clear of the virus before returning to work.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/232439/original/file-20180817-165943-1k417v1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Children in a day care setting are vulnerable to gastro outbreaks.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>While 24 hours may be appropriate for many people, a specific 48-hour exclusion rule is considered necessary for <a href="https://ww2.health.wa.gov.au/%7E/media/Files/Corporate/general%20documents/food/PDF/Guidelines_for_Exclusion_from_Work_Due_to_Gastroenteritis.pdf">those in a higher-risk category</a> for spreading gastro to others. These include food handlers, health care workers and children under the age of five at child care or play group.</p>
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Read more:
<a href="https://theconversation.com/health-check-what-to-eat-and-drink-when-you-have-gastro-56424">Health Check: what to eat and drink when you have gastro</a>
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<p>If you have a positive stool culture for a notifiable organism, that may change the situation. Food handlers, childcare workers and health-care workers affected by <a href="https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-information-advice/verotoxin-e-coli">verotoxin E.coli</a>, for example, are not permitted to work until symptoms have stopped and two consecutive faecal specimens taken at least 24 hours apart have tested negative for verotoxin E. coli. This may lead to a lengthy exclusion period from work, possibly several days. </p>
<h2>How to stop the spread</h2>
<p>Diligently washing your hands often with soap and water is the most effective way to stop the spread of these gastro bugs to others. </p>
<p>Consider this: when 10,000 giardia cysts were placed in the palm of a hand, handwashing with soap <a href="http://jfoodprotection.org/doi/pdf/10.4315/0362-028X-73.10.1937">eliminated 99%</a> of them.</p>
<p>To prevent others from becoming sick, disinfect contaminated surfaces thoroughly immediately after <a href="https://epi.publichealth.nc.gov/cd/norovirus/home.html">someone vomits or has diarrhoea</a>. While wearing disposable gloves, wash surfaces with <a href="http://www.health.nsw.gov.au/Infectious/factsheets/Pages/gastroenteritis-outbreaks.aspx">hot water and a neutral detergent</a>, then use household bleach containing 0.1% hypochlorite solution as a disinfectant.</p><img src="https://counter.theconversation.com/content/98769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In many cases you may still be contagious long after you’ve returned to school or work. But there are simple things you can do to minimise the risk of spreading it to others.Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/981522018-06-14T05:58:51Z2018-06-14T05:58:51ZResearch Check: can tea towels cause food poisoning?<figure><img src="https://images.theconversation.com/files/223142/original/file-20180614-32313-n2bp35.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Let your tea towel dry out after each use to reduce its bacterial load.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/profile-view-young-couple-washing-drying-295734776?src=SoUw9BDl2nbZNp2E-luduQ-1-5">Shutterstock/antoniodiaz</a></span></figcaption></figure><p>Aside from being up to the task of drying our dishes, we don’t usually give the humble tea towel much thought. But this week it’s being blamed for causing food poisoning: </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1005589963403091968"}"></div></p>
<p>But there’s no cause for concern.</p>
<p>Yes, bacteria can accumulate on tea towels, especially when they’re infrequently washed and don’t dry out between use. But most of the bacteria the researchers found on tea towels are not responsible for food poisoning or other gastrointestinal symptoms.</p>
<p>While the media reports focused on the food poisoning risk, the research didn’t actually look at the participants’ gastrointestinal health. </p>
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<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">Explainer: what is gastroenteritis and why can't I get rid of it?</a>
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<h2>How was the research conducted?</h2>
<p>The story came about from a <a href="http://www.abstractsonline.com/pp8/#!/4623/presentation/15470">June 9 poster presentation</a> to the American Society of Microbiology’s 2018 meeting in Atlanta, based on research carried out at the University of Mauritius. </p>
<p>The Mauritian researchers purchased <a href="https://www.medpagetoday.com/meetingcoverage/asmmicrobe/73401">100 tea towels</a> to give to the study participants; 36 were a mixture of cotton and nylon, 33 were pure nylon, and 31 were pure cotton. </p>
<p>After one month of use, the towels were collected to “culture” any bacteria present on them. This means taking bacterial samples and letting them grow in a petri dish to determine the type of organism. </p>
<p>The participants also completed a questionnaire about their tea towel use, diet and family size. </p>
<p>The research did not look at whether the participants had food poisoning or other gastrointestinal illnesses. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/food-safety-are-the-sniff-test-the-five-second-rule-and-rare-burgers-safe-92661">Food safety: are the sniff test, the five-second rule and rare burgers safe?</a>
</strong>
</em>
</p>
<hr>
<h2>What were the results?</h2>
<p>Bacterial growth was found in 49% of the kitchen towels. Cotton towels had higher levels of bacteria than nylon towels or a mixture of the two. </p>
<p>Bacterial growth increased significantly with increased family size and the presence of children. </p>
<p>Tea towels which were considered “multipurpose” – such as for cleaning table and bench tops in addition to the kitchen – had higher levels of bacteria than towels that were “single purpose”, such as drying hands and dishes in the kitchen.</p>
<p>The researchers found “humid” (or moist) towels had significantly greater concentrations of certain types of bacteria, such as coliforms. <a href="https://www.health.ny.gov/environmental/water/drinking/coliform_bacteria.htm">Coliforms</a> are a broad class of bacteria found in the digestive tract of animals including humans, and are found in their faeces. Although most coliforms are harmless, some rare strains can cause serious illness. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223143/original/file-20180614-32307-gwa5n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Washing your tea towel after each use is ideal but often not practical.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tea-towels-on-washing-line-blowing-2273449?src=MGp9rFsLGUgTnC3CsNB_7Q-1-79">Sean Nel/Shutterstock</a></span>
</figcaption>
</figure>
<p>They also found that <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/staphylococcus-aureus-golden-staph">Staphylococcus aureus</a> (S. aureus), a common baterium that lives on the skin, was isolated at a significantly higher rate from families of lower socioeconomic status and families with children, as well as bigger families. </p>
<p>They looked at the influence of diet. Coliform and S. aureus were detected on tea towels at a significantly higher rate from families on non-vegetarian diets.</p>
<p>A higher prevalence of enterococcus species was detected on the kitchen towels of vegetarian families. <a href="http://www.stjames.ie/Patients/Infectionpreventioncontrol/VRE.pdf">Enterococci</a> are bacteria which are normally found in a person’s gastrointestinal tract and do not normally cause infections in healthy people, but may in those with a weakened immune system. </p>
<h2>What does it all mean?</h2>
<p>The research is interesting but shouldn’t cause concern. The majority of bacteria identified were enterococcus and pseudomonas species which are not classically involved with <a href="http://www.foodstandards.gov.au/consumer/safety/foodpoison/Pages/default.aspx">food poisoning</a> unlike campylobacter, salmonella, escherichia and listeria species. </p>
<p>But there are some practical points to take away from the research.</p>
<p>For the best protection, <a href="https://www.food.gov.uk/sites/default/files/media/document/cloths.pdf">wash the tea towel after every use</a>. But most of us are unlikely to do this, so waiting until tea towels are dry is okay, as drier tea towels will have a lower bacteria load. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-most-hygienic-way-to-dry-your-hands-54196">What's the most hygienic way to dry your hands?</a>
</strong>
</em>
</p>
<hr>
<p>It’s best to use tea towels for a single purpose such as drying the dishes, rather than multiple purposes. This will reduce the towel’s bacterial load. </p>
<p>Disposable paper towels are less likely to accumulate bacteria than tea towels that are used multiple times, but the research is yet to establish whether they lessen the risk of gastroenteritis.</p>
<p>Surprisingly, tea towels are not the dirtiest item in the kitchen. <a href="http://www.nsf.org/consumer-resources/studies-surveys-infographics/germ-studies/germiest-items-home">More than 75% of dish sponges/rags</a> contain bacteria. Yet most people who use dish sponges/rags with their hands don’t get gastroenteritis. </p>
<h2>What else do we need to take into account?</h2>
<p>What we don’t know in this research is what the participants were using for kitchen cleaning before being given the tea towels. Were they using tea towels, a rag or disposable wipes? </p>
<p>We also don’t know how frequently participants cleaned their assigned tea towels and what they used to clean them.</p>
<p>The bacterial growth was found to increase significantly with increased family size, extended family and the presence of children. But does that mean the family members and/or children were using the tea towels more or could it be due to other factors such as children playing outdoors in a dirty environment and bringing organisms back to the house? That was not addressed in the poster.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223144/original/file-20180614-32310-s13a83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s best to use a different cloth to wipe down benches.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/RjZjYwimO6Y">Nick Karvounis</a></span>
</figcaption>
</figure>
<p>Generalising the findings to different countries may be a problem. Mauritius is a <a href="https://en.wikipedia.org/wiki/Mauritius">tropical country</a> and the type and quantity of bacteria on tea towels there could very well be different than in a country with a colder, temperate climate.</p>
<p>Finally, this research was a poster presentation at the American Society of Microbiology meeting this year. The process of getting research published in a peer reviewed journal is a more intense and exhaustive process, which helps to iron out any flaws in the methodology or findings that may not be obvious to the investigators at the time. </p>
<p>So it’s helpful to wait for the formal publication which will have gone through the peer review process before we can extrapolate more conclusions. – <strong>Vincent Ho</strong></p>
<hr>
<h2>Blind peer review</h2>
<p>This Research Check accurately reflects the abstract. This study is <a href="https://blogs.jwatch.org/hiv-id-observations/index.php/news-flash-world-isnt-sterile/2018/04/01/">one of many</a> that look at bacterial contamination of household items, without reference to more relevant outcomes such as illness rates.
– <strong>Allen Cheng</strong></p><img src="https://counter.theconversation.com/content/98152/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allen Cheng receives funding from the Australian National Health and Medical Research Council.</span></em></p><p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Yes, bacteria can accumulate on tea towels. But most of the bacteria the researchers found are not responsible for food poisoning or other gastrointestinal symptoms.Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/622612016-07-18T17:40:02Z2016-07-18T17:40:02ZTravellers’ diarrhoea could dash Olympic dreams – here’s how to avoid it<figure><img src="https://images.theconversation.com/files/130913/original/image-20160718-2153-1q144fk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Imagine this: you’re an elite athlete, and you’ve spent years working towards your shot at Olympic glory. You’ve trained hard, been totally dedicated to your sport and now, here you are in Rio, getting ready for the pinnacle of your sporting career. It’s your time to shine. But suddenly, without warning, you are hit with stomach cramps. It’s not nerves – it’s more intense than that. Vomiting and diarrhoea kick in. Slowly and devastatingly, your chances of success go down the toilet. </p>
<p>Competing internationally is not without its challenges: extreme temperatures, different food and water, and exposure to new disease-causing microbes all take their toll on the human body. Combined with the strain that training, travelling and competition can put on the immune system, world-class athletes can suffer an increased risk of picking up infections. </p>
<p>That’s why, <a href="http://edition.cnn.com/2010/WORLD/asiapcf/10/07/india.commonwealth.games/">time</a> and <a href="https://www.theguardian.com/sport/2014/jul/16/virus-hits-athlete-village-commonwealth-games">time again</a>, we hear about elite athletes competing abroad being struck down by travellers’ diarrhoea (TD) – an acute gastrointestinal condition characterised by diarrhoea, vomiting, fever and abdominal pain. </p>
<p>Imagine trying to compete when you are feeling so ill – or even in the days after the infection has gone, when you are still dehydrated and tired. At international competitions such as the Olympics – when the difference between winning and losing can be the tiniest of margins – TD can be a game changer.</p>
<p>Just look at what happened in the 2010 Commonwealth Games in Delhi, for example, when a fifth of the England team were reported to be suffering from gastroenteritis. And who can blame Usain Bolt for sticking to a diet of <a href="http://www.independent.co.uk/sport/general/athletics/usain-bolt-reveals-he-devoured-1000-chicken-mcnuggets-during-the-2008-beijing-olympics-8920870.html">chicken nuggets</a> at the Beijing Olympics? </p>
<p>On top of the known risks, Rio may have its own specific hygiene problems. Water sports athletes competing in Guanabara Bay, Copacabana Beach and the marina may be at an <a href="http://edition.cnn.com/2016/06/02/sport/brazil-olympic-bay-pollution/">increased risk</a> of contracting a number of infections, including ones that target the gut, respiratory system and skin. </p>
<h2>Bacteria fighting back</h2>
<p>So, how can people protect themselves against TD when travelling abroad? The answer may lie with the billions of microorganisms living within our guts. These organisms <a href="http://s3.amazonaws.com/academia.edu.documents/38936324/859.full.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1468863055&Signature=uEe%2Fw6tnjUhl8kSD%2BefAxXR%2FqC0%3D&response-content-disposition=inline%3B%20filename%3DGut_Microbiota_in_Health_and_Disease.pdf">work with us</a>; for example, they can aid digestion, modify immune functions and outcompete invading microorganisms. As such, they could be key players in reducing our TD risk. </p>
<p>It all comes down to the types and amounts of microorganisms that dominate in the gut. We host thousands of different species of microorganisms; some are beneficial for us, some are less so. The composition of this microbial consortium is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303825/">greatly influenced by diet</a>, and other factors such as stress, training intensity and antibiotic use have an impact, too. </p>
<p>Research <a href="http://www.sciencedirect.com/science/article/pii/S0014579314002543">shows that</a> maintaining an appropriate balance of these microorganisms has the potential to have a positive impact on our health. One way to improve our gut microbial community is to consume prebiotics. Prebiotics are foods (fibre), which reach our large intestines and enhance the growth or activities of the health-promoting microbes within.</p>
<h2>Preventive measures</h2>
<p>The idea is that by fortifying our own gut bacteria with prebiotics, we are better equipped to fight off the bacteria that can cause TD. Our own bacteria may outcompete the disease-causing bacteria, and even aid immune function and produce anti-microbial substances to limit the growth of other organisms. </p>
<p>For instance, a prebiotic called galactooligosaccharide (B-GOS) <a href="http://www.ncbi.nlm.nih.gov/pubmed/20798214">has been shown</a> to reduce the ability of Salmonella to stick to the gut wall, which is how infection takes hold. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19756029">Another study</a> showed that there was a lower TD incidence among travellers who used B-GOS, compared with those who took a placebo. So, there’s a growing body of evidence to suggest that fortifying our gut community can help us to fight against TD.</p>
<p>For all those travelling to Rio this year, there are a few things you can do to reduce the risk of getting travellers’ diarrhoea. Taking a prebiotic supplement a week before your trip will help your gut bacteria to adjust. And continue taking them after you arrive, to keep your gut in optimal condition – ready to fight back against any disease-causing bacteria you encounter. </p>
<p>There are also, of course, all the familiar travellers’ laws: only drink bottled water, and use it when cleaning your teeth, too. Steer clear of ice cubes, which are likely to be made from local water. Only eat hot food, and avoid street vendors. Always carry sanitising gel, and use it before you handle food, and after going to the toilet. By following these tips, you’ll help your gut to put on a gold-medal performance during the games.</p><img src="https://counter.theconversation.com/content/62261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kirsty Hunter receives funding from Clasado Healthcare. </span></em></p><p class="fine-print"><em><span>Gemma Walton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You gotta have guts to succeed at Rio 2016 – and very healthy ones, at that.Kirsty Hunter, Senior Lecturer in Nutrition, Nottingham Trent UniversityGemma Walton, Lecturer in Metagenomics, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/564242016-04-24T20:51:36Z2016-04-24T20:51:36ZHealth Check: what to eat and drink when you have gastro<figure><img src="https://images.theconversation.com/files/119564/original/image-20160421-8007-xti90t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Inflammation in your stomach and intestinal tract causes diarrhoea, nausea, vomiting, abdominal cramping and pain.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-340548818/stock-photo-reflection-in-mirror-of-teenage-girl-feeling-sick.html?src=NcOTgmqCVe9Id2PVPZTKQw-3-35">Photographee.eu/Shutterstock</a></span></figcaption></figure><p>When you catch a bug that causes <a href="https://theconversation.com/explainer-what-is-gastroenteritis-and-why-cant-i-get-rid-of-it-34351">acute infectious gastroenteritis</a> (gastro), your stomach and intestinal tract become inflamed, causing diarrhoea, nausea, vomiting, abdominal cramping and pain. The last thing you probably feel like doing is eating. </p>
<p>As you recover and the inflammation dies down, your appetite will gradually return. But what should you eat? Information abounds online but it’s difficult to sort fact from fiction. </p>
<h2>Electrolytes</h2>
<p>Oral rehydration therapy is a type of fluid replacement containing sodium and potassium. It is the cornerstone of treatment for gastro, especially if you’re suffering from mild to moderate dehydration. </p>
<p>You can buy oral rehydration solution from a pharmacy, or make it by combining water, salts and sugar. Diluted juice or lemonade (mixed as one part juice or lemonade with four parts water) <a href="http://www0.health.nsw.gov.au/policies/gl/2014/pdf/GL2014_024.pdf">can also be used</a>, as can sports drinks, but not in young children. </p>
<p>Oral rehydration therapy should be favoured over plain water, as water simply doesn’t have the essential electrolytes required to maintain electrolyte balance. </p>
<h2>Food</h2>
<p>Eat small, light meals and build up from there. </p>
<p>Bland foods such as crackers are typically recommended to avoid irritating the stomach, although there is no scientific evidence to support this. </p>
<p>Chicken soup is often touted to aid recovery from gastroenteritis, among other illnesses, but again there is no data to support this claim. </p>
<p>Keep in mind that chicken broth has <a href="http://www.ncbi.nlm.nih.gov/pubmed/4047121">high levels of sodium</a> and can very occasionally result in high blood sodium levels and <a href="http://connection.ebscohost.com/c/articles/16741527/fluid-overload-following-chicken-soup-rehydration-gastroenteritis-demything-therapeutic-legacy">fluid overload</a>.</p>
<p>One <a href="https://www.researchgate.net/publication/242524660_The_BRAT_diet_for_acute_diarrhea_in_children_Should_it_be_used">popular diet</a> recommended for people recovering from gastroenteritis is the BRAT diet, which stands for “bananas, rice, apple sauce and toast”. </p>
<p>The bananas and rice portions of this diet are higher in fibre, leading to more solid stools and a decrease in the frequency of diarrhoea. </p>
<p>But a major disadvantage is that it does not supply a source of protein that the body needs during an acute illness. In <a href="http://www.ncbi.nlm.nih.gov/pubmed/9669718">two rare cases</a>, a very restrictive BRAT diet for acute diarrhoea led to severe protein malnutrition. </p>
<p>When recovering from gastro, it’s good to avoid caffeine and alcohol for several days, as these <a href="http://www.mckinley.illinois.edu/handouts/gastroenteritis.html">can worsen dehydration</a>. But you don’t need to restrict your diet. </p>
<h2>Probiotics</h2>
<p>Probiotics are live microorganisms that are thought to be effective in the treatment and prevention of diarrhoea. They <a href="http://www.ncbi.nlm.nih.gov/pubmed/25459995">alter the composition</a> of gut microbes and can act against noxious gut pathogens.</p>
<p>Probiotics have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/21069673">found to have a moderate benefit</a> in the treatment of infectious gastroenteritis in adults and children. But more research is needed and is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728803/">under way</a>. </p>
<h2>Babies and young children</h2>
<p>Dramatic changes have occurred over the last century in the treatment of acute gastroenteritis in children, who are more likely than adults to get gastro and can become dehydrated very quickly. </p>
<p>In the late 1920s, the <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=1174359">standard practice was to</a> administer fluids and withhold foods for a period of time, usually at least 24 hours. After a period of starvation, young children would be reintroduced to food in gradually increasing amounts. </p>
<p>This <a href="http://www.ncbi.nlm.nih.gov/pubmed/9427881">approach was justified</a> in part by the belief that intolerance to foods was a main cause of diarrhoea in children. </p>
<p>Later on, with the realisation that infection was a major cause of gastroenteritis, along with the availability of oral rehydration therapy, this treatment approach was challenged. </p>
<p>Subsequent research has found the gradual re-feeding approach provides <a href="http://www.ncbi.nlm.nih.gov/pubmed/86003">no benefit</a> over regular, continued breastfeeding, which was <a href="http://www.ncbi.nlm.nih.gov/pubmed/3918683">shown to be safe</a> when babies have diarrhoea. </p>
<p>In children older than six months, studies <a href="http://www.ncbi.nlm.nih.gov/pubmed/7039519">found</a> that after oral rehydration therapy, full feeding <a href="http://www.ncbi.nlm.nih.gov/pubmed/3286579">was best</a>. Restarting a child’s normal feeding after four hours of rehydration with a glucose oral rehydration solution <a href="http://www.ncbi.nlm.nih.gov/pubmed/9161945">led to greater weight gain</a> than late feeders. And it didn’t prolong diarrhoea or make it worse. </p>
<p>Importantly, if you’re caring for a child (or adult) who has gastro and becomes dehydrated, consult a medical professional immediately. Signs and symptoms of deydration can include thirst, dry or sticky mouth, <a href="https://www.nlm.nih.gov/medlineplus/ency/article/000982.htm">reduced urine volume, headache</a> and dry skin that doesn’t bounce back when you pinch it. </p>
<p>Severe dehydration is serious and can lead to a rapid heartbeat, rapid breathing, sunken eyes and a reduced level of consciousness.</p><img src="https://counter.theconversation.com/content/56424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Oral rehydration is the cornerstone of treatment for gastro, especially if you’re suffering from mild to moderate dehydration.Vincent Ho, Lecturer and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/427592015-07-13T04:28:04Z2015-07-13T04:28:04ZHealth Check: I feel a bit sick, should I stay home or go to work?<figure><img src="https://images.theconversation.com/files/87863/original/image-20150709-31590-1ilwy3d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People aren't productive at work when they're ill and they risk infecting others.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/williambrawley/4867472163/">William Brawley/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>You wake up on a work day and feel under the weather. If you’re vomiting or have a fever, the decision to stay at home is probably clear cut. But what if you generally feel unwell but are torn about missing work? </p>
<p>We all get minor illness; this is simply a part of the human condition. In winter, the culprit is often the <a href="https://theconversation.com/health-check-when-is-the-flu-really-a-cold-25150">common cold</a>. The average adult gets two or three per year. </p>
<p>The best course of action for the common cold is to rest and stay hydrated. You can use throat lozenges or gargles for sore throats, and the occasional paracetamol for pain. But antibiotics <a href="https://theconversation.com/well-known-antibiotic-amoxycillin-found-to-be-ineffective-cough-treatment-11436">don’t help</a>. And most of the popular treatments for the cold you can buy over-the-counter <a href="https://theconversation.com/health-check-can-you-treat-the-common-cold-25323">don’t work</a> either.</p>
<p>Most people recover fully within ten to 12 days, sometimes much more quickly. </p>
<p>One of the essential activities that we can all do to reduce the risk of passing the cold to others is <a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">good hand hygiene</a>. So wash your hands after coughing, sneezing or handling tissues.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=318&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=318&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=318&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=400&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=400&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87866/original/image-20150709-31569-1rlvb9y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=400&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For a cold, rest and hydration is best.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/seanfreese/6926759386/">Sean Freese/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Self-imposed isolation – staying at home – is an important measure to avoid spreading the virus. With the common cold, we are <a href="http://www.cf.ac.uk/biosi/subsites/cold/commoncold.html">most infective</a> during the early symptoms of sneezing, runny nose and a cough. </p>
<p>The number of days to take off work depends on the severity of the illness, and the nature of the work and workplace. It’s important for an intensive care nurse, for instance, to avoid any contact with critically ill patients while they have symptoms. An office worker? Perhaps a few days if you have uncontrolled sneezing and coughing, and feel unwell.</p>
<p>What about <a href="https://theconversation.com/explainer-what-is-stomach-flu-15412">gastroenteritis</a>? “Gastro” causes nausea and vomiting, diarrhoea, tummy cramps and pain. People suffering from the typical viral gastroenteritis in Australia recover within five to seven days.</p>
<p>Like the common cold, it’s important to wash your hands. This is crucial around the preparation and handling of food. Viral gastroenteritis is highly contagious and the virus can be spread for at least <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdna-norovirus.htm-l%7Ecda-cdna-norovirus.htm-l-app2">two days after</a> diarrhoea or vomiting stops. </p>
<p>The amount of time to take off work depends on the individual’s illness and the risk to public health. As GPs, we would insist, for instance, that a chef not return to work until at least two days after their last vomit or loose bowel motion.</p>
<p>We’ve recently had many discussions with worried parents about <a href="http://www.rch.org.au/kidsinfo/fact_sheets/Hand_foot_and_mouth_disease_coxsackie_virus/">hand, foot and mouth disease</a> (HFMD). This mild viral infection is particularly common in children in childcare and school. As indicated by its name, it can cause small blisters on the hands, feet, the inside of the mouth and tongue, and also around the nappy area. </p>
<p>HFMD can be spread from the fluid inside the blisters, but also from coughing and sneezing. The virus is in the bowel motions as well.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=586&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=586&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87869/original/image-20150709-10899-y1n6tm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=586&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children should stay away from childcare or school until blisters are dry.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-139906510/stock-photo-group-of-kids-playing-with-colorful-constructor-on-floor.html?src=jOM96hT-X0MVweyh_bMJHg-1-69">Olesya Feketa/Shutterstock</a></span>
</figcaption>
</figure>
<p>Again, hand-washing is important to stop the spread. Don’t pop the blisters, and avoid sharing cups, plates and eating utensils. </p>
<p>The blisters are no longer contagious once they dry, and the usual recommendation is for children to stay at home from childcare until they do. Unfortunately for parents, this can take seven to ten days. </p>
<p>What about <a href="https://theconversation.com/craig-thomson-saga-shows-doctors-certificates-are-a-sick-joke-3354">sick notes</a>? </p>
<p>For the most part, the number of days to take off work for minor illnesses that resolve without treatment is a matter of common sense. As GPs, we’re often bemused by the mutual waste of time that occurs every winter as people see us for no other reason than needing a sick note.</p>
<p>As a society, we need to move away from <a href="https://theconversation.com/craig-thomson-saga-shows-doctors-certificates-are-a-sick-joke-3354">requiring a sick certificate</a> from the doctor for minor work absences. You don’t need to doctor’s “permission” to be sick so you shouldn’t need it to take sick leave. </p>
<p>People aren’t productive at work when they’re ill and they risk infecting others. The responsibility for this should lie with employers and employees – after all, they know their own workplaces best. </p>
<p><em>Dr Alan Huynh, a general practice registrar from the General Practice Unit, Fairfield Hospital, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/42759/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Tam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>You wake up and feel under the weather. If you’re vomiting or have a fever, the decision to stay at home is probably clear cut. But what if you generally feel unwell but are torn about missing work?Michael Tam, General Practitioner, and Conjoint Senior Lecturer, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/433892015-06-17T06:15:47Z2015-06-17T06:15:47ZExplainer: what is KPC and should I be worried about these superbugs?<figure><img src="https://images.theconversation.com/files/85343/original/image-20150617-23259-axi2vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New antibiotics are desperately needed to treat these infections. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-157681805/stock-photo-woman-lying-down-in-hospital-bed.html?src=mCMExOTXOnVDqrAEYkstyA-1-15">wandee007/Shutterstock</a></span></figcaption></figure><p>Superbugs are <a href="http://www.heraldsun.com.au/news/victoria/deadly-superbug-cre-kills-two-in-melbourne-spreads-across-victoria-infecting-60/story-fni0fit3-1227400507088">back</a> in the <a href="http://www.skynews.com.au/news/national/2015/06/16/superbug-found-in-vic-hospitals.html">news</a> – and <a href="http://www.theage.com.au/victoria/deadly-superbug-found-spreading-in-victorian-hospitals-20150616-ghp9x2.html">everybody</a> loves a good germ panic <a href="http://www.abc.net.au/news/2015-06-16/hospitals-warned-over-new-antibiotic-resistant-bacteria-kpc/6550398">story</a>. The bugs raising alarm are called KPC (<em>Klebsiella pneumoniae</em> carbapenemase) or CRE (carbapenem-resistant Enterobacteriaceae).</p>
<p>The <a href="https://en.wikipedia.org/wiki/Enterobacteriaceae">Enterobacteriaceae</a> (pronounced enter-oh-bact-ear-ee-ay-cee-ee) are a large family of bacteria, which largely live as a normal part of people’s healthy gut bacteria. It includes <em>E. coli</em> as well as some more nasty bugs such as <em>Salmonella</em> and <em>Shigella</em>, which cause gastroenteritis. </p>
<p>A member of the family that doesn’t get as much press is <em><a href="https://en.wikipedia.org/wiki/Klebsiella">Klebsiella</a></em>. It’s a fairly common cause of infections in hospitals, such as urinary tract infections and pneumonia. Different species also live widely in the environment.</p>
<p>The C refers to a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1932750/">carbapenemase</a>, which is an enzyme the bacteria produces that can <a href="https://theconversation.com/the-last-stand-the-strongest-of-the-superbugs-and-their-antibiotic-nemesis-10727">break down</a> the class of antibiotics called carbapenems. <a href="https://en.wikipedia.org/wiki/Carbapenem">Carbapenems</a> are the hospital’s “big guns”, used for patients who are critically ill, or where there is resistance to other antibiotics. </p>
<p>The problem is that carbapenems share a common structure with penicillins and cephalosporins. Together, this family of antibiotics account for <a href="http://www.safetyandquality.gov.au/publications/antimicrobial-prescribing-practice-in-australia-results-of-the-2013-national-antimicrobial-prescribing-survey-november-2014/">the majority</a> of antibiotic use in hospital. </p>
<p>These bugs sometimes carry extra resistance genes which stop other commonly used antibiotics from working. This often leaves <a href="https://theconversation.com/back-to-the-future-breathing-new-life-into-old-antibiotics-to-fight-superbugs-1421">antibiotics</a> which we no longer commonly use (often because they have significant side-effects) as the only treatment option. There have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/19527172">reports</a> of bacteria <a href="http://jmidonline.org/upload/sayi/18/JMID-00780.pdf">resistant</a> to all available antibiotics, and trials on the best way to treat these bugs are underway.</p>
<p>The first isolates of these bacteria seem to have been imported from <a href="http://www.ncbi.nlm.nih.gov/pubmed/21258100">travellers from overseas</a> or Australians returning home. But these bugs may spread between people relatively easily, especially in health-care facilities. <a href="http://www.abc.net.au/am/content/2015/s4256463.htm">Reports suggest</a> this has occurred in Victoria.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The bacteria seems to have been imported from travellers.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-248584702/stock-photo-girl-in-the-airport.html?src=MsELYNi8-thH6MqDToSx4A-1-56">Capricorn Studio/Shutterstock</a></span>
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<p>Although these infections may be easily transmitted, becoming sick from them is rare. As the bugs that carry the resistance are similar to normal gut bacteria, they can live there quite happily without causing you any bother. We call this being “colonised” by the bacterium. When they get into places they shouldn’t be (such as your lungs or into your blood) the bacteria can then cause infection. This is more likely in patients who are very unwell, such as people in intensive care units. </p>
<p>Most people who have tested positive for CRE are carrying the bacterium, but are not sick from it. Media reports are therefore <a href="http://www.skynews.com.au/news/national/2015/06/16/superbug-found-in-vic-hospitals.html">carefully phrased</a> with lines such as “have died with a … superbug in their systems”, which means the patient was colonised rather than infected. </p>
<p>When actual infection does occur, the outcomes are often poor. Intensive care units in Europe <a href="http://www.ncbi.nlm.nih.gov/pubmed/25017796">have reported</a> death rates up to 50%. This is generally because patients who acquire CRE are very sick before their infection, but <a href="http://www.ncbi.nlm.nih.gov/pubmed/25017796">outcomes</a> are certainly worse for very resistant infections than for more sensitive ones. </p>
<p>Resistance also <a href="http://www.ncbi.nlm.nih.gov/pubmed/16355321">increases</a> the cost of care and hospital length of stay, impacting everybody in the health-care system.</p>
<p>New antibiotics are desperately needed to treat these infections. The United States government has announced the <a href="http://www.idsociety.org/10x20/">10x20 initiative</a> – ten new antibiotics by 2020. Australian <a href="http://cooper.imb.uq.edu.au/">researchers</a> are <a href="http://www.deakin.edu.au/research/mmr/our-research/infection-and-immunity-theme">also</a> active in this <a href="http://www.uqccr.uq.edu.au/research/infection-and-immunity.aspx">area</a>. But antibiotic <a href="https://theconversation.com/new-antibiotics-whats-in-the-pipeline-10724">development</a> is a slow process, so in the meantime, a holding strategy is needed.</p>
<p>There are two ways to hold the bugs back – prevent people from acquiring them in the first place, and slow the development of antibiotic resistance. </p>
<p><a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">Infection control</a> is a critical, but often under-appreciated part of our hospitals. And the most important part of infection control is <a href="http://www.hha.org.au/home.aspx">hand hygiene</a>. The hands of health-care workers are critical to the transmission of bacteria between patients. Patients with resistant organisms are often kept isolated, but at least some of the benefit of this isolation comes from prompting health-care workers to clean their hands before and after patient care. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The most important part of infection control is hand washing.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-206779540/stock-photo-surgeon-washing-hands-before-operation.html?src=jbLvMXccCsFAtGYiWjJ2wg-1-2">nata-lunata/Shutterstock</a></span>
</figcaption>
</figure>
<p>Australia has <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_exec_summary.pdf">national guidelines</a> for infection control generally, and <a href="http://www.safetyandquality.gov.au/wp-content/uploads/2013/12/MRGN-Guide-Enterobacteriaceae-PDF-1.89MB.pdf">specific guidelines</a> for CRE. </p>
<p>The second key intervention is <a href="https://theconversation.com/we-can-beat-superbugs-with-better-stewardship-of-antibiotics-9492">antimicrobial stewardship</a>. Exposing bacteria to antibiotics is the way resistance comes about, and by reducing the use of antibiotics, we can delay resistance. Reducing the use of carbapenem is an important target of stewardship programs, which are now a mandatory requirement for hospitals to be <a href="http://www.achs.org.au/publications-resources/equipnational/">accredited</a>.</p>
<p>The last two years have been a time of rapid development in the fight against antimicrobial resistance. The <a href="http://www.who.int/mediacentre/news/releases/2015/antibiotic-resistance-lacking/en/">World Health Organisation</a> has increased its focus on resistance, and the Australian government has released its own <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-amr.htm">national strategy</a>.</p>
<p>Outbreaks such as this highlight the need for government, academia and industry to work together to help take these plans beyond the summits and discussion papers and into our hospitals. Understanding by and involvement of the public is also crucial. </p>
<p>Only with a united front can we hope to slow the “<a href="https://www.mja.com.au/journal/2013/198/5/gram-negative-resistance-can-we-combat-coming-new-red-plague">red tide</a>” of resistance.</p><img src="https://counter.theconversation.com/content/43389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trent has no financial disclosures relevant to this article, but has participated as an investigator in (industry-funded) clinical trials on new antimicrobial agents. He is a member of the Australian Society for Infectious Diseases, the Australian College of Infection Prevention and Control, and the Public Health Association of Australia. These views are his own, and not those of his employer or professional associations.</span></em></p>Superbugs are back in the news – and everybody loves a good germ panic story.Trent Yarwood, Infectious Diseases Physician, Senior Lecturer, James Cook University and, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/343512015-01-07T02:36:18Z2015-01-07T02:36:18ZExplainer: what is gastroenteritis and why can’t I get rid of it?<figure><img src="https://images.theconversation.com/files/67627/original/image-20141218-31046-1a0v5p.jpg?ixlib=rb-1.1.0&rect=0%2C738%2C3738%2C2764&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Symptoms can occur as soon as 30 minutes after exposure to the culprit organism or toxin.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=N0GhD_GHoSLslCeW0RaaZg&searchterm=vomiting&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=103672964">Anton Brand/Shutterstock</a></span></figcaption></figure><p>We’ve all experienced the abdominal cramps and the urge to get to a toilet – quickly! When the stomach and intestinal tract become inflamed, our bodies respond with the sudden onset of diarrhoea, associated nausea and vomiting, abdominal cramping and pain. </p>
<p>Transmissible gastroenteritis is colourfully known as “Montezuma’s revenge”, “Delhi belly”, “stomach flu” and “viral gastro” but let’s use the term “infectious gastroenteritis”. This includes food poisoning, where bacterial toxins consumed in contaminated food rapidly cause symptoms. </p>
<p>Although infectious gastroenteritis usually resolves on its own, in some cases it can lead to severe consequences, chiefly through dehydration. Worldwide, 1.45 million people <a href="http://www.ncbi.nlm.nih.gov/pubmed/24981041">die from infectious gastroenteritis</a> each year.</p>
<p>Symptoms can occur as soon as 30 minutes after exposure to the culprit organism or toxin. But most often, <a href="http://www.hnehealth.nsw.gov.au/__data/assets/pdf_file/0011/89786/Symptom_Profile_of_Gastroenteritis.pdf">symptoms develop</a> 12 to 72 hours after exposure. </p>
<p>Acute infectious gastroenteritis usually resolves within two weeks but severe cases can last several weeks. </p>
<h2>Causes</h2>
<p>Viruses such as <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rotavirus">rotavirus</a>, <a href="http://access.health.qld.gov.au/hid/infectionsandparasites/viralinfections/norovirus_fs.asp">norovirus</a>, <a href="http://www.cdc.gov/adenovirus/">adenovirus</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21843659">astrovirus</a> are <a href="http://www.nlm.nih.gov/medlineplus/ency/article/000252.htm">common causes</a> of infectious gastroenteritis. Rotavirus is the leading cause of severe acute gastroenteritis in infants and young children. Almost every child in the world <a href="http://www.ncirs.edu.au/immunisation/fact-sheets/rotavirus-fact-sheet.pdf">will suffer</a> at least one infection by the time they are three years old.</p>
<p>Norovirus is the leading cause of gastroenteritis in adults. Norovirus is highly contagious and outbreaks commonly occur in residential care facilities and hospitals. Patients can <a href="http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdna-norovirus.htm-l%7Ecda-cdna-norovirus.htm-l-app2">remain contagious</a> for at least 48 hours after their symptoms have disappeared. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1006&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1006&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67159/original/image-20141214-6042-xzvox2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1006&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Campylonbacter bacteria is a common cause of gastroenteritis.</span>
<span class="attribution"><a class="source" href="http://en.wikipedia.org/wiki/Campylobacter#mediaviewer/File:ARS_Campylobacter_jejuni.jpg">Wikimedia commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p><em><a href="http://www.cdc.gov/ecoli/">Escherichia coli</a></em> (e. coli), <em><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Gastroenteritis_salmonellosis">Salmonella</a></em>, <em><a href="http://www.mayoclinic.org/diseases-conditions/shigella/basics/definition/con-20028418">Shigella</a></em> and <em><a href="http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/">Campylobacter</a></em> are <a href="http://www.nlm.nih.gov/medlineplus/ency/article/000254.htm">common causes</a> of bacterial gastroenteritis. They are often found in contaminated foods including raw or undercooked meat, poultry, seafood and unpasteurised milk. </p>
<p>Bacterial gastroenteritis <a href="http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htmParasites">accounts for</a> 80% of cases of traveller’s diarrhoea and is thought to affect 20% to 50% of international travellers.</p>
<p>Some parasites such as <em><a href="http://www.cdc.gov/parasites/giardia/">Giardia lamblia</a></em>, <em><a href="http://www.cdc.gov/parasites/amebiasis/">entamoeba histolytica</a></em> and <em><a href="http://www.cdc.gov/parasites/crypto/">cryptosporidium</a></em> are known to cause gastroenteritis. Although usually <a href="http://www.ncbi.nlm.nih.gov/pubmed/7838606">parasitic gastroenteritis</a> resolves without treatment, people with compromised immune systems can have prolonged symptoms. </p>
<h2>Prevention and treatment</h2>
<p>The use of clean water and good sanitation practices are important for <a href="http://www.jcu.edu.au/jrtph/vol/v02dean.pdf">reducing rates</a> of infectious gastroenteritis. Handwashing with soap has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/12726975">shown to reduce</a> the risk of gastroenteritis by up to 47%. </p>
<p>Of course, avoiding contaminated foods that could harbour toxic bacteria and parasites is also important.</p>
<p>Vaccinations are also effective, particularly for rotavirus. The rotavirus vaccines have seen a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20622508">marked decline</a> in the rate and severity of disease in both developing and developed countries. </p>
<p>Oral rehydration is the cornerstone of treatment for those suffering from mild to moderate dehydration. This can be achieved through a solution containing water, salts and sugar. For severe cases of dehydration, hospitalisation and <a href="http://www.rch.org.au/clinicalguide/guideline_index/Gastroenteritis/">intravenous fluids</a> may be required.</p>
<p>Antibiotics are generally not recommended unless the gastroenteritis is bacterial or parasitic and symptoms are severe. </p>
<h2>Longer-term illnesses</h2>
<p>What if the symptoms of gastroenteritis still persist months or even years into the future?</p>
<p>Mounting evidence links bacterial, viral, and parasitic infections with an increased risk of developing irritable bowel syndrome. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20427395">One study</a> followed patients that developed acute gastroenteritis during a large outbreak in 2000. The prevalence of irritable bowel syndrome at three years was very high at 28.3%. Eight years after the outbreak it was still high at 15.4%. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pubmed/19560575">intestinal barrier</a> allows key nutrients to enter the gut while maintaining a defence against toxins and noxious organisms. This barrier however can be damaged in acute infectious gastroenteritis. Foreign substances can <a href="http://www.ncbi.nlm.nih.gov/pubmed/15606393">then enter</a> the deeper tissues of the gut and promote inflammation.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67633/original/image-20141218-31025-4vtdsv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Handwashing with soap reduces the risk of gastroenteritis by almost 50%.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jessicarone/7720202208/in/photolist-cLd49C-7HU8u-hfx3o-9sd1bY-7BXH3b-CgHL7-nxYk8-8eShn7-bAgqYi-9sd1W1-pdBSx-ptfyE4-dBrMDA-aBX5Qp-9dxYGX-8KEdSk-WfHxo-Nx4qX-79xHvC-mhmmbt-GL9U-KzfYk-S4rYn-79xHCG-b3AHpg-9sgfam-9sa34T-47FQB6-79xHoN-oLtCPD-51ibq-mjTeTq-a8qUGw-9Qr9Aj-M7Y6M-5Avmsm-bswUBz-aFigc-9sgeWf-oLJ1MC-4FnRGA-7QjnEr-dje98W-9jvuGB-5dLZ7z-5kHhW4-8Jdao4-2cEoj-8FKJg2-5dRixU">Brandon Otto/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/15247174">study examining patients</a> who had gastroenteritis caused by <em>Shigella</em> found that there were increased mast cell numbers in the gut. Mast cells are known to secrete the hormone serotonin which is important for signalling in the <a href="https://theconversation.com/how-the-bacteria-in-our-gut-affect-our-cravings-for-food-33141">enteric nervous system</a>. This then may be another mechanism by which post-infectious irritable bowel syndrome can develop. </p>
<p>Researchers have also studied what happens, at a cellular level, in the gut after acute gastroenteritis. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14695026">Interstitial cells of Cajal</a> are known as the pacemaker cells of the gut and help digest food and move it through the gut. These <a href="http://www.ncbi.nlm.nih.gov/pubmed/25484117">cells were altered</a> in mice that were exposed to a type of bacterial gastroenteritis. </p>
<h2>Unanswered questions</h2>
<p>We have a reasonably good understanding of the causes of infectious gastroenteritis and treatment. But there’s more we need to learn, especially when it comes to understanding how symptoms might persist over the long term. </p>
<p>We are learning to appreciate the significance of a disordered immune system for long-term gastrointestinal symptoms. This opens the possibility for selective use of anti-inflammatory drugs or <a href="http://www.ncbi.nlm.nih.gov/pubmed/25431489">immune-modifying medications</a> in patients recovering from infectious gastroenteritis.</p><img src="https://counter.theconversation.com/content/34351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’ve all experienced the abdominal cramps and the urge to get to a toilet – quickly! When the stomach and intestinal tract become inflamed, our bodies respond with the sudden onset of diarrhoea, associated…Vincent Ho, Lecturer and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/344832014-12-21T18:51:13Z2014-12-21T18:51:13ZHealth Check: how to avoid food poisoning at summer picnics<figure><img src="https://images.theconversation.com/files/67463/original/image-20141217-19725-bmclf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Avoiding food poisoning could be as simple as using an esky to transport your food to the picnic. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&searchterm=summer%20picnic&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=156067106">oliveromg/Shutterstock</a></span></figcaption></figure><p>Warmer temperatures and eating outside go hand-in-hand, but picnics can sometimes lead to nasty surprises. Food poisoning is unsurprisingly more common in summer months.</p>
<p>Every Australian experiences food poisoning <a href="http://wwwnc.cdc.gov/eid/article/20/11/13-1315_article">about once every five years</a>. For most people, this “gastro” includes diarrhoea and vomiting and may be mild, but it can be more serious. </p>
<p>Children, older people, and those who have a compromised immune system are more likely to be hospitalised from food poisoning. Some more <a href="http://www.foodstandards.gov.au/publications/Pages/listeriabrochuretext.aspx">serious infections, such as <em>Listeria</em></a>, can affect certain groups such as pregnant women, leading to premature labour or stillbirth.</p>
<h2>Usual suspects</h2>
<p>Many foods can cause food poisoning, but some are more likely to make people ill than others. Meat, in particular, is commonly contaminated by bacteria, such as Salmonella and <a href="https://theconversation.com/health-check-how-to-avoid-getting-ill-from-chicken-34795">Campylobacter</a>. It needs to be kept separate from foods that don’t require cooking. </p>
<p>Utensils used for preparing raw meat should also be separate and not used for other foods. For picnics and meals outdoors, meats need to be kept refrigerated or in a portable insulated container, such as an esky, with ice before they are cooked.</p>
<p>If you are using an esky or portable fridge, it is important to make sure that you change the ice regularly. Definitely don’t let meats and their juices come into contact with other foods that are eaten without cooking.</p>
<p>Barbecues are a summer tradition. To avoid illness, meats should be cooked thoroughly. Ideally, use a thermometer to check the temperature of sausages, hamburgers and poultry, which should be about 75°C in the centre. </p>
<p>It’s important to use a clean tray for cooked meat, and not the one that previously held raw meat, as the tray can allow bacteria to transfer onto the cooked meat.</p>
<h2>Other culprits</h2>
<p>Some other foods that can cause illness include dishes made with <a href="http://www.foodauthority.nsw.gov.au/retail/safe-use-of-raw-egg-products">raw or undercooked eggs</a>, soft cheeses, and fresh produce. To prevent foodborne illness as a result of outdoor summer eating, it’s best to avoid dishes containing raw eggs, such as aioli and mayonnaise.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/67464/original/image-20141217-16559-pt8v7r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Always use a clean tray for cooked meat - not the one that has been used to hold raw meat.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&search_tracking_id=sZ2nAdfLBkiNQbJn_UC7VA&searchterm=bbq&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=208554478">Andrew Barker/Shutterstock</a></span>
</figcaption>
</figure>
<p>Fresh produce, such as fruits and salad vegetables, need to be washed before eating, as they may be contaminated with bacteria or viruses. It’s also important to refrigerate foods you intend to eat outdoors, as bacteria can grow to dangerous levels in warmer temperatures. </p>
<p>Another way to reduce the chances of illness while on picnics, eating outdoors, or camping is for people to wash their hands before eating; ideally with soap and running water. Soap and water is the most effective way to clean your hands, especially if they have visible dirt on them. </p>
<p>If they aren’t available, an alcohol gel or hand sanitiser will do. It’s also particularly important that people don’t prepare food for others if they have gastro themselves, as they could contaminate food with bacteria or viruses.</p>
<p>Most people think that the last thing they ate before becoming ill made them sick. Unfortunately, this can be difficult to tell, as most illness can take days to develop after eating contaminated food. And it is rare that there are leftover foods to undergo microbiological testing. </p>
<p>The exception is when several people are affected. We call this an outbreak, and <a href="http://www.health.nsw.gov.au/Infectious/controlguideline/Pages/foodborne_illness.aspx">health departments can investigate</a> affected people to determine the likely cause. Foods eaten by most of the affected people – and few of the unaffected people – are likely culprits. And poor food handling often plays a central role. </p>
<p>Keeping food refrigerated, washing fresh produce, cooking meat thoroughly, and keeping raw and cooked meat separate can all help to prevent outbreaks. You can find more tips for safe eating at barbecues and picnics <a href="http://www.foodsafety.asn.au/resources/eating-outdoors-bbqs-and-picnics/">here</a>.</p><img src="https://counter.theconversation.com/content/34483/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martyn Kirk receives funding from Commonwealth Department of Health, Food Standards Australia New Zealand, the New South Wales Food Safety Authority, and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Kathryn Glass receives funding from the Commonwealth Department of Health, Food Standards Australia New Zealand, the New South Wales Food Authority, and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Emily Fearnley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Warmer temperatures and eating outside go hand-in-hand, but picnics can sometimes lead to nasty surprises. Food poisoning is unsurprisingly more common in summer months. Every Australian experiences food…Martyn Kirk, Convener, Master of Philosophy in Applied Epidemiology, Australian National UniversityEmily Fearnley, Research fellow, Australian National UniversityKathryn Glass, Fellow, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/154122013-08-21T04:32:00Z2013-08-21T04:32:00ZExplainer: what is stomach flu?<figure><img src="https://images.theconversation.com/files/29218/original/vbgqw863-1376448050.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The dreaded stomach flu strikes again? Not likely.</span> <span class="attribution"><span class="source">RLHyde</span></span></figcaption></figure><p>Nausea, vomiting, tummy pain and cramps, watery diarrhoea … We’ve all had acute <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Gastroenteritis">gastroenteritis</a> at some stage.</p>
<p>As a general practitioner, my patients usually refer to their condition in more colloquial terms – “gastro”, “the runs”, “the trots”, “stomach flu”, as well as other colourful names that are too indecent to publish.</p>
<p>Gastroenteritis is usually an infection of the gastrointestinal tract and can be caused by many different organisms:</p>
<ul>
<li>viruses (such as <a href="http://en.wikipedia.org/wiki/Norovirus">norovirus</a>, <a href="http://en.wikipedia.org/wiki/Enterovirus">enterovirus</a>, and <a href="http://en.wikipedia.org/wiki/Rotavirus">rotavirus</a>),</li>
<li>bacteria (such as <em><a href="http://en.wikipedia.org/wiki/Enterotoxigenic_Escherichia_coli">E. coli</a></em> and <em><a href="http://en.wikipedia.org/wiki/Campylobacter_jejuni">Campylobacter</a></em>), and</li>
<li>parasites (such as <a href="http://en.wikipedia.org/wiki/Giardiasis">giardia</a>).<br></li>
</ul>
<p>In Australia, acute gastroenteritis is most commonly due to viruses, and is typically mild. Although it is not usually dangerous, it can be severe and even life-threatening in rare cases.</p>
<p>Australian readers may be aware of norovirus, which has had some recent notoriety in the news. <a href="http://www.smh.com.au/travel/travel-incidents/qantas-passengers-struck-down-with-gastro-on-flight-from-chile-20130802-2r2wh.html">Earlier this month</a>, it was responsible for 26 passengers vomiting and having diarrhoea on a flight from Chile to Sydney. </p>
<p>The “<a href="http://theconversation.com/new-norovirus-strain-could-cause-gastroentiritis-epidimic-11614">Sydney 2012 mutant</a>” strain of norovirus has been responsible for major outbreaks of gastroenteritis <a href="http://www.smh.com.au/world/australias-mutant-vomiting-bug-spreads-misery-around-the-world-20130116-2cs6r.html">worldwide</a> over the past year.</p>
<p>It is also worth mentioning rotavirus, which is a contemporary public health triumph. Rotavirus is one of the leading causes of severe gastroenteritis in children aged under five and responsible for half a million deaths a year – mainly in low-income countries.</p>
<p>In Australia, it was previously responsible for more than 10,000 hospitalisations each year. But since the introduction of the <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/nips-ctn">oral rotavirus vaccine</a> into the national immunisation program in 2007, there’s been a sustained reduction in hospitalisation due to this organism by <a href="http://www.mja.com.au/journal/2012/197/8/changes-hospitalisations-acute-gastroenteritis-australia-after-national-rotavirus">over 70%</a>.</p>
<p>Bacterial and parasitic causes of gastroenteritis are uncommon in Australia, except in the case of returned travellers. <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Traveller's_diarrhoea">Traveller’s diarrhoea</a> is frequently the result of an infection with one of the strains of <em>E. coli</em> that release toxins that affect the bowel.</p>
<p>Like gastroenteritis, traveller’s diarrhoea is also known by a range of popular names, generally in keeping with the exotic locale where disaster struck. We have “Montezuma’s revenge”, “Bali belly”, the “Rangoon runs”, and the “Hong Kong dog” among others.</p>
<h2>Where did it come from?</h2>
<p>On the theme of the use of vernacular slang for diarrhoeal diseases, one of interesting changes that I have noticed as an Australian GP is use of the term “stomach flu” for gastroenteritis. Reflecting back, I don’t think any of my patients used this label even a few years ago.</p>
<p>The fantastic <a href="http://www.google.com.au/trends/">Google Trends</a> tool seems to bear out my (unscientific) observation. As far as Google is concerned, the first occurrence of “search interest” for the term “stomach flu” in <a href="http://www.google.com.au/trends/explore?q=stomach+flu#q=%22stomach%20flu%22&geo=AU&cmpt=q">Australia</a> was in August 2008 (Figure 1).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=227&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=227&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=227&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=286&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=286&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28969/original/7dqdhbhh-1376029163.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=286&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 1 - Google Trends Web Search Interest “stomach flu”; Australia 2004-2013.</span>
<span class="attribution"><span class="source">Google Trends</span></span>
</figcaption>
</figure>
<p>There have been subsequent spikes of interest in the winters of 2009 to 2013, which is consistent with the fact that outbreaks of viral gastroenteritis tend to occur in the colder months. </p>
<p>In fact, the British call norovirus by the descriptive (and rather unimaginative) moniker “<a href="http://www.nhs.uk/Conditions/Norovirus/Pages/Introduction.aspx">winter vomiting disease</a>”.</p>
<p>We see different search statistics for the <a href="http://www.google.com.au/trends/explore?q=stomach+flu#q=%22stomach%20flu%22&geo=US&cmpt=q">United States</a> (Figure 2) where the term “stomach flu” is used much more frequently. There are consistent search interest spikes for “stomach flu” in winter months of the northern hemisphere all the way back to 2004, the earliest available data.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=227&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=227&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=227&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=286&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=286&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28971/original/4b58skc5-1376029759.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=286&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 2 - Google Trends Web Search Interest “stomach flu”; United States 2004-2013.</span>
<span class="attribution"><span class="source">Google Trends</span></span>
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<p>The community shift in calling gastroenteritis “stomach flu” in Australia has come with some confusion; some of my patients recently asked whether the “flu vaccine” would protect them against “stomach flu”!</p>
<h2>What influenza is (and isn’t)</h2>
<p>Although many viruses can cause acute gastroenteritis, <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/flu_influenza?open">influenza</a>, the virus that is responsible for “flu” is not one of them. </p>
<p>Influenza is a respiratory disease, not a gastrointestinal one. Although people suffering from influenza may experience nausea, vomiting and diarrhoea, they are rarely the main symptoms. </p>
<p>Common symptoms of the flu include fever, sweats, body aches, lethargy and coughs. Influenza immunisation is not effective against contracting gastroenteritis – even in the slightest.</p>
<p>For the most part, acute gastroenteritis is a self-limiting disease. It usually resolves completely without medical treatment. </p>
<p>Most people simply require some rest and plenty of fluids. <a href="http://en.wikipedia.org/wiki/Oral_rehydration_therapy">Oral rehydration solutions</a>, which contain a specific mix of sugar and salts, can be useful in recovering from dehydration and are available from community pharmacies.</p>
<p>But gastroenteritis is contagious, so scrupulous hand hygiene is important to <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/F2A4C351C705B6C6CA257783000C24CA/$File/norovirus-guidelines.pdf">prevent transmission</a>. Other simple preventive strategies include not preparing food for others, and avoiding child care, school or work for at least 48 hours after diarrhoea or vomiting stops. </p>
<p>As always, if you are unsure or have questions about your health, you should seek the assistance of your regular general practitioner.</p><img src="https://counter.theconversation.com/content/15412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Tam is a community general practitioner and sees patients suffering from gastroenteritis.</span></em></p>Nausea, vomiting, tummy pain and cramps, watery diarrhoea … We’ve all had acute gastroenteritis at some stage. As a general practitioner, my patients usually refer to their condition in more colloquial…Michael Tam, Lecturer in Primary Care and General Practitioner, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.