It’s looking like gastroenteritis (stomach flu/tummy bugs) are on the prowl again. I’ve had a lot of hits on Gastro posts over the past few weeks and it seems there’s been a lot of Gastro questions thrown up -er – into Search Engines. Namely: When I can return back to work or school after Gastro?
Last year, in light of the Norovirus Pandemic (World Wide spread of a really nasty vomiting bug) I started a grassroots campaign: Stop Gastro Spread, in attempt to educate my local (and broader online) community to help prevent the spread by staying at home for 48 hours post last symptom.
So, I thought it was time to have a quick look again at the global recommendations for staying at home with gastro.
The Magic 48 Hour Waiting Period
NSW Health recommends that anyone who has had gastro should wait 48 hours after the last symptom before returning back to work. This is because during that period, it is thought that you are still infectious, as they put it: ‘viral shedding’ is still very high. The UK and USA also specify this waiting period.
This is great and it’s exactly what I’ve been banging on about. BUT, there is potential for some confusion here and I deliberately haven’t mentioned it in any of the material I’ve handed to centres because it deserves a discussion of its own. So here it is…
What counts as the “last symptom”?
This is where the ground is slightly sticky… Gastro has a few symptoms; Nausea, Vomiting, Diarrhoea, Myalgia (fancy medical speak for ‘muscle aches’) with the most obvious being acute vomiting and diarrhoea. Vomiting tends to occur in violent bouts over a few hours and the diarrhoea starting very promptly with or after the vomiting but, and here’s the rub…Diarrhoea can go on for a few days post the cessation of vomiting.
The NSW Health Guidelines state “Anyone with vomiting or diarrhoea should rest at home and not attend work, school or child-care or visit a residential care facility until vomiting and diarrhoea have stopped for 48 hours.”
However, one document by NSW Health states that on-going diarrhoea can be an issue post initial infection and they state it would be impractical to recommend the exclusion of anyone from the work force after this time.
The Australian Department of Health have an excellent document under their “Stay Healthy in Childcare” guidelines that specify that the 48 hour period actually applies to the last incidence of diarrhoea. Now I love the fact they have specified this, since, as you will know if you’ve read other posts I’ve written on gastro, stools (poo) can still be infectious with Norovirus virus particles for ‘some time’ post-acute illness. Interestingly young babies seem to have the biggest issue with their body excreting Norovirus particles as one study showed very young babies still excreting virus particles in their poo 6 months post acute infection! Although the researchers did admit that they didn’t know just how infectious those stools would be 6 months on.
My Main Messages
The 48 hour period isn’t really “magic” at all as you can still infect others with Norovirus past this time if you aren’t careful. But as a rough guideline to employ it will definitely be very helpful in stopping the spread as most people return back to the public domain far too early when they are still very infectious. Sigh.
For adults returning to the workforce post-acute infection, remember to close the toilet lid to flush to prevent aerolised particles whizzing around the toilet booth. And wash hands thoroughly (vigorously for at least 15 seconds) afterwards and dry on something clean (if there is something available).
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