The Pocono area ducked the flu this winter, but we didn’t get off scot-free.

The region is seeing a rash of nasty stomach viruses — the kind that keep you close to home.

Cases of the stomach bug have more than tripled locally, said Dr. Susheer Gandotra, medical director of infectious diseases at Pocono Medical Center, East Stroudsburg.

Also known as gastroenteritis, it’s an inflammation of the intestines. the culprit is typically a norovirus, the most common food-borne illness in the United States, according to Stroudsburg gastroenterologist Dr. Charles Cohan.

Symptoms usually include nausea and vomiting, abdominal pain and diarrhea. Low-grade fevers sometime occur.

“Nausea and vomiting is first to go away, followed by abdominal pain, which resolves second. Diarrhea is third — it usually goes away in five days,” Cohan said.

For most healthy people with properly functioning immune systems, the virus is hardly ever dangerous.

“The overwhelming majority of cases resolve without treatment whatsoever,” Cohan said. “Keep yourself hydrated. the best formula is water with sugar and electrolytes or sports drinks like Gatorade.”

Noroviruses are highly contagious, according to the U.S. Centers for Disease Control and Prevention. the illness usually is over in 24 to 48 hours, but people can still feel run down for a few days after.

“The danger is major dehydration,” said Dr. Jeff Jahre, section chief of infectious diseases at St. Luke’s University Health Network.

Between 80 and 90 percent of stomach bugs are viral in origin, not bacterial, according to Cohan.

“Assuming the person’s immune system is intact, your immune system will overcome the virus and you typically will get better,” he said.

At greatest risk are young children, the elderly and people who are already sick. “They are more prone to get dehydrated,” Gandotra said.

In a separate report released last week, the CDC said noroviruses are more deadly than previously realized. the report says that, on average, they were linked to 800 deaths a year in the U.S., but deaths also doubled in years where new strains emerged. the study looked at gastroenteritis-related deaths from 1999 to 2007 and showed that noroviruses ranked second among the causes.

“Our findings highlight the need for effective measures to prevent, diagnose and manage gastroenteritis,” said lead researcher Aron Hall.

Noroviruses can spread through contaminated food or water and by touching contaminated surfaces, the CDC says.

Contamination occurs, Jahre said, through what health officials politely call the “fecal-oral route,” meaning it’s likely spread first by someone who did not wash his hands after using the bathroom or after vomiting.

In addition, people who have been sick remain contagious for three days to two weeks, the CDC said, so being vigilant is important to stop the spread of the illness.

Gandotra said the outbreak will probably last another few weeks, but it’s impossible to say for sure.

If there is a bright spot, he added, it’s what the illness is not — the flu. Influenza, a much more serious and often deadly virus, has been “virtually non-existent” this year, Jahre said.

Laboratory-confirmed cases of influenza in Pennsylvania fell 96 percent this winter, from 9,851 last year to 367 this year.

Monroe County had four cases positively identified as influenza this year compared with 130 last year — a 97 percent drop. Pike reported an 81 percent drop, from 16 a year ago to three this year.

MCT Information Services contributed to this story.

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ScienceWatch.com correspondent Simon Mitton interviewed him by phone about his work on cholera.

 A notable feature of your highly cited papers is that almost without exception they feature laboratory work on Vibrio cholerae. the citation analysis shows that you are a world expert on the pathogenic strains of this organism. what sparked your interest?

my first degree is in zoology from the University of Madras, following which I studied at Annamalai University for a master’s in marine biology, specializing in marine microbiology. At that time I developed an interest in seafood-borne pathogens that cause diarrhea. my doctorate likewise was in marine microbiology, carried out at the Centre of Advanced Study in Marine Biology in Porto Novo in south India, where I was investigating the ecology and taxonomy of Vibrio parahaemolyticus, which is an organism that causes gastroenteritis and is transmitted by contaminated seafood.

At that point I became familiar with Vibrio cholerae, and I became very interested in it. by good fortune, towards the end of my doctoral work, the then-director of the National Institute of Cholera Diseases, Dr. S.C. Pal, visited our center in south India, and offered me a position.

 Having got a junior position, how did your interest in the microbiology of cholera develop?

I started at this institute in Kolkata, where I am now the director, in August 1981. then I did a couple of short stints in the laboratories of Rita Colwell at the University of Maryland, and at Ottawa, at the Laboratory Center for Disease Control (which no longer exists). I then went to Japan for a longer postdoc assignment at the National Children’s’ Medical Research Centre and with Yoshifumi Takeda at Tokyo University.

I was here at NICED until 2000, when I moved to Dhaka, the capital of Bangladesh, to the International Centre for Diarrhoeal Diseases Research. I came back to NICED in 2007 because I thought it would be great to head a team of very good scientists and to give a research direction to this Institute.

 Can you give me a snapshot of how your papers have contributed to our understanding of cholera as a disease?

“…cholera overwhelms the public health system.”

I have been trained as an environmental microbiologist, so I am basically a laboratory person. over the past 30 years of working on cholera we have written a substantial number of papers on the laboratory aspects, which evolved from conventional techniques to more modern molecular methods including analysis of the genome of this elusive pathogen. Most of the papers in the past decade continue the story of laboratory research as applied to understanding the molecular epidemiology of the pathogen.

 You spent seven years in Dhaka. Did that influence the direction of your research?

it certainly did. At the hospital in Dhaka I saw that the number of cholera patients did not seem to decline: sometimes they spilled over into the balconies or into the lounge, the courtyard, and even the parking garage! it struck me that I had done a lot of lab work but I had not made a difference to patient outcomes. that reflection changed my perspective: I wanted to look at the disease from an epidemiological point of view, and that characterizes the more recent papers.

I recently conducted a search of papers about cholera published in the past 30 years. Naturally there has been a steep increase in publications. it struck me that as the number of research papers increased, so the global burden of cholera seemed to be on the rise. To a statistician it would have seemed that the more knowledge we had, the greater the burden!

obviously that’s too simplistic but it set me thinking: henceforth I wanted to spend my research time on developing a tangible understanding of how to reduce burden of disease and develop prevention and control strategies.

 Can vaccines make a difference, or is it more complicated than that?

Much more complicated! Look, when I came back to Kolkata the Institute was in the midst of a large field trial of a cholera vaccine in collaboration with Dr. John Clemens and his team at the International Vaccine Institute (IVI, Seoul, South Korea). I joined them. that trial, and the collaboration with IVI, has led to a new generation of heat-killed cholera vaccine which from December 2009 is licensed in India.

in a series of lectures given throughout India we told clinicians, particularly those in pediatrics, that we now have a cholera vaccine. But I got a huge surprise: after my first lecture pediatricians asked why we require a vaccine for a disease that does not exist!

that appalled me. I think this denial has occurred because cholera has a negative political connotation: “don’t use the C word—sweep it under the carpet—call it watery diarrhea, dysentery, gastroenteritis, what you like, but not cholera.” this has been going on for 30 years: Bangladesh does not report cholera to the WHO. so what I observe is that people have almost forgotten about cholera and the huge burden it causes because of this denial.

 There’s also a strong link between poverty and cholera I believe.

“At the hospital in Dhaka I saw that the number of cholera patients did not seem to decline: sometimes they spilled over into the balconies or into the lounge, the courtyard, and even the parking garage!”

yes: cholera unfortunately is driven by poverty. we need to tell the world that cholera has not gone away. What’s happened in Haiti, in Zimbabwe, and in a whole lot of places in Africa and Asia gives us clear indication that there is a lot of cholera and it is going to persist because cholera has an environmental reservoir and the moment there is a drop (or even no improvement) in standards of sanitation and hygiene you can be sure that this disease will prevail to an extent that will cause grave public health consequences.

 Your papers demonstrate a strong focus on understanding how specific serogroups, O1 and O139 are implicated in cholera. could you tell me about that?

when I came to this Institute in 1981 I was intrigued by the distinction of serogroups. Only one serogroup at that point, namely O1, caused cholera and epidemics, while the other 130-odd serotypes, then known as non-O1, were incapable of causing cholera and epidemics, but were occasionally associated with diarrhea.

what struck me was a disparity in thinking because everyone worked on serotype O1 because that was the causative agent. a central question which they asked was: Why does O1 cause cholera and the epidemics? I reframed this question: I asked myself why do non-O1s not have the ability to cause cholera?

I imagined if I were able to answer this question perhaps the understanding of why O1 causes cholera would come to light. therefore the research questions that I asked were different, and in many ways this interest in the non-O1 V. cholerae led to the first discovery of O139 serogroup in 1993.

in 1993 we discovered in Bengal the new bacterium causing cholera, O139. that was an important turning point. we are always on alert for changing phenotypes, and this interest led us to discover the variant/hybrid El Tor strains in 2002 which is now on a rampage across the world because it seems to have the virulence of both the biotypes, the classical and El Tor.

it fascinates us how this organism makes subtle changes. I still do not know if they are due to pre-existing immunity in endemic populations. But that may explain why V. cholerae comes back in slightly different forms and causes epidemics, spreading so efficiently as compared to other enteric pathogens.

 So does the organism have the capacity to produce menacing variants?

it is a fascinating organism! my recent publications have been mostly related to these discoveries of subtle new forms, including the variant which we know has caused the outbreak in Zimbabwe. I’m not too sure about the strain causing the outbreak of cholera in Haiti but that is something we are working on right now.

 Thank you for such an engaging and informative conversation. I know I’ve caught you at a busy time as you prepare to go to Haiti. How do you see the future?

I want to see the crushing burden of cholera decrease. I feel that my experience in the laboratory, field, and hospital gives a feel for what cholera can do and what an epidemic is like. I was involved in the epidemic caused by O139 in 1993. we had one patient arriving every four minutes at the infectious-diseases hospital here where we have 770 beds. Within 24 hours we were totally swamped: cholera overwhelms the public health system.

in reality, studies of the kind I make are not going to help very much on the front line. Cholera has become a social problem that requires issues of poverty to be addressed. we know how to eliminate cholera: there is none in Europe or America. it involves upgrading sanitation to levels where there is no water-borne transmission and also the provision of safe drinking water. in India and other developing countries it’s a question of education and advocacy. That’s what I am working on right now.

G. Balakrish Nair, M.Sc., Ph.D. National Institute of Cholera & Enteric Diseases Beleghata, Kolkata, India

G. BALAKRISH NAIR’S MOST CURRENT MOST-CITED PAPER IN ESSENTIAL SCIENCE INDICATORS:

Sack DA, et al., “Cholera,” Lancet 363(9404): 223-33, 17 January 2004 with 189 cites. Source: Essential Science Indicators from Thomson Reuters.

KEYWORDS: CHOLERA, VIBRIO CHOLERAE, PATHOGENIC STRAINS, DIARRHEA, VIBRIO PARAHAEMOLYTICUS, GASTROENTERITIS, CONTAMINATED SEAFOOD, LABORATORY RESEARCH, MOLECULAR EPIDEMIOLOGY, PATIENT OUTCOMES, GLOBAL BURDEN, PREVENTION, CONTROL STRATEGIES, VACCINES, POVERTY, POLITICS, ENVIRONMENTAL RESERVOIR, SANITATION, HYGIENE, PUBLIC HEALTH, SEROGROUPS, O139, EL TOR, SAFE DRINKING WATER, EDUCATION, ADVOCACY.

INDIANAPOLIS — A stomach illness is making the rounds in central Indiana, closing a Muncie school after dozens of students fell ill.immediate care centers and emergency rooms have been swamped with patients complaining of fever, vomiting and diarrhea, 6News’ Stacia Matthews reported.St. Lawrence School closed Friday after more than half of the students reported similar symptoms.”We sanitized the entire school with a bleach solution,” said Principal Lynn Ranieri. “Today, only seven students called in sick.”Gastroenteritis, as it’s officially known, can’t be treated with drugs or antibiotics, but must simply run its course.”We’ve seen a lot of kids coming in with vomiting, usually lasting 24 hours. they may complain of fever and some kids are getting diarrhea,” said pediatrician Dr. Alex Sleder with Community Health Network.With fluids and rest, vomiting can subside within 24 hours, but diarrhea usually lasts between five to seven days, Sleder said.to keep from getting sick, experts advise people wash their hands, especially when they’re out in public.”It’s hard to tell how much virus it takes (to get sick), but it’s enough that you don’t even know you’re touching something that’s soiled,” said Shawn Richards with the Indiana State Department of Health.”People don’t think about it when they are at the store, the shopping cart, just in the elevator,” Sleder said. “You have to be wary of where you are and your environment.”Experts also stress that people don’t ever become immune to the stomach illness, so prevention is key to keep from getting it again.