Why did Christina Applegate wear an adult diaper? Discussing sapovirus, bad salads, and infection prevention

By Frances Gatta | Fact-checked by Barbara Bekiesz
Published May 15, 2024

Key Takeaways

  • Sapovirus, like norovirus, causes acute gastroenteritis and can affect anyone at any time—even celebrities. Actor Christina Applegate recently disclosed her experience with sapovirus, and how it necessitated wearing adult diapers.

  • Sapoviruses are highly contagious, produce devastating symptoms, lead to complications, and even cause death in older adults and people who are immunocompromised. 

  • Preventive measures against sapovirus involve maintaining thorough hygiene and limiting contact with patients with the infection. Treatment strategies aim to manage symptoms and maintain patients' hydration.

Actor Christina Applegate, 52, shared details about her experience with an embarrassing GI condition on a recent episode of her podcast MeSsy. On the show, she claimed she had to wear adult diapers after contracting sapovirus from a tainted salad.[]

Applegate has multiple sclerosis and is immunocompromised, and around the time of contracting the sapovirus infection, she was also dealing with long COVID and a chest infection.

She took a stool test when she started having severe diarrhea, fecal incontinence, loss of appetite, and dizziness. The test revealed that she had contracted the sapovirus from possibly eating takeout salad contaminated with fecal matter.

What is sapovirus?

Sapoviruses are single-stranded RNA viruses belonging to the family Caliciviridae, which also includes noroviruses.[] The virus was named after the city where a diarrhea outbreak occurred in children in the 1970s, in Sapporo, Japan.[] It was found in human diarrhea samples in 1976 through electron microscopy and has also been found in animals, including pigs, mink, dogs, sea lions, rats, and bats.

Sapoviruses can affect anyone, regardless of age or celebrity status, and cause acute gastroenteritis.[] However, infection is more common in children under 5.

A review in StatPearls notes that older adults and people with immunocompromising conditions are also susceptible to the infection and may have worse  symptoms and outcomes.[]

Worldwide, sapovirus accounts for 2% to 9% of acute gastroenteritis cases.  Symptoms of gastroenteritis from sapoviruses are similar to those of illness from noroviruses. Only a laboratory test can identify the causative virus. Sapovirus can also sometimes be found in people with no symptoms.

Reverse transcription-PCR (RT-PCR) assays have been popularly adopted for detecting sapovirus because they have high sensitivity and broad reactivity. However, sapovirus diagnosis is typically not performed due to the high cost and inaccessibility of PCR and because diagnosis does not inform treatment., 

Sapovirus is classified into five genogroups: GI, GII, GIII, GIV, and GV.[] Genogroups I, II, IV, and V infect humans.

Contracting sapovirus

Sapoviruses spread from person to person, causing water- or food-borne illness. A sapovirus infection may occur after close contact with someone with gastrointestinal symptoms, especially in crowded households, or exposure to contaminated water, food (like shellfish), and surfaces.[] 

In children, the highest risk of infection is observed at age 2, when maternal immunity starts declining and exposure to contaminated food or environment increases. By this age, it is estimated that around 82% of children will have experienced at least one sapovirus infection.

Additionally, 64% of children in this age group will have experienced at least one episode of sapovirus diarrhea, according to authors writing in Current Opinion in Infectious Diseases.[]

It is unknown whether animal-to-human spread is possible, as it has yet to be confirmed if sapoviruses are zoonotic pathogens.[] Strict hygiene throughout food production and preparation can help prevent food and water contamination. 

Symptoms and prevention

Symptoms of sapovirus infection are the same as those from other viruses that involve the intestines. They may appear suddenly within 1 to 2 hours, and people in close contact may have similar symptoms. These symptoms include diarrhea, nausea, vomiting, abdominal pain, and fever

These symptoms can range from mild to severe, and some people may require hospitalization, but typically they resolve within a week. 

Understanding of sapovirus disease risk factors is currently limited, making establishing prevention measures challenging.[] However, best practices to avoid contracting sapovirus are similar to those for noroviruses, as outlined in the CDC’s guide on preventing norovirus spread:[]

  • Regularly practicing proper hand hygiene

  • Adequately cleaning and disinfecting contaminated surfaces

  • Safely throwing away materials soiled with stool or vomit

  • Limiting contact with people who have the infection

  • Thoroughly washing fruits and vegetables before consuming them

  • Cooking seafood thoroughly

  • Washing laundry soiled with vomit or stool using the maximum wash cycle

Treatment options

The goal when treating gastroenteritis is to manage symptoms, keep the body hydrated, and restore lost fluids and electrolytes through fluid therapy.

Hospitalization may be necessary for people with severe dehydration, intractable vomiting, severe electrolyte disturbances, renal failure, severe abdominal pain, or pregnancy. Treatment for people who may be dehydrated or unable to take oral fluids may involve intravenous fluids, including saline and lactated Ringer’s solutions, and monitoring of electrolyte levels. 

Antiemetic medications, including metoclopramide, may help manage nausea and vomiting. Antidiarrheal medications may be given to those under 65, but they are not recommended if the patient can stay well-hydrated.

Potential complications

Sapovirus infection usually resolves on its own without causing any complications as long as the patient is adequately hydrated. Complications may arise in older adults and people with immunocompromising conditions. Complications associated with acute gastroenteritis include the following:[]

  • Dehydration

  • Metabolic acidosis

  • Predisposition to reinfection

  • Electrolyte disturbance

  • Development of food intolerance (eg, cow’s milk and soy protein)

  • Hemolytic uremic syndrome

  • Iatrogenic complications from intravenous fluids (inappropriate composition or amount)

  • Death

Multiple sclerosis and sapovirus

Multiple sclerosis is a chronic inflammatory demyelinating and neurodegenerative disease that involves many symptoms, including dysphagia, dyspepsia, bladder and bowel dysfunction, defecation problems, and other gastrointestinal issues.[]

When a patient with multiple sclerosis contracts a sapovirus infection, their symptoms, including diarrhea and dehydration, can be more distressing.

Though patients with multiple sclerosis are not necessarily immunocompromised, they may be at a higher risk of having infections and experiencing complications.[] Most disease-modifying medications recommended for treating the condition work by modulating or suppressing the immune system, which raises susceptibility to infections like sapovirus infection and associated complications.

These factors, among others, may have contributed to Applegate's severe symptoms, which she says lasted for almost 3 weeks.

What this means for you

Healthcare professionals can stay up-to-date with research on sapovirus, including specific risk factors for contracting sapovirus infection and managing its symptoms. Prevention and management are particularly important in people at a higher risk of developing complications. Patients should be instructed on preventive measures against spreading an outbreak to reduce the incidence and burden of sapovirus infections.

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