December 24, 2008

Cruises and the Norovirus


My husband wants to go on a cruise, but I am hesitant because I worry about the norovirus outbreaks that we read about. What do you think?


One of us took a cruise, paid for by a generous son, and really enjoyed it. The cruise line in reference is clearly aware of—and nervous about—the risk of norovirus, because every person entering a dining area had their hands sanitized with an alcohol spray. This is a major step in the right direction, but the norovirus can contaminate not only our hands.
The virus causes gastroenteritis, which typically causes vomiting and diarrhea. It is very infectious, and the illness can range from mild to very debilitating. A case study was reported in the U.S. Centers for Disease Control’s Morbidity and Mortality Weekly Report (November 23, 2007; vol. 56, No. 46) of an outbreak in a BarryEaton District restaurant in Michigan. The outbreak occurred in January 2006, and 625 people were interviewed—584 patrons, 32 employees, and nine others who came in contact with an affected patron or employee.
It became apparent that one employee had vomited on the premises, and the cleanup had not utilized bleach solution, which is required to kill the virus. Several employees had become ill. Transmission of the virus is possible before the illness becomes overt.
Some deficiencies in handwashing were identified, and cleaning practices were inadequate in some cases. Monitoring of food temperature—keeping hot food hot and cold food really cold—was not ideal.
Recommendations included the discarding of singleuse items such as napkins, cleaning all surfaces with
bleach disinfectants, exclusion of all ill employees for 72 hours postrecovery, and closure of restrooms used during a vomiting episode.
These measures are being implemented by responsible cruise lines, but we think in our own homes we should also emulate some of these practices.
The washing of hands; maintenance of food preparation surfaces (clean them with bleach!); disposal of leftover, uneaten foods; and placing sick family members out of bounds in foodhandling areas would help a lot.


How much water shoul done drink each day?


Drinking eight glasses of water every day meets the physiological requirements of the average adult person. This volume is calculated by taking into account factors such as vapor loss in respiration, and water in sweat and urine. It assumes normal activity, not strenuous exercise or athletic training, and life in a temperate climate. Stress factors would call for greater water intake.
We recognize water may be a component of our food—just think of a slice of juicy watermelon!—and metabolism produces water itself. Nevertheless, we support the “eight glasses per day” concept as a reasonable target.
Risk of bladder cancer has been shown to fall by 7 percent for every cup of extra water subjects of a study drank over that taken by a control group. And Loma Linda researchers showed a reduction in heart attack risk in women taking at least five glasses of water per day.
We should be careful to note that we are not discussing sugarladen drinks, nor artificially sweetened
drinks, which add other complications to this discussion—especially weight gain.
Additionally, water intoxication can follow excessive water intake, as was demonstrated when a radio talk show host challenged people to see how much they could drink, and the winner died of water intoxication.
Studies are never as decisive as we would hope they would be, and we often pick and choose to find some to suit our biases. But on this issue, we feel eight glasses to be a very reasonable recommendation and know of no harmful effect at all.

Sip away at your water all day, as long as it is pure, clean water!

Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA execu-
tive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or you may send your questions via e-mail to [email protected] While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.