Norovirus Follow-up

Updated: Oct 20, 2015
  • Author: Zartash Zafar Khan, MD, FACP; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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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. [22] 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 log 10 reduction in virus titer was achieved after exposure to ethanol (62%-99.5%) for 30 seconds. Another study showed a 2 and 3 log 10 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. [23] Hand washing with soap and water is necessary for hands that are visibly soiled. [24]
  • Environmental sanitization and disinfection should be performed.
  • Instruct individuals with viral gastroenteritis to self-quarantine.
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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. [25]

One case of norovirus encephalopathy was reported in a 23-month-old child. [26]

Hemolytic uremic syndrome has been reported in association with norovirus gastroenteritis in a patient with chronic renal failure. [27]

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Prognosis

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

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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.

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