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Kawasaki Norovirus Spreads Concern In The UK: Here's How Prominent It Is In SA

The Kawasaki norovirus is the GII.17 strain of the infection that causes vomiting, diarrhea, stomach craps and fever.

A highly infectious bug sweeping through Britain already has an established footprint in South Africa.

Kawasaki norovirus, named after the Japanese city where it was first identified, is a viral gastroenteritis infection.

Severe stomach bug

It has sparked concern in Britain after the UK Health Security Agency confirmed that the Kawasaki strain is responsible for 70% of all norovirus cases currently being reported, as per The Independent.

Acting Head of the Centre for Entric Diseases at South Africa's National Institute of Communicable Diseases (NICD) Professor Nicola Page, explained that the novel GII.17 variant, known as Kawasaki, was first identified in South Africa around 2015.

"The variant was detected for the first time in wastewater in South Africa and two years later it was detected in hospitalized children," Professor Page explained to The Citizen.

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It is now the second most prevalent norovirus in SA.

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The GII.4 norovirus is the only strain more prevalent in South Africa over the last two years, with GII.17 often leading to hospitalisation of children suffering from diarrhoea.

"While most people recover without the need for medical treatment, children younger than five years old, older adults, and people with weakened immune systems are more likely to develop severe infections," Professor Page said.

Should those experiencing symptoms become severely dehydrated, they should go to the clinic or hospital as they may require intravenous fluids, she advises.

Detected in 14% of norovirus cases

Noroviruses cause diarrhoea, vomiting, nausea and stomach cramps, and are very contagious. Other symptoms include fever, headache and body aches.

The infection may be caught through direct contact with someone infected with norovirus or touching contaminated objects or surfaces.

Additionally, eating food or drinking liquids that are contaminated with norovirus can also lead to infection.

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Symptoms develop 12 to 48 hours after exposure and even after diarrhoea and vomiting subside, individuals can shed norovirus for two weeks or more.

Between January 2021 and December 2023, GII.4 was detected in 46% of norovirus cases, with GII.17 present 14% of the time, explained the Professor, citing data from a Virology Africa conference presentation by Grobler G, et al from earlier this year.

Stay hydrated

Professor Page says that steps to take to protect oneself from catching Kawasaki and other norovirus' include:  

  • Washing your hands well and often
  • Washing fruits and vegetables
  • Cleaning and disinfecting contaminated surfaces
  • Washing laundry in hot water
  • If possible, stay home when sick for 48 hours after symptoms stop
  • Should anyone develop symptoms, they are reminded to stay well hydrated.

    NOW READ: Marburg virus in Rwanda: No case in South Africa since 1975

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    What Causes A Strawberry Tongue?

    Strawberry tongue refers to a swollen, red, and bumpy tongue that looks similar to the surface of a strawberry. It is not a health condition on its own but a symptom of several diseases, including bacterial and viral infections, Kawasaki disease, and toxic shock syndrome (TSS). Strawberry tongue can also be a sign of food or drug allergies or nutritional deficiencies. 

    Your tongue can provide important clues about your health. A strawberry tongue is a sign of a condition that requires treatment, so it's important to see a healthcare provider if you notice your or your child's tongue has a strawberry-like appearance. Treatment typically includes lifestyle changes and medications.

    A healthy tongue is pink with small bumps (called papillae). A strawberry tongue changes the appearance of your tongue, causing it to appear bright red, swollen, and bumpy. These bumps typically resemble strawberry seeds, hence the name strawberry tongue. Depending on the cause of strawberry tongue, your tongue may initially have a white coating, making it look like a white (unripe) strawberry. Eventually, the white coating disappears, and the tongue appears bright red.  Along with visual symptoms, a swollen tongue can be uncomfortable, making chewing or swallowing difficult. Some people also experience tongue soreness or sensitivity. Because strawberry tongue is an underlying sign of other conditions, you may also experience symptoms of the condition that's causing your strawberry tongue. These symptoms may include fever, sore throat, skin rashes, and fatigue.  Several conditions can cause strawberry tongue. While a strawberry tongue can be alarming, most causes of your symptoms are treatable. Seek care from your provider if you have any of the following conditions, as they require treatment to reduce the appearance of your strawberry tongue and improve your other symptoms. Kawasaki Disease Kawasaki disease is one of the most common causes of strawberry tongue. It is a rare condition that primarily happens to children under five, causing inflammation that affects the blood vessels and heart. It's unclear what causes this inflammatory reaction, but experts believe it may develop due to an infection.  Children with Kawasaki disease typically have a high fever that lasts five days or longer. Alongside a strawberry tongue, your child may also develop the following symptoms of Kawasaki disease:  Skin rash on the back, groin, and chest  Red, cracked lips  Eye irritation and redness  Swelling in the hands and feet Swollen lymph nodes in the neck  Because Kawasaki disease affects the body's blood vessels and heart, it requires prompt medical treatment to prevent complications, such as heart damage or heart valve problems. Scarlet Fever Scarlet fever is a bacterial infection that develops within 2-5 days after exposure to group A Streptococcus bacteria—the same bacteria responsible for strep throat. Strawberry tongue is a hallmark symptom of scarlet fever. Your tongue may initially have a white coating, which peels away to reveal a bright red, bumpy surface. The bacteria that causes scarlet fever is highly contagious and most commonly affects children. Common symptoms of scarlet fever include: Fever Rough or sandpaper-like skin rash  Bright red skin in armpit creases and groin Sore throat Flushed face with a pale area around the mouth Petechiae (tiny red spots on the roof of the mouth)  Swollen tonsils or white streaks on the tonsils Headache or muscle aches Abdominal pain Nausea and vomiting Toxic Shock Syndrome (TSS) Toxic shock syndrome is a rare, potentially life-threatening infection that develops when Staphylococcus aureus (staph) or Streptococcus pyogenes (strep) bacteria enter the body's tissues or bloodstream and produce toxins.  About 30% of people have staph bacteria living on their skin and in their noses. Most of the time, these bacteria do not cause problems. TSS can develop when bacteria enter the body through a break in the skin, such as a cut or scrape, or through the mucous membranes of the nose, mouth, or vagina. Although TSS is often associated with tampon use in menstruating people, it can affect males and females of all ages. Symptoms of TSS include: High fever Widespread rash that may look like sunburned skin  Headaches or muscle aches Nausea and vomiting  Diarrhea Rapid heart rate Confusion  Seizures Red eyes, mouth, and throat  Low blood pressure Vitamin Deficiencies  Low levels of vitamin B12 or folic acid (vitamin B9) can cause strawberry tongue. Vitamin B12 is essential for producing red blood cells. Folic acid helps the body make new cells, including brain, blood, and skin cells. Vitamin B12 and folic acid work together to make red blood cells and help the body break down and make new proteins.  A deficiency in either of these essential vitamins can occur if you don't get enough nutrients through your diet or if you have a condition that affects nutrient absorption (e.G., celiac disease or Crohn's disease). These vitamin deficiencies can cause strawberry tongue along with other symptoms, such as: Fatigue Irritability  Diarrhea Weakness  Pale skin  Shortness of breath Difficulty concentrating  Allergic Reactions Allergic reactions to certain foods or medications can sometimes cause strawberry tongue. People with oral allergy syndrome (OAS) may develop a strawberry tongue after eating raw fruits or vegetables pollinated by grasses, birch trees, or ragweed. OAS usually causes mild allergy symptoms, though symptoms may worsen during the pollen season.  OAS symptoms include:  Swollen or irritated gums Runny nose Watery eyes Itchy, tingly mouth  Swollen lips and tongue Sore throat  Drug-related allergies can also cause tongue changes, including tongue swelling and redness. It is possible to develop an allergy to any medication, but some medications are more likely to cause an allergic reaction than others, including:  Anti-seizure drugs  Insulin  Iodine-containing substances, such as X-ray contrast dyes  Antibiotics, such as penicillin and sulfonamides Drug-related allergies can also cause additional symptoms, such as hives, itchy skin or eyes, wheezing, and a swollen tongue, lips, or face.  Rare Infectious Diseases  Several rare infectious diseases can also lead to a strawberry tongue, including:  Recurrent toxin-mediated perianal erythema: This is a rare condition that develops in response to toxins Staphylococcus or Streptococcus bacteria. It often begins with mild symptoms like low fever, strawberry tongue, and red hands that later start peeling. After a few days, redness similar to a skin infection appears around the anus, which eventually peels as well. Yellow fever: This viral infection is spread by mosquitoes, mainly in tropical regions. Symptoms include fever, vomiting, headache, back pain, fatigue, jaundice (yellowing of the skin and whites of the eyes), and bleeding from the eyes, nose, or mouth. Some people also develop facial redness and strawberry tongue, especially on the tip and sides of the tongue. Yersinia pseudotuberculosis: This zoonotic bacterial infection spreads from animals to humans, often through contaminated food. Symptoms include fever and lower abdominal pain. Certain strains of this bacteria can cause strawberry tongue. It usually resolves on its own, but in people with conditions like diabetes, chronic liver disease, or iron overload (hemochromatosis), it can lead to a more severe bloodstream infection. Recalcitrant erythematous desquamating disorder: This rare condition develops in response to toxins produced by Staphylococcus bacteria, similar to TSS. Symptoms include fever, red patches of skin that later peel, strawberry tongue, and redness in the eyes and mouth. It's important to see a healthcare provider if you or your child develop a strawberry tongue. Since many of the conditions associated with strawberry tongue can worsen if left untreated, diagnosis and treatment are essential for preventing complications.  Seek prompt medical attention if you develop strawberry tongue that occurs alongside any of the following symptoms:  High fever Difficulty swallowing Skin rash  Swelling in other body areas  A primary care physician (PCP) or pediatrician can perform a physical examination and may order diagnostic tests, such as throat swabs for bacterial infections and blood tests to check for inflammatory markers and nutritional deficiencies. If your healthcare provider suspects an allergy is causing strawberry tongue, they may order allergy testing to identify which allergens are causing your symptoms.  There is no specific treatment for addressing strawberry tongue on its own. Your healthcare provider will develop a treatment plan to address the condition causing a strawberry tongue and any other symptoms you are experiencing. Depending on the diagnosis, this may include:  Antibiotics for bacterial infections Pain relievers to reduce fever and manage body aches Aspirin and intravenous (IV) immunoglobin to treat Kawasaki disease Dietary changes or supplements to address vitamin deficiencies It is not always possible to prevent strawberry tongue, but there are steps you can take to avoid some of the conditions that cause it. Consider these prevention strategies:  Wash your hands frequently with soap and water  Avoid close contact with people who are sick  Limit contact with wild animals  Stay up to date on vaccinations  Eat a nutritious diet to maintain a healthy immune system and prevent nutritional deficiencies  Manage chronic conditions associated with a weakened immune system by following your treatment plan Strawberry tongue itself isn't harmful, but it is a symptom of conditions that require treatment and can lead to complications if left untreated. Kawasaki disease can damage the heart and blood vessels throughout the body, causing the heart to work harder to pump blood. This can lead to aneurysms (swollen, bulging arteries) in the coronary arteries (your heart's blood vessels) that can be life-threatening if they weaken and burst open. Untreated bacterial infections, such as scarlet fever and toxic shock syndrome, can cause sepsis, a life-threatening infection in the bloodstream that can lead to organ damage and failure or death. To improve your symptoms and limit your risk of complications, seek support from your healthcare provider and follow their treatment recommendations as directed. Strawberry tongue is a term for a red, swollen, and bumpy tongue that resembles the skin of a strawberry. Several conditions can cause strawberry tongue. The most common causes include Kawasaki disease, scarlet fever, toxic shock syndrome, and vitamin B12 or folic acid deficiency. See a healthcare provider if you or your child develop a strawberry tongue. Early diagnosis ensures prompt treatment for the underlying cause, helping you feel better sooner and preventing complications.

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    What Is Kawasaki Disease? How To Recognize The Symptoms In Your Child

  • Kawasaki disease is a rare condition that mostly occurs in children younger than five years old. 
  • Symptoms include high fever and rash in the first two weeks, and body ache, diarrhea, or vomiting in the two to six weeks after fever begins.
  • With effective treatment to reduce inflammation, most kids will fully recover from Kawasaki disease. 
  • This article was medically reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine. 
  • Visit Insider's Health Reference library for more advice.
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    Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an inflammation of the blood vessels that is most common in children. About 75% of Kawasaki disease cases occur in kids younger than five years old. 

    Overall, the disease is very rare, affecting between 9 and 19 out of every 100,000 children under the age of five in the US. The disease is most common in Japan, where it affects 308 out of every 100,000 children under age 5. 

    With treatment, most kids with Kawasaki disease can make a full recovery, says Daniel S. Ganjian, MD, a pediatrician at Providence Saint John's Health Center. 

    However, Kawasaki disease is the leading cause of acquired heart disease in American kids. Even among kids who get treatment for Kawasaki disease, 4% to 6% will develop coronary artery aneurysms, a condition that affects the arteries around the heart. 

    Many of these aneurysms resolve themselves within two years. In rare cases, the cardiac complications from Kawasaki disease can lead to life-long heart disease or sudden death. 

    Here's what you need to know to recognize and treat this rare condition if you're concerned about your child. 

    Symptoms

    The symptoms of Kawasaki disease develop in stages, according to Sylvia Owusu-Ansah, MD, a pediatrician at Children's Hospital of Pittsburgh. These include: 

    Early stages 

    The first stage, which can last through weeks 1 and 2, includes the following symptoms: 

  • High fever (between 100 and 104 degrees Fahrenheit) which lasts for five days or more
  • Rash on the torso
  • Bloodshot eyes and "strawberry tongue," a bright red tongue 
  • Swollen hands and swollen lymph nodes
  • Discomfort in the mouth, throat or abdomen 
  • Later stages 

    The second stage, which usually lasts from weeks 2 through 6 after fever begins, can include symptoms like:  

  • Joint pain 
  • Belly ache 
  • Diarrhea 
  • Vomiting 
  • Peeling skin on the hands or feet 
  • Symptoms will usually resolve within three months, but if the disease is not treated, children may experience serious complications, such as coronary artery aneurysms, which are diagnosed using hospital imaging. 

    Diagnosis 

    There's no specific diagnostic test for Kawasaki disease, so it's diagnosed based on a child's symptoms and a physical exam, including inflammatory markers throughout the body, Ganjian says. 

    And since the early symptoms  — fever and rash — can mimic many other childhood diseases, like hand foot and mouth disease, diagnosis can be difficult. 

    "It's so frequent that kids get high fevers and rash," Ganjian said. He recommends going to a children's hospital or trusted pediatrician if you are concerned about your child.

    If the fever has persisted for five days, or the child has symptoms like red, cracked lips and a strawberry tongue or bloodshot eyes, you should seek medical attention.

    Causes

    The cause for Kawasaki disease isn't known, but doctors suspect that it's caused by infection, or by the body's immune response to infection. 

    It's most common in Japan, and in America, it occurs most often in children of Asian heritage, especially of Japanese and Korean heritage, Owusu-Ansah says.  

    Genetics can also play a role in who develops Kawasaki disease. A 2019 study found that genetic variations, including in the ACE gene, which controls enzyme production, increase susceptibility to the disease. 

    Boys are twice as likely as girls to have Kawasaki disease. Boys whose parents had the disease are more likely to have it themselves, says Leo Nissola, MD, an immunology scholar at The Parker Institute for Cancer Immunotherapy. 

    Kawasaki disease and COVID-19

    Preliminary studies have found that some children who test positive for COVID-19 are also exhibiting symptoms of Kawasaki disease. 

    A 2020 article published in The Lancet noted a "30-fold increased incidence of Kawasaki-like disease" at one Italian medical center before and during the pandemic. And similar reports of increased cases of a Kawasaki-like disease have also come out of the US. 

    However, there are also key differences. The children in the Italian study were slightly older than is usual with Kawasaki disease. And the racial differences that are typical with Kawasaki disease have not been present. 

    "We don't want to call it Kawasaki, because then providers are looking for Asians or really young kids, and missing other cases," Ganjian explains.

    Pediatric inflammatory multisystem syndrome

    Health providers have given this Kawasaki-like disease a different name: pediatric inflammatory multisystem syndrome (PIMS). 

    "There's a lot of overlap, but we don't know if they're the same thing at this point," Ganjian says. 

    While both diseases have the same symptoms, PIMS can be observed in older children, while Kawasaki is mostly diagnosed in children under five. If doctors were looking for Kawasaki disease specifically, they might miss cases that present in older kids and non-Asians. 

    Overall, labeling the COVID-related cases as a different syndrome can help doctors detect cases more accurately and intervene with treatment, which is similar for both PIMS and Kawasaki disease. 

    Treatment

    If you believe your child is displaying symptoms of Kawasaki disease, seek medical advice from your pediatrician or the emergency room at a children's hospital. 

    "If your child has manifested a fever and you noticed that it is lasting more than a couple of days, you need to seek medical help," Nissola says. "Keep your eye out for unusual symptoms, like pink eyes, swollen tongue, redness in the hand or feet, rashes in the body, and swollen lymph nodes around the neck."

    To treat Kawasaki disease, doctors will take action to reduce inflammation in the swollen blood vessels.

    Parents should not try treating suspected Kawasaki disease or PIMS at home. Only a doctor will be able to administer the following treatment methods: 

  • Intravenous immunoglobulin. IVIG treatment infuses immunoglobulin — antibodies derived from plasma donations — into the blood. These antibodies help regulate the body's immune response, to reduce and prevent further inflammation. 
  • Aspirin. Small doses of aspirin can be used to reduce inflammation and pain for children. Your doctor will advise the right amount for your child. 
  • Steroids. Steroids can also help reduce inflammation, Ganjian says, which your doctor may choose to prescribe. 
  • Before IVIG treatment, 20% to 25% of kids with Kawasaki disease developed coronary artery aneurysms, but with the treatment, only 4% to 6% of children will develop this complication. 

    Most of these aneurysms resolve within two years, but in some cases they can lead to lasting heart disease or death. Children who develop aneurysms should meet with a cardiologist, Owusu-Ansah says.

    The bottom line

    Both Kawasaki disease and PIMS remain very rare. Ganjian says that most COVID-related cases have occurred in kids with other medical conditions, although he said "at this point, we just don't know," what conditions might increase risk for developing PIMS. 

    "Parents are going to start worrying about all their kids, so it's important to note that this is very rare," he says. 

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