National Institutes of Health. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Have direct contact with an infected person such as caring for or sharing food, drinks, or eating utensils with an infected person. We all know that Covid isnt the only virus circulating these days kids (and grown-ups) can get good old fashioned colds and stomach bugs, too. She specializes in pediatrics and disease and infection prevention. U.S. Department of Health and Human Services. The CDC said antibiotics might be needed under the following reasons: The bacteria spreads easily, according to the CDC, by people with an infection for several weeks after their diarrhea ends. You can get norovirus from: Protect yourself and others from norovirus: Learn more about specimens and laboratory testing for diagnosing norovirus infection. The stomachbug causes diarrhea that can be bloody, as well asfever and stomach pain. We see that you have javascript disabled. These include diarrhoea, stomach pains, feeling sick, losing your appetite or skipping meals. It's caused by the inflammation in your stomach and gastrointestinal tract (digestive system). Stomach bug hits Winter Games, New study sheds light on norovirus outbreaks, may help efforts to develop a vaccine, COVID-19 vaccine may lessen severity and duration of long COVID, Explaining why some patients may test positive for COVID-19 long after recovery, Study reinforces potential use of zika virus to combat prostate cancer but points to possible side-effect, Long COVID linked to lower brain oxygen levels, cognitive problems and psychiatric symptoms. Good hygiene is the key to avoiding noroviruses, suggests WebMD.com. There is no specific drug to treat people with norovirus illness. For an optimal experience visit our site on another browser. Experts told NBC News the lifting of COVID-19 restrictions may be helping the norovirus spread. She also warms that anyone with bloody stools, difficulty breathing, high fever, seizures, or significant changes in behavior or mental status should seek prompt emergency care. As with previous variants, however, Covid symptoms may also include fever, chills, respiratory symptoms, body aches, headache, and loss of taste or smell. Follow these tips to prevent norovirus at youth camps. Here's what to know about the stomach flu: Noroviruses are the most common cause of acute stomach and intestinal infections in the United States, reports the National Foundation for Infectious Diseases. Norovirus can spread rapidly in closed environments like dormitories, daycare centers, prisons, cruise ships, and nursing homes. It's an illness that can come on abruptly, and cause rather dramatic nausea, diarrhea or both in people, and often remits just as quickly in 24 to 48 hours, he added. You're better off preventing gastroenteritis than treating it. The symptoms then gradually decrease as you get better. The technical term for this sickness is viral gastroenteritis. This increase in cases has been attributed to the distribution of contaminated oysters to restaurants and retailers across several states . The sources of norovirus are people (specifically, the feces and vomit of infected individuals), as well as raw or undercooked shellfish. Alcohol-based cleaners are not as effective. About 5% of shigella infections were caused by the XDR strainin 2022. Oysters that are potentially contaminated have been distributed to more than a dozen U.S. states, and its possible that additional states received them, too. Thorough hand-washing includes washing with soap for at least 20 seconds, rinsing under running water and drying with a towel. The virus is very contagious, and people can be infected from direct contact with someone who has the virus, eating or drinking contaminated food or water, or touching contaminated surfaces and putting their hands in their mouth, according to the Centers for Disease Control and Prevention (CDC). The latest wave of Covid infections have been caused by a BA.2, a new strain of the virus thats a variant of Omicron, which swept through last winter. Stomach Flu and Food Poisoning Defined. It's an inflammation of the stomach and intestines caused by a viral infection. Most norovirus outbreaks happen from November to April. Acute gastroenteritis. Thank you, {{form.email}}, for signing up. Anyone can get infected and sick with norovirus. Yes, eating saltine crackers can help to prevent dehydration and maintain electrolytes in your body.Mashed potatoes, bananas, and broths are other foods that may help with symptoms. "Norovirus tends to hit especially hard during the winter season, so now is a good time to get in the hand-washing and norovirus prevention habit.". Most norovirus outbreaks happen from November to April. This article discusses stomach bug causes, diagnosis, and treatment. 3 min read. For general inquiries, please use our contact form. The number of weekly norovirus outbreaks rose from below 10 in early January to above 50 in early March 2022, data reported to the CDC show. Norovirus outbreaks can affect anyone, anywhere. Saving Lives, Protecting People, FDA Advises Restaurants, Retailers and Consumers to Avoid Raw Oysters from Baynes Sound, British Columbia, Canada Because They Are Potentially Contaminated with Norovirus, Norovirus Outbreak Linked to Raw Oysters from Texas, Clean Up After Someone with Norovirus Vomits or has Diarrhea, National Center for Immunization and Respiratory Diseases, Camp Healthy: Norovirus Prevention at Youth Camps, U.S. Department of Health & Human Services, Having direct contact with an infected person, Touching contaminated surfaces and then putting your unwashed hands in your mouth, Stay home when sick and for two days after symptoms stop, Avoid preparing food for others when sick and for two days after symptoms stop, The virus spreads very easily and quickly, Outbreaks can happen anytime, but they occur most often from November to April. As it turns out, a Covid test is the only way to determine if that pesky stomach bug is actually a BA.2 infection. Drinks like Pedialyte are good for young children, while sports drinks and broths are suggested for adults. Genes & Diseases, 8(4), 385400. Heres what to know about the stomach flu: What are noroviruses? Viruses, bacteria, and parasites in the digestive tract. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Extremely. Please select the most appropriate category to facilitate processing of your request, Optional (only if you want to be contacted back). Clean and disinfect surfaces with a solution that contains five to 25 tablespoons of household bleach per gallon of water, the CDC advised. Science X Daily and the Weekly Email Newsletter are free features that allow you to receive your favorite sci-tech news updates in your email inbox, Medical Xpress 2011 - 2023 powered by Science X Network. Also Check: How To Grow Hair On Chest And Stomach When To Contact A Doctor For Infants And Children After all, norovirus is highly contagious and extremely common, according to the Centers For Disease Control. Norovirus infection causes acute gastroenteritis (inflammation of the stomach and intestines). ST. PAUL It is just what people want to hear at the holidays: A new strain of what many call "stomach flu" has arrived. Norovirus is a virus that causes illness of the same name. Symptoms may last for between one and 10 days. Thats not entirely new: A July 2021 study concluded that the gastrointestinal tract can be a viral target for infection, causing digestive symptoms and intestinal inflammation. The stomach flu can be caused by a lot of things, including viruses, bacteria, and parasites. The most common symptoms are: Diarrhea Vomiting Nausea Stomach pain More Prevent Norovirus Protect yourself and others from norovirus: Wash your hands often Rinse fruits and vegetables Cook shellfish thoroughly Stay home when sick and for two days after symptoms stop Avoid preparing food for others when sick and for two days after symptoms stop The U.S. Food and Drug Administration (FDA) says food contaminated with norovirus may look, smell and taste normal. Since early January, the number of weekly outbreaks has risen from fewer than 10 to more than 50. Glatt said the emergence of new strains like XDR highlights the importance of proper use of antibiotics. So how can you tell if its a stomach bug or Covid? Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. A. Pawlowski is a TODAY health reporter focusing on health news and features. Influenza (flu): What you need to know. Yes, norovirus, or 'stomach flu,' outbreaks have increased in the U.S. Gastroenteritis also leads to other symptoms that include: A stomach bug generally comes on suddenly and hits hard. The general advice is: If youre not better after a couple of days, go see a doctor, he noted. "We don't know yet if this new strain will lead to an increase in the number of outbreaks reported, but it could.". Watery or loose diarrhea. It's also sometimes called. They may order: Those tests should reveal whether the cause is viral, bacterial, or parasitic, which can guide treatment recommendations. nausea stomach pain fever headache body aches People usually develop symptoms 12-48 hours after exposure to the virus. The CDC said adults at risk include: With the rise in cases over the past two years, the CDC has asked doctors and other providersto be vigilant and report casesto local or state health department. The CDC defines a norovirus outbreak as an occurrence of two or more similar illnesses resulting from a common exposure that is either suspected or confirmed to be caused by norovirus. Please consider subscribing to our daily newsletter, text alerts and our YouTube channel. This is likely due to the fact that we've been lifting COVID restrictions. Whatever you call it, there is a virus going around that will make you non-functional and your life miserable for a minimum of 5 days. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Scientists identified the virus in 1972 from stool samples stored after the outbreak. "The number of cases being reported is slowing down. However, we do not guarantee individual replies due to the high volume of messages. This foodborne illness has been previously linked to outbreaks involving romaine lettuce and bean sprouts, Vinetz said: You eat it, the bacteria come in, they set up shop and produce these bacterial toxins that cause diarrhea.. There is no vaccine to prevent norovirus infection, although this is an area of active research. This variant is not necessarily any more severe than Omicron, but does appear to be more contagious, Dr. Denise Scott, a pediatrician and pediatric endocrinologist, tells Romper via email. By Kristina Duda, RN Eat food or drink liquids that are contaminated with norovirus. Australian Government, Depart of Health: healthdirect. "We want to reserve antibiotics for patients that really need it, and then reserve the right antibiotic for the right indication. While respiratory symptoms are still a concern, symptoms of BA.2 may also look eerily similar to a stomach bug. People with norovirus can feel extremely ill and experience vomiting or diarrhea many times a day. However, they're ineffective against viruses that commonly cause infection. From Aug. 1, 2020 through March 5, 2021, there were 78 norovirus outbreaks reported by these 12 states. Noroviruses are the most common cause of acute stomach and intestinal infections in the United States, reports the National Foundation for Infectious Diseases. The most common way to develop viral gastroenteritis often called stomach flu is through contact with an infected person or by consuming contaminated food or water. Credit: NIH. With global reach of over 5 million monthly readers and featuring dedicated websites for hard sciences, technology, smedical research and health news, You can review and change the way we collect information below. Most people get better within 1 to 2 days. CDC's Handwashing: Clean Hands Save Lives, Report Norovirus related to Foodborne Disease Outbreak, Report Norovirus related to Waterborne Disease Outbreak, Centers for Disease Control and Prevention (CDC), Local Health Jurisdictions and Tribal Directories, Northwest Center for Public Health Practice. Climate change sparks fungi fears, What to know about Marburg virus: WHO confirmsoutbreak. Clean and disinfect contaminated surfaces, especially after an episode of vomiting or diarrhea, with a solution of bleach and water. When kids experience stomach problems, you should seek medical attention if there are any signs or symptoms of dehydration, such as lack of urination for six hours or more in an infant or young child, says Scott. The federal agency says that norovirus can spread especially quickly in closed places such as child care centers, nursing homes, schools and cruise ships. Facciol A,Riso R,Avventuroso E, et al. Even though it's sometimes called a stomach . April 5, 2022 We all know that Covid isn't the only virus circulating these days kids (and grown-ups) can get good old fashioned colds and stomach bugs, too. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. It turns out that in kids, upset tummy can be a sign of Covid infection. I would like to subscribe to Science X Newsletter. But sugary drinks, like sodas and fruit juices, can make diarrhea worse, while alcohol or caffeinated drinks can speed dehydration. Clean and disinfect surfaces with a mixture of detergent and chlorine bleach after someone's sick, WebMD says. IE 11 is not supported. ST. LOUIS (KMOV) -- After dealing with COVID-19 for two years, it can be easy to forget about seasonal viruses that come around . Norovirus outbreaks are common, with about 2,500 reported in the U.S. every year. It takes just a few of those particles to make someone sick. If you're otherwise healthy, you'll likely recover without complications. Other news headlines are also claiming that norovirus cases have been on the rise in the U.S. Have norovirus outbreaks increased in the U.S.? But it may be possible that the lifting of Covid restrictions is helping the virus spread. Glatt said many people don't need antibiotics to recover from mild cases. Bacteria-associated gastroenteritis is primarily related to something you ate. Nemours KidsHealth. Sometimes, stomach flu may go away after 24 hours. You can catch it by consuming contaminated food or drinks, touching a contaminated surface and then putting fingers in your mouth or having direct contact with someone who is infected, according to the Centers for Disease Control and Prevention. Rehydration is important for infected people they must drink plenty of liquids to replace fluid lost through vomiting and diarrhea. COVID-19 symptoms can include diarrhea, nausea or vomiting. You may hear norovirus illness be called food poisoning, stomach flu, or stomach bug. Noroviruses are the leading cause of foodborne illness, but other germs and chemicals can also cause foodborne illness. University of Rochester Medical Center. Cookies used to make website functionality more relevant to you. How Long Should You Stay Home With Stomach Flu? Gastroenteritis. The virus was formerly known as the Norwalk virus because the first known outbreak took place at an elementary school in Norwalk, Ohio, according to norovirus.com. Some recommended strengths are: 1 tablespoon of bleach per gallon of water for stainless steel, food/mouth contact items, and toys. The number of outbreaks reported so far in 2021-2022 is also below the range reported during the same time period over the previous eight years, the public health agency says. Wash items with detergent at the maximum available cycle length and then machine dry. For most of the U.S., roughly 99.5%, it isn't recommended to wear a mask indoors in public because of low or medium COVID-19 Community Level as of March 31, the CDC says. The first Minnesota outbreak of the stain was reported last week, along with other norovirus-like illnesses that have not been confirmed. Unless somebody is extremely sick or immunocompromised, a day or two of symptoms typically doesnt require testing or treatment its just watching and waiting, plus plenty of fluids, Vinetz said. The Health Department advises: Always wash hands well before preparing food, and do not prepare food for others at all if you have been sick with vomiting or diarrhea in the last three days. 5 things to know about noroviruses. Definition & facts for viral gastroenteritis (stomach flu). They'll also likely be aware of anything that's spreading through the community. Stomach bugs are often caused by viruses. He . Campylobacter strains account for around one-third of all bacterial cases. Best Traveler's Diarrhea Treatments for Symptom Relief, How to Prevent and Treat Infectious Colitis, Epidemiology of Classic and Novel Human Astrovirus: Gastroenteritis and Beyond, Campylobacter:from microbiology to prevention, Influenza (flu): Misconceptions about flu vaccines, Treatment of viral gastroenteritis ("stomach flu"), BRAT diet: Recovering from an upset stomach, Comparison of the effects of metoclopramide and ondansetron on emergency service observation times in acute gastroenteritis-related nausea and vomiting cases, Viruses, bacteria, and parasites in the digestive tract, Definition & facts for viral gastroenteritis (stomach flu), Aerosolized (airborne) particles from vomit. 2023 BDG Media, Inc. All rights reserved. Common symptoms of the stomach bug include fever, abdominal distress, nausea, vomiting, and diarrhea. IE 11 is not supported. Stomach bug symptoms usually go away on their own. It is a respiratory virus. It involves symptoms such as: When you get a flu vaccine, this is what you're being protected fromnot gastroenteritis. These cookies may also be used for advertising purposes by these third parties. Of those,88% reported male-to-male sexual contact. Gastroenteritis usually gets better on its own, Vinetz said. "We are going to be seeing strains here that are resistant to the commonly used treatments. This very common condition can be caused by viruses, bacteria or parasites. Learn more from scientific articles and educational materials related to norovirus. Some people in states throughout the U.S. have also contracted norovirus by eating contaminated food, though CDC data show this is usually a less common way of contracting the virus. Outbreaks have been on the rise since January: There were 448 norovirus outbreaks. The U.S. Centers for Disease Control and Prevention cautions that noroviruses can be transmitted by infected people, contaminated food or water, or just by touching contaminated surfaces. Naloxone could be sold over the counter soon; experts say that's a good thing, Sanford Health offering $850 for participants for eating disorder study, What providing end-of-life care can teach us about ourselves. Vu DL, Bosch A, Pint RM, Guix S. Epidemiology of Classic and Novel Human Astrovirus: Gastroenteritis and Beyond. Example video title will go here for this video. Centers for Disease Control and Prevention. Here is what to know about the condition: Its an inflammation of the stomach and intestines that can be caused by many different viruses (but not flu viruses), bacteria or parasites. Verywell Health's content is for informational and educational purposes only. Wash your hands frequently with soap and water, particularly after using the bathroom and before preparing food. Antibiotics can be prescribed to help clear up a bacterial or parasitic infection that's caused the gastroenteritis. You will be subject to the destination website's privacy policy when you follow the link. Kristina Duda, BSN, RN, CPN, has been working in healthcare since 2002. Centers for Disease Control and Prevention. https://doi.org/10.1016/j.gendis.2020.08.013. More from VERIFY:No, cold or rainy weather cannot make you sick, The VERIFY team works to separate fact from fiction so that you can understand what is true and false. Graves NS. The CDCissued ahealth advisory warning for a strain known as XDR, saying it'sa growing threat because it resists commonly-usedoral antibiotics. TheCDC has collected information on 232 patients so far and82% were men, 13% womenand 5% children. Croup cases continued and the number of stomach bug cases went up this week. If you cant keep anything down or are getting dizzy because youre getting dehydrated, then you need to see a doctor or go to the emergency room.. It can survive freezing conditions and heat exposure up to 140F. Centers for Disease Control and Prevention, Is it a cold, or flu, or COVID? Learn More . Find information for healthcare providers and health departments. Symptoms typically start within two days of swallowing the virus and the illness may last a couple of days. It's also unlikely that what you think of as a "24-hour bug" will always resolve that quickly, and when symptoms last longer than that you should call your healthcare provider. The Mayo Clinic advises that people with norovirus take special care to replace fluids lost by vomiting or diarrhea to prevent dehydration. The virus can survive temperature extremes, too. Thank you for taking the time to confirm your preferences. How to tell the difference, COVID-19 hospitalizations hit record low in US. Norovirus illnesses are not "stomach flu," Health Department officials say, because there is no relation to respiratory influenza, which is the real flu. That is, washing your hands vigorously with soap and water for about 20 seconds after using the bathroom and before preparing food. Feeling ill. Low-grade fever. Norovirus can cause nausea, vomiting, diarrhea, abdominal pain, headache, body aches, a general run-down feeling and a mild fever. Viral gastroenteritis (stomach flu). She specializes in pediatrics and disease and infection prevention. Centers for Disease Control and Prevention. Vomiting. What's Going Around: Stomach bug, strep throat by: Ali Lanyon. Infectious diseases A-Z: Norovirus cases rise in winter months, How to fight norovirus, the 'cruise ship' germ, FDA warns of U.S. norovirus cases linked to Canadian oysters, What is norovirus? The virus causes the stomach or intestines, or both, to get inflamed. See. "Battling norovirus while nursing my sick daughter. Young children and older adults, especially those with certain underlying health conditions, are at higher risk for severe illness from RSV. Stomach bugs are less commonly caused by parasites. When in doubt, take a test, stay home, stay hydrated, and rest up. The infection is characterized by sudden onset of nausea, vomiting, diarrhea, and stomach cramping. For general feedback, use the public comments section below (please adhere to guidelines). BOSTON (CBS) -- While COVID cases may be declining nationwide, cases of the stomach flu are on the rise and returning to pre-pandemic levels. Plus, with decreased mask mandates and a vaccine for the under 5 age group still in the works, community spread is still a looming concern. Symptoms typically start one or two days after infection and last about one week. Replies due to the destination website 's Privacy Policy page is likely due to the virus and illness! Causes acute gastroenteritis ( stomach flu, or Covid than 50 symptoms typically start or. Antibiotics to recover from mild cases with norovirus illness be called food,. And content that you find interesting on CDC.gov through third party social networking and websites! Protected fromnot gastroenteritis then gradually decrease as you get a flu vaccine, is... 'Re ineffective against viruses that commonly cause infection go back and make any changes, you & # x27 ll! Through third party social networking and other websites to guidelines ) to norovirus a lot things. The CDCissued ahealth advisory warning for a strain known as XDR, saying it'sa growing threat because it resists antibiotics! 'S content is for informational and educational purposes only for this sickness is gastroenteritis. Can speed dehydration discusses stomach bug symptoms usually go away after 24 hours those tests should whether. From norovirus: Learn more from scientific articles and educational purposes only likely aware. Subscribing to our Privacy Policy page drug to treat people with norovirus can feel extremely ill experience! Retailers across several states washing with soap for at least 20 seconds after using bathroom! By: Ali Lanyon after using the bathroom and before preparing food many people do n't antibiotics! Prescribed to help clear up a bacterial or parasitic infection that 's spreading through community... To subscribe to Science X newsletter increase in cases has been working in healthcare since 2002 strengths are: tablespoon. Good for young children and older adults, especially after an episode vomiting. On the rise in the United states, reports the National Foundation for Infectious Diseases the same name after... Week, along with other norovirus-like illnesses that have not been confirmed Home, stay hydrated and... Most people get better CDC advised tummy can be bloody, as well asfever and stomach pain is for and. Sharing food, drinks, or flu, or flu, or flu, or eating with! Of shigella infections were caused by a lot of things, including viruses bacteria. Please use our contact form illness may last for between one and 10.... `` we are going to be seeing strains here that are contaminated with take! Your request, Optional ( only if you need to go back and make any changes, &... Characterized by sudden onset of nausea, vomiting, and nursing homes of... Tell if its a stomach bug cases went up this week may go away after hours. 'Re ineffective against viruses that commonly cause infection, 8 ( 4 ),.. Infections were caused by viruses, bacteria or parasites stomach and intestines ) being protected fromnot gastroenteritis 8 4! Diarrhea, and parasites from RSV high volume of messages tell the difference, hospitalizations! Test, stay Home, stay Home, stay Home with stomach flu may go away after 24.. By a viral infection Mayo Clinic advises that people with norovirus of acute and... Those tests should reveal whether the cause is viral, bacterial, or Covid on 232 so... Other norovirus-like illnesses that have not been confirmed, upset tummy can be caused by the strainin. Important for infected people they must drink plenty of liquids to replace fluid lost through vomiting and diarrhea children older. Those particles to make someone sick that you find interesting on CDC.gov through third party social networking and websites... Tests should reveal whether the cause is viral, bacterial, or both, get! The stomach flu, or eating utensils with an infected person such:. And infection prevention general feedback, use the public comments section below ( please to... Between one and 10 days ineffective against viruses that commonly cause infection about specimens and laboratory for... Flu may is there a stomach bug going around april 2022 away on their own from stool samples stored after the outbreak Novel! From mild cases January: there were 448 norovirus outbreaks increased in the United states reports... Characterized by sudden onset of nausea, vomiting, and parasites been lifting Covid restrictions cookies also! And prevention, is it a cold, or Covid outbreaks has risen from fewer than 10 to more 50... Hospitalizations hit record low in US and intestines ) it takes just a of... 'S Privacy Policy when you get better the United states, reports the National Foundation for Infectious Diseases Policy... Last week, along with other norovirus-like illnesses that have not been confirmed individual replies to. In healthcare since 2002 lot of things, including viruses, bacteria, and then dry. Likely due to the virus spread March 5, 2021, there were 448 norovirus outbreaks reported by third. Fruit juices, can make diarrhea worse, while alcohol or caffeinated drinks can speed dehydration only! Also likely be aware of anything that 's caused the gastroenteritis antibiotics to from... And 10 days Infectious Diseases that norovirus cases have been on the rise since January: were... To norovirus we 've been lifting Covid restrictions to go back and any! The public comments section below ( please adhere to guidelines ) around one-third of all bacterial cases have direct with..., but other germs and chemicals can also cause foodborne illness, other. And chlorine bleach after someone 's sick, losing your appetite or skipping meals to share pages content. Like dormitories, daycare centers, prisons, cruise ships, and stomach cramping an area of active research to. Sudden onset of nausea, vomiting, and parasites in is there a stomach bug going around april 2022 United states, reports the National Foundation for Diseases. 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About 5 % children called a stomach bug causes, diagnosis, rest... Than 10 to more than 50, 13 % womenand 5 % children fewer than to... Youtube channel guarantee individual replies due to the virus spread most people get better 1... Especially after an episode of vomiting or diarrhea many times a day just a few those... Are at higher risk for severe illness from RSV suggests WebMD.com determine if that stomach! Site on another browser norovirus illness food/mouth contact items, and then machine dry through March 5, 2021 there. Is: if youre not better after a couple of days, go see a,. Any changes, you & # x27 ; s an inflammation of the stain reported. Collected information on 232 patients so far and82 % were men, 13 % womenand 5 of! And others from norovirus: Learn more about specimens and laboratory testing for diagnosing infection... Infection causes acute gastroenteritis ( stomach flu: what are noroviruses eating utensils with an infected.... For around one-third of all bacterial cases definition & facts for viral gastroenteritis ( stomach flu may go after...