The doors of Aberdeen's Music Hall opened around 7.30pm. In dribs and drabs, the crowd began trekking up the venue's steps and into the warm belly of the hall. That evening last May was the first night of the Charlatans' warm-up tour - a long-awaited gig attracting a young and gleeful crowd of about 1,500. At one point, fairly early in the evening, someone was sick on the steps, but the crowd trudged on and up the stairs regardless.
Five hundred people fell ill after the gig - struck down by the nausea, vomiting and aching muscles that characterise winter vomiting disease. The most probable explanation, an inquiry for Aberdeen council found this week, is that germs from the vomit on the hall steps were carried into the venue in the rush of gig-goers and redistributed by the Music Hall's air-conditioning system. A solitary vomiting attack releases about 30 million virus particles; a mere 100 are needed to be infectious.
Winter vomiting disease affects up to one million people in Britain a year. Numbers tend to peak in January, a trend that has been attributed to the fact that we tend to live more closely together in the winter time: we travel, huddled up close, on trains and buses, to our centrally-heated, air-conditioned offices and schools, then make the crowded journey home again, to the snug of our double-glazed houses, spending evenings indoors with the heating ramped up high.
Already, this January has seen several hospital wards closed - at Dartford in Kent, Redhill in Surrey and Crawley in East Sussex - as medical staff attempt to stem outbreaks of the disease. Most recently, 10 of the 13 wards at the Kent and Sussex Hospital in Tunbridge Wells, Kent, were closed when seven members of staff and 35 patients fell victim to the bug. "It's not been an unusual year in terms of numbers of outbreaks," says a spokesman for the Health Protection Agency (HPA). "It is the most common cause of infectious gastroenteritis, and we would normally expect between 600,000 and one million cases, or 220-odd outbreaks a year." He adds that outbreaks tend to occur in semi-closed environments, "where large numbers of people congregate for periods of several days; hospitals, residential and nursing homes, schools and cruise ships."
Although it is not generally serious, winter vomiting disease, as the name implies, is a far from pleasant experience. Whereas common seasonal complaints such as colds and flu target the respiratory system, the winter vomiting virus heads for the digestive system. "The symptoms caused will last for 12 to 60 hours and will start with the sudden onset of nausea followed by projectile vomiting and diarrhoea," says Dr Bob Adak, who monitors the disease for the HPA. Some people may experience additional flu- like symptoms, however, such as headaches, abdominal pain, aching bones, chills and fever.
At blame is the norovirus, which also masquerades as "small round structured viruses" or the Norwalk-like viruses. It works by damaging the cells in the lining of the small intestine, causing fluids to leak from the cells into the intestine and produce diarrhoea. As viruses go, the norovirus is a hardy little specimen, able to weather it out in the harsh environment for several days, and is also quite possibly airborne (think of it as the cockroach of viruses). This is the most likely explanation for the speed at which it spreads. It is also rather adept at the art of infection. "Because there are so many strains of norovirus, and immunity is short-lived, outbreaks tend to affect 50% of people," says the HPA spokesman.
Winter vomiting disease travels person-to-person, via physical contact, consuming contaminated food or water, or even through contact with contaminated objects or surfaces. It can also spread through what the HPA so euphemistically terms the "aerosols of projectile vomit", as the good concert-going people of Aberdeen discovered somewhat overwhelmingly.
A doctor will usually be able to diagnose winter vomiting disease based on the symptoms and also a physical examination. She also may possibly request a stool sample so that she can rule out other sources of the symptoms, such as bacteria, parasites or the imbibing of a vast quantity of cider. However, sufferers should avoid the temptation to head straight for A&E, as this could mean the further spreading of the virus, and, potentially, chaos for the hospital.
Alas, there is no specified treatment for winter vomiting disease - antibiotics are, of course, ineffective against viral infections, and, as Adak explains, the norovirus is what is known as a "self-limiting" virus, which means it will simply run its course. So the main goal is simply to reduce the symptoms: sufferers would be advised to drink plenty of fluids to prevent the dehydration that often accompanies bouts of sickness and diarrhoea. Doctors also suggest avoiding any foodstuffs which might irritate the lining of the intestines, such as dairy products, and caffeine, which stimulates the bowel, exacerbating vomiting and diarrhoea, and also dehydrates the sufferer.
The occasions where a simple, if messy, winter vomiting infection may escalate into something more serious come when the virus strikes people who cannot drink enough fluids to replace what is lost through vomiting and diarrhoea. These include young children, the elderly, and people with weak immune systems. These sufferers may require hospitalisation. For the rest of us, it is just a matter of feeling wretched and taking up a long residency in the bathroom.
Those carrying the virus remain infectious for 48 hours after symptoms develop, which is why many hospitals instigate ward closures, to both contain the epidemic and allow for deep cleaning to prevent the bug from spreading further. Preventative hygiene measures can also be instigated at home. "Any contaminated surfaces or areas should be thoroughly disinfected after an episode of illness," warns Adak, and hands should always be washed thoroughly, "especially after toilet visits", he adds. The HPA also suggests isolating the sufferer - although it would perhaps draw the line at forcing the sufferer to wear a bell around his neck.
The HPA advises that, as the virus is so highly contagious - and one might easily contract it from simply being with an infected person - sufferers should ensure that they have been entirely symptom-free for 48 hours before returning to work or school. During this time, and for three days afterwards, they should avoid any food preparation. They should also resist the urge to visit friends or relatives in hospitals, residential or nursing homes - or attend any Charlatans gigs.
