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The messy illness known as "winter vomiting disease" has struck Tucson, joining a growing list of cities across the country now battling outbreaks.

The bug causing the disease — marked by sudden-onset vomiting, diarrhea and severe abdominal cramps — is most likely norovirus, the same bug that sometimes sweeps through cruise ships.

The highly contagious norovirus has been confirmed as the culprit sickening residents of an assisted-living facility in Tucson this week, county health officials said.

And it is the suspected cause of a "notable increase" in diarrhea symptoms among patients showing up in the past week at the city's largest ER, at Tucson Medical Center, hospital officials said.

Although Tucson's outbreak has not reached an alarming level, it is part of a nationwide sweep of gastrointestinal illness that has packed ERs, infected nursing homes and even quarantined a prison since the Christmas holidays.

States now reporting unusual outbreaks include California, Massachusetts, Michigan, Montana, Ohio, Oregon, Pennsylvania, Washington and Wisconsin.

Federal health authorities are so concerned that they'll conduct a conference call this week with disease trackers from across the nation to gauge the impact of a norovirus outbreak — the worst in four years.

"But the bottom line is we don't really know why," said Dr. Marc-Alain Widdowson, a norovirus specialist at the U.S. Centers for Disease Control and Prevention. The virus now circulating may be a more easily transmitted strain or one that spawns more severe symptoms, he speculated.

Norovirus typically hits hardest during the cold months, when people are clustered in close quarters in their homes, said Francelli Lugo, Pima County epidemiologist.

Tucson normally records at least one winter outbreak, so it's unclear if the problem will worsen here, as it has elsewhere.

Lugo declined to name the affected assisted-living facility, and said it is too early in the county's investigation to determine the number of victims.

At TMC, the number of patients with noroviruslike symptoms has doubled in recent days, from a normal 10 a day to 20, officials there said.

"What you have to do is disinfect the place, from top to bottom — every place a hand can touch," Lugo said. "That means doorknobs, light switches, even the bingo chips have to be dunked in bleach.

"Please tell people that hand-washing right now is critical, when we're all inside together in this cold weather. And use disinfectant."

Not normally fatal, norovirus can cause severe illness in vulnerable people, especially the elderly and very young. The intense vomiting and diarrhea causes severe dehydration, which often requires the hospitalization of frail victims.

One of the worst outbreaks has hit Boston, where more than 3,700 patients stricken with nausea, vomiting and diarrhea have visited that city's emergency rooms during the past six weeks.

Any lingering doubts about the breadth and severity of that outbreak were erased when figures delineating ER visits on Christmas — a day when patients do almost anything to avoid a trip to the hospital — were released. On that day, 73 patients with gastrointestinal woes turned up in Boston's 10 emergency rooms.

"If people are coming to the emergency room on Christmas Day, that suggests to me this illness is more severe than your routine gastrointestinal illness," said Dr. Anita Barry, Boston's director of communicable-disease control.

By the middle of December, Barry knew that the increase in ER patients with their hands clutching their stomachs was no fluke. And while the volume fluctuated, it was generally increasing.

"We have seen a large number of cases of what appears to be a sudden-onset and intense, short-lived diarrhea, nausea and some abdominal pain," said Dr. Jonathan Olshaker, Boston Medical Center's emergency department chief. "Although if you're going through it, it doesn't seem short-lived."

Similar symptoms sickened hundreds of inmates and staff at San Quentin State Prison near San Francisco, forcing a three-week quarantine that finally was lifted Tuesday.

Vomiting, diarrhea and other viral symptoms left the prison virtually closed to new inmates, volunteers and visitors since Dec. 28, said Lt. Eric Messick, a prison spokesman.

The virus resulted in no deaths or serious complications, and most inmates recovered in about three days. In all, 859 inmates and 49 staffers fell ill during the outbreak, he said.

"I've been here 25 years," Messick said. "I can remember the flu going around, but nothing like this."

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