Treatment of Norovirus Infection
Norovirus infection is primarily managed through supportive care, as there is no specific antiviral treatment available. 1 The focus of treatment is on preventing and treating dehydration, which is the main cause of morbidity and mortality in norovirus infections.
Supportive Care Approach
Fluid Management
- Oral rehydration therapy is the cornerstone of treatment for most patients
- For severe dehydration or inability to tolerate oral fluids, intravenous fluid therapy may be necessary
- Approximately 10% of persons with norovirus gastroenteritis seek medical attention, which might include hospitalization and treatment for dehydration 1
Symptom Management
- Anti-emetics for severe vomiting
- Avoid anti-diarrheal medications in most cases, especially in children
- Monitor electrolyte balance, particularly in vulnerable populations
Special Considerations for High-Risk Populations
Immunocompromised Patients
- More likely to develop severe, prolonged illness
- May experience symptoms for weeks to months rather than days
- Higher risk of complications including severe dehydration and malnutrition
- In immunocompromised patients, norovirus gastroenteritis can last for several years and result in villous atrophy 2
Elderly and Young Children
- More susceptible to dehydration
- May require more aggressive fluid management
- Norovirus-associated deaths have been reported among elderly persons, particularly in long-term care facilities 1
Infection Control Measures
Preventing transmission is critical, especially in healthcare and institutional settings:
Hand hygiene: Frequent washing with soap and running water for at least 20 seconds
- Important note: Alcohol-based hand sanitizers can be used as an adjunct but are NOT a substitute for soap and water handwashing 1
Environmental disinfection:
- After initial cleaning to remove soiling, disinfect potentially contaminated surfaces using:
- Chlorine bleach solution (1,000–5,000 ppm concentration, 1:50–1:10 dilution of household bleach) 1
- Or other EPA-approved disinfectants specifically registered as effective against norovirus
Isolation precautions:
- Exclude ill staff in food service, childcare, and healthcare settings until 48–72 hours after symptom resolution
- In institutional settings, isolate ill residents/patients until 24–48 hours after symptom resolution 1
Experimental Treatments
For immunocompromised patients with severe, prolonged infection, case reports have suggested potential benefit from:
- Nitazoxanide
- Ribavirin
- Enterally administered immunoglobulin
- Favipiravir (not yet tested in humans) 2
However, these treatments remain experimental and are not part of standard care guidelines.
Common Pitfalls to Avoid
Relying on alcohol-based sanitizers alone - they are less effective against norovirus than handwashing with soap and water
Premature return to work/school - individuals remain contagious for up to 48-72 hours after symptoms resolve
Inadequate environmental cleaning - norovirus is highly resistant to many common disinfectants
Underestimating dehydration - especially in vulnerable populations like young children and the elderly
Inappropriate use of antibiotics - norovirus is a viral infection and antibiotics are ineffective
Duration and Prognosis
- In healthy individuals, symptoms typically resolve without treatment after 1–3 days 1
- More prolonged courses of illness lasting 4–6 days can occur in young children, elderly persons, and hospitalized patients 1
- The virus can be detected in stool for an average of 4 weeks following infection, with peak viral shedding occurring 2–5 days after infection 1
Remember that norovirus is extremely contagious, with an estimated infectious dose as low as 18 viral particles 1. Proper infection control measures are essential to prevent outbreaks, especially in healthcare facilities, schools, cruise ships, and other closed settings.