eMedicine Specialties > Infectious Diseases > Viral Infections

Norwalk Virus: Follow-up

Author: Zartash Zafar Khan, MD, Fellow in Infectious Diseases, University of Oklahoma Health Science Center
Coauthor(s): Mark Martin Huycke, MD, Professor of Medicine, Infectious Diseases Section, University of Oklahoma Health Sciences Center; Chief, Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City; Todd S Wills, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, University of South Florida College of Medicine; Michelle A Jaworski, MD, Consulting Staff, Midland Orthopedic Associates
Contributor Information and Disclosures

Updated: Nov 11, 2009

Follow-up

Deterrence/Prevention

In cases of norovirus outbreaks, several measures should be taken to prevent further transmission, as follows:

  • Contaminated sources should be identified and eliminated.
  • Strict hand hygiene is necessary. Food handlers should be thoroughly educated on the infectivity of norovirus, and updated hygienic codes should be maintained.19 Although virucidal efficacy of alcohol against feline calicivirus is inferior to that of povidone-iodine, it is greatly variable depending on different formulations, concentrations, and contact times. In one study, only a 0.5-1 log10 reduction in virus titer was achieved after exposure to ethanol (62%-99.5%) for 30 seconds. Another study showed a 2 and 3 log10 reduction in virus titer when 80% ethanol was used for 30 seconds and 1 minute, respectively. Successful control of a norovirus outbreak using 80% alcohol-based hand rubs was reported in an infirmary.20 Hand washing with soap and water is necessary for hands that are visibly soiled.
  • Environmental sanitization and disinfection should be performed.
  • Instruct individuals with viral gastroenteritis to self-quarantine.

Complications

  • Significant electrolyte and blood chemistry abnormalities such as hypokalemia, hyponatremia, metabolic alkalosis, and elevated creatinine phosphokinase can occur in patients with pre-existing conditions such as inflammatory bowel disease, renal failure, immunocompromising conditions, and cardiovascular disease. Severe clinical features, including acute renal failure, arrhythmia, and signs of acute organ rejection in renal transplant patients were observed in a university hospital outbreak.21
  • One case of norovirus encephalopathy was reported in a 23-month-old child.22
  • Hemolytic uremic syndrome has been reported in association with norovirus gastroenteritis in a patient with chronic renal failure.23

Prognosis

Norovirus gastroenteritis is a self-limiting disease with an excellent prognosis in otherwise healthy individuals.

Patient Education

Patients with norovirus infection should be educated on personal and environmental hygiene, including avoiding/eliminating contaminated foods and water. Ill individuals should refrain from attending school or work.

Miscellaneous

Medicolegal Pitfalls

All suspected norovirus outbreaks (>2 people who shared a common meal and became infected) should be reported to state or local health departments so that an investigation can be considered to limit further transmission.

 


More on Norwalk Virus

Overview: Norwalk Virus
Differential Diagnoses & Workup: Norwalk Virus
Treatment & Medication: Norwalk Virus
Follow-up: Norwalk Virus
Multimedia: Norwalk Virus
References
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References

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Further Reading

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Keywords

norovirus, Norwalk virus, calicivirus, viral gastroenteritis, infectious diarrhea, nonbacterial gastroenteritis, food poisoning, stomach flu, intestinal flu, dysentery, diarrhea, traveler's diarrhea, Norwalk-like virus, Sapovirus, Sapporo-like virus, Norovirus, Caliciviridae

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Contributor Information and Disclosures

Author

Zartash Zafar Khan, MD, Fellow in Infectious Diseases, University of Oklahoma Health Science Center
Zartash Zafar Khan, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International Society for Infectious Diseases
Disclosure: Nothing to disclose.

Coauthor(s)

Mark Martin Huycke, MD, Professor of Medicine, Infectious Diseases Section, University of Oklahoma Health Sciences Center; Chief, Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City
Mark Martin Huycke, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Todd S Wills, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, University of South Florida College of Medicine
Todd S Wills, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Michelle A Jaworski, MD, Consulting Staff, Midland Orthopedic Associates
Disclosure: Nothing to disclose.

Medical Editor

Joseph Richard Masci, MD, Chief of Infectious Diseases, Associate Director, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Elmhurst Hospital Center, Mount Sinai School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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