Parents are being urged to keep young children at home if they are sick because of a rise in viral gastroenteritis cases.
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NSW Health's Keira Glasgow said there had been an increase in outbreaks in NSW childcare centres and a high number of children aged under five seeking treatment at emergency departments.
Across the Murrumbidgee Local Health District, there were four reported cases of gastro in childcare centres during August.
"Nearly 100 childcare centres reported outbreaks of gastro in August, double the average for this time of year and at least 820 children and 165 staff have fallen ill," Ms Glasgow said.
"The number of children seeking treatment for the highly-contagious infection at EDs has also risen above usual levels, with 609 children seeking medical attention in the last week."
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Ms Glasgow said gastro was often spread by direct contact with an infected person. Viral gastroenteritis is usually caused by norovirus or rotavirus.
"It spreads easily between people if they haven't carefully washed their hands after using the toilet or before handling food," she said.
"The best defence is to wash your hands thoroughly with soap and running water for at least 10 seconds before handling and eating food, and always wash your hands after using the toilet, changing nappies or assisting someone who has diarrhoea or vomiting.
"Infants or children in childcare or school who develop vomiting or diarrhoea should stay at home for at least 48 hours after their symptoms have stopped."
People whose work involves handling food or looking after children, the elderly or patients, should not return to work until 48 hours after symptoms have stopped to avoid spread of infection. Anyone not involved in these occupations should stay home for at least 24 hours.
Symptoms include nausea, vomiting, diarrhoea, fever, abdominal pain, headache and muscle aches. They can take up to three days to develop and usually last between one or two days, sometimes longer.
The main treatment for viral gastroenteritis is to rest and drink plenty of fluids. Most people recover without complications, however, it can be serious for infants, people with suppressed immune systems and the elderly.
Anyone recovering from gastroenteritis should avoid visiting hospitals and aged care facilities to avoid spreading the infection to those most vulnerable.