Viral

Gastroenteritis
National Digestive Diseases Information Clearinghouse

What is viral gastroenteritis?

U.S. Department
of Health and
Human Services
NATIONAL
INSTITUTES
OF HEALTH

Viral gastroenteritis is inflammation of the

lining of the stomach, small intestine, and
large intestine. Several different viruses can
cause viral gastroenteritis, which is highly
contagious and extremely common. Viral
gastroenteritis causes millions of cases of
diarrhea each year.
Anyone can get viral gastroenteritis and most
people recover without any complications,
unless they become dehydrated.

What are the symptoms of

viral gastroenteritis?
The main symptoms of viral gastroenteritis
are
watery diarrhea
vomiting
Other symptoms include
headache
fever
chills
abdominal pain
Symptoms usually appear within 12 to
48 hours after exposure to a gastroenteritiscausing virus and last for 1 to 3 days. Some
viruses cause symptoms that last longer.

Stomach

Small
intestine

Large
intestine

Viral gastroenteritis is inflammation of the lining of

the stomach, small intestine, and large intestine.

What are the complications

of viral gastroenteritis?
Dehydration is the most common complication of viral gastroenteritis. When someone
does not drink enough fluids to replace those
that are lost through vomiting and diarrhea,
dehydration can result. When dehydrated,
the body does not have enough fluids to
keep the proper balance of important salts
or minerals, known as electrolytes. Infants,
young children, older adults, and people with
weak immune systems have the greatest risk
of becoming dehydrated.

The signs of dehydration in adults are

excessive thirst
infrequent urination
dark-colored urine
dry skin
lethargy, dizziness, or faintness
Signs of dehydration in babies and young
children are
dry mouth and tongue
lack of tears when crying
no wet diapers for 3 hours or more
high fever
unusually cranky or drowsy behavior
sunken eyes, cheeks, or soft spot in the
skull
Also, when people are dehydrated, their skin
does not flatten back to normal right away
after being gently pinched and released.
People should talk with a health care
provider if they have
blood in their stool, which may indicate
a bacterial infection
symptoms that are severe or last more
than a few days
symptoms of dehydration
Severe dehydration may require intravenous fluids and hospitalization. Untreated
severe dehydration can cause serious health
problems such as organ damage, shock, or
comaa sleeplike state in which a person is
not conscious.

2 Viral Gastroenteritis

What causes viral

gastroenteritis?
Four types of viruses cause most cases of
viral gastroenteritis.

Rotavirus
Rotavirus is the leading cause of gastroenteritis among infants and young children.
Rotavirus infections are most common in
infants 3 to 15 months old. Symptoms usually appear 1 to 3 days after exposure. Rotavirus typically causes vomiting and watery
diarrhea for 3 to 7 days, along with fever and
abdominal pain. Rotavirus can also infect
adults who are in close contact with infected
children, but the symptoms in adults are
milder.

Caliciviruses
Caliciviruses cause infection in people of
all ages. Norovirus is the most common
calicivirus and the most common cause of
viral gastroenteritis in adults. Norovirus is
usually responsible for epidemics of viral
gastroenteritis. Norovirus outbreaks occur
all year but are more frequent from October
to April. People infected with norovirus typically experience nausea, vomiting, diarrhea,
abdominal cramps, fatigue, headache, and
muscle aches. The symptoms usually appear
1 to 2 days after exposure to the virus and
last for 1 to 3 days.

Adenovirus
Adenovirus mainly infects children younger
than 2 years old. Of the 49 types of adenoviruses, one strain affects the gastrointestinal tract, causing vomiting and diarrhea.
Symptoms typically appear 8 to 10 days after
exposure and last 5 to 12 days. Adenovirus
infections occur year-round.

Astrovirus
Astrovirus primarily infects infants and
young children, but adults may also be
infected. This virus causes vomiting and
watery diarrhea. Symptoms usually appear
3 to 4 days after exposure and last 2 to
7 days. The symptoms are milder than the
symptoms of norovirus or rotavirus infections. Infections occur year-round, but the
virus is most active during the winter months.

Viral gastroenteritis is often mistakenly

called stomach flu, but it is not caused
by the influenza virus. Some forms of
gastroenteritis are caused by bacteria
or parasites rather than viruses. For
information about bacterial infections,
see the Bacteria and Foodborne Illness
fact sheet from the National Institute
of Diabetes and Digestive and Kidney
Diseases (NIDDK).

3 Viral Gastroenteritis

How is viral gastroenteritis

transmitted?
Viral gastroenteritis is transmitted from
person to person. Viruses are present in the
stool and vomit of people who are infected.
Infected people may contaminate surfaces,
objects, food, and drinks with viruses, especially if they do not wash their hands thoroughly after using the bathroom. When an
infected person with unwashed hands shakes
hands with or touches another person, the
virus can spread. When an infected person
vomits, the virus can become airborne.
People may be infected with viruses by
touching contaminated surfaces or
objects and then touching their mouths
sharing food, drink, or eating utensils
with infected people
eating foods that are contaminated with
the virus, such as oysters from contaminated waters
swallowing airborne particles that contain viruses
Norovirus is especially contagious. Norovirus can survive for months on surfaces that
are not thoroughly disinfected with a bleach
solution. Hard surfaces should be cleaned
with a mixture of 2 cups of bleach and
1 gallon of water.

Infected people who do not have symptoms

can still transmit viruses. Viruses may be
present in the stool up to 2 weeks after a
person recovers from gastroenteritis.
Outbreaks of viral gastroenteritis can occur
in households, childcare settings, schools,
nursing homes, cruise ships, camps, dormitories, restaurants, and other places where
people gather in groups. People who suspect
they were exposed to a virus in one of these
settings may want to contact a local health
department that tracks viral gastroenteritis
outbreaks.

How is viral gastroenteritis

diagnosed?
Viral gastroenteritis is usually diagnosed
based on symptoms alone. People who have
symptoms that are severe or last for more
than a few days may want to see a health
care provider for additional tests. A health
care provider may ask for a stool sample
to test for rotavirus or norovirus or to rule
out bacteria or parasites as the cause of the
gastroenteritis.
During an epidemic of viral gastroenteritis,
health care providers or public health officials may test stool samples to find out which
virus is responsible for the outbreak.

How is viral gastroenteritis

treated?
Most cases of viral gastroenteritis resolve
over time without specific treatment. Antibiotics are not effective against viral infections.
The primary goal of treatment is to reduce
symptoms and prevent complications.
Over-the-counter medicines such as loperamide (Imodium) and bismuth subsalicylate
(Pepto-Bismol) can help relieve symptoms
in adults. These medicines are not recommended for children.

Eating, Diet, and Nutrition

The following steps may help relieve the
symptoms of viral gastroenteritis in adults:
drinking plenty of liquids such as fruit
juices, sports drinks, caffeine-free soft
drinks, and broths to replace fluids and
electrolytes
sipping small amounts of clear liquids or
sucking on ice chips if vomiting is still a
problem
gradually reintroducing food, starting
with bland, easy-to-digest foods such
as rice, potatoes, toast or bread, cereal,
lean meat, applesauce, and bananas
avoiding fatty foods, sugary foods, dairy
products, caffeine, and alcohol until
recovery is complete
getting plenty of rest

4 Viral Gastroenteritis

Children present special concerns. Because

of their smaller body size, infants and children are likely to become dehydrated more
quickly from diarrhea and vomiting. The
following steps may help relieve symptoms of
viral gastroenteritis and prevent dehydration
in children:
giving oral rehydration solutions such
as Pedialyte, Naturalyte, Infalyte, and
CeraLyte
giving food as soon as the child is

hungry

giving infants breast milk or full

strength formula, as usual, along with
oral rehydration solutions
Older adults and adults with weak immune
systems should also drink oral rehydration
solutions to prevent dehydration.

How can viral gastroenteritis

be prevented?
People can reduce their chances of getting or
spreading viral gastroenteritis if they
wash their hands thoroughly with soap
and warm water for 20 seconds after
using the bathroom or changing diapers
and before eating or handling food
disinfect contaminated surfaces such as
countertops and baby changing tables
with a mixture of 2 cups of household
bleach and 1 gallon of water
avoid foods and drinks that might be
contaminated

5 Viral Gastroenteritis

The U.S. Food and Drug Administration has

approved two vaccines to protect children
from rotavirus infections: rotavirus vaccine,
live, oral, pentavalent (RotaTeq); and rotavirus vaccine, live, oral (Rotarix). RotaTeq is
given to infants in three doses at 2, 4, and
6 months of age. Rotarix is given in two
doses. The first dose is given when the infant
is 6 weeks old, and the second is given at
least 4 weeks later but before the infant is
24 weeks old.
Parents of infants should discuss rotavirus
vaccination with a health care provider.
For more information, parents can visit the
Centers for Disease Control and Prevention
rotavirus vaccination webpage at www.cdc.
gov/vaccines/vpd-vac/rotavirus.
In the past, rotavirus infections were most
common from November to April in the
United States. However, recently widespread vaccination slowed the transmission
of the virus, delaying rotavirus activity until
late February. Overall rates of infection have
also been lower than in previous years.

Points to Remember
Viral gastroenteritis is inflammation
of the lining of the stomach, small
intestine, and large intestine. Several
different viruses can cause viral gastroenteritis, which is highly contagious and
extremely common.
The main symptoms of viral gastroenteritis are watery diarrhea and vomiting.
Dehydration is the most common complication of viral gastroenteritis.
When someone does not drink enough
fluids to replace those that are lost
through vomiting and diarrhea, dehydration can result. Signs of dehydration
in adults are excessive thirst, infrequent
urination, dark-colored urine, dry skin,
and lethargy, dizziness, or faintness.
Infants, young children, older adults,
and people with weak immune systems
have the greatest risk of becoming
dehydrated.
Viral gastroenteritis is transmitted from
person to person.
Diagnosis of viral gastroenteritis is usually based on symptoms alone.
Most cases of viral gastroenteritis
resolve over time without specific
treatment. Antibiotics are not effective against viral infections. The primary goal of treatment is to reduce
symptoms.
Adults with viral gastroenteritis should
drink plenty of liquids such as fruit
juices, sports drinks, caffeine-free soft
drinks, and broths to replace fluids and
electrolytes.

6 Viral Gastroenteritis

Children with viral gastroenteritis

should be given oral rehydration solutions to prevent dehydration.
People can reduce their chances of getting or spreading viral gastroenteritis if
they wash their hands thoroughly with
soap and warm water for 20 seconds
after using the bathroom or changing
diapers and before eating or handling
food, disinfect contaminated surfaces,
and avoid foods or liquids that might be
contaminated.

Hope through Research

The NIDDKs Division of Digestive Diseases
and Nutrition supports basic and clinical
research into gastrointestinal diseases,
including viral gastroenteritis.
Researchers are investigating
diagnostic tests for virus strains
new vaccines for rotavirus and norovirus
the use of probiotics to treat

gastroenteritis

Participants in clinical trials can play a more

active role in their own health care, gain
access to new research treatments before
they are widely available, and help others by
contributing to medical research. For information about current studies, visit
www.ClinicalTrials.gov.

For More Information

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Phone: 1800CDCINFO
(18002324636)
Fax: 4043715488
Email: cdcinfo@cdc.gov
Internet: www.cdc.gov

Acknowledgments
Publications produced by the Clearinghouse
are carefully reviewed by both NIDDK scientists and outside experts. This publication
was originally reviewed by Mary K. Estes,
Ph.D., and Robert Atmar, M.D., Baylor College of Medicine.

7 Viral Gastroenteritis

You may also find additional information about this

topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about
medications. When prepared, this publication
included the most current information available.
For updates or for questions about any medications,
contact the U.S. Food and Drug Administration tollfree at 1888INFOFDA (18884636332) or visit
www.fda.gov. Consult your health care provider for
more information.

The U.S. Government does not endorse or favor any

specific commercial product or company. Trade,
proprietary, or company names appearing in this
document are used only because they are considered
necessary in the context of the information provided.
If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.

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U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES
National Institutes of Health

NIH Publication No. 115103

April 2011
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