What is the treatment for norovirus infection?

Treatment of Norovirus Infection

The treatment of norovirus infection is primarily supportive care, focusing on preventing and treating dehydration, as there are no specific antiviral medications approved for norovirus. 1

Supportive Care Measures

• Fluid replacement therapy is the cornerstone of treatment to prevent and correct dehydration, which is the main cause of morbidity and mortality in norovirus infection 1, 2
• Oral rehydration with solutions containing appropriate electrolytes should be the first-line approach for mild to moderate dehydration 2
• Intravenous fluid therapy may be necessary for patients with severe dehydration or those unable to tolerate oral intake 2, 3
• Symptoms typically resolve without treatment within 1-3 days in otherwise healthy individuals, though they can last 4-6 days in young children, elderly persons, and hospitalized patients 1

Medication Considerations

• Loperamide may be considered for symptomatic relief of diarrhea in adults and children over 2 years of age, but should be used with caution 4

  • For adults and children ≥13 years: Initial dose of 4 mg followed by 2 mg after each loose stool, maximum 16 mg daily 4
  • For children 2-12 years: Age-appropriate dosing based on weight (see specific guidelines) 4
  • Contraindicated in children under 2 years due to risks of respiratory depression and cardiac adverse reactions 4

• Experimental treatments for immunocompromised patients with prolonged infection may include nitazoxanide, ribavirin, or enterally administered immunoglobulin, though evidence is limited to case reports 3

Infection Control Measures

• Isolation of infected individuals is crucial to prevent transmission:

  • Ill residents/patients/passengers should be isolated until 24-48 hours after symptom resolution 1
  • Food handlers, healthcare workers, and childcare workers should be excluded from work until 48-72 hours after symptom resolution 1

• Hand hygiene is the single most important method to prevent norovirus infection and control transmission:

  • Thorough handwashing with soap and running water for at least 20 seconds 1
  • Alcohol-based hand sanitizers (≥70% ethanol) can be used as an adjunct between proper handwashings but are not substitutes for soap and water 1

• Environmental disinfection of contaminated surfaces:

  • Use chlorine bleach solution with concentration of 1,000-5,000 ppm (1:50-1:10 dilution of household bleach) or EPA-approved disinfectants 1, 5
  • Clean surfaces thoroughly before disinfection to remove organic material 1

Special Considerations for High-Risk Groups

• Immunocompromised patients are at risk for prolonged infection lasting weeks to years, which can lead to:

  • Villous atrophy
  • Severe malnutrition
  • Dehydration and electrolyte imbalances
  • Continuous viral shedding 3, 6

• Children and elderly may require more aggressive hydration and monitoring due to higher risk of severe dehydration 1, 2

• Healthcare facilities should implement strict infection control protocols during outbreaks:

  • Cohorting of ill patients with dedicated staff 1
  • Limiting transfer of patients between units 1
  • Enhanced environmental cleaning 1, 5

Pitfalls and Caveats

• Norovirus is highly contagious with an infectious dose as low as 18 viral particles 1
• Infected individuals can shed virus for an average of 4 weeks following infection, with peak shedding 2-5 days after infection 1
• Asymptomatic individuals can still shed virus and potentially transmit infection 1
• Alcohol-based hand sanitizers alone are not sufficiently effective against norovirus 1
• Immunity after infection is typically short-lived (8 weeks to 6 months) and strain-specific 1