What is the treatment for norovirus infection?

Treatment of Norovirus Infection

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

Clinical Features and Diagnosis

• Norovirus causes acute gastroenteritis with symptoms including nonbloody diarrhea, vomiting, nausea, and abdominal cramps, typically beginning 12-48 hours after exposure 1
• Symptoms usually resolve without treatment within 1-3 days in healthy individuals, though more prolonged illness lasting 4-6 days can occur in young children, elderly persons, and hospitalized patients 1
• Diagnosis is typically made clinically during outbreaks, but can be confirmed by RT-PCR testing of stool specimens collected during the acute phase of illness (≤72 hours from onset) 1

Treatment Approach

Supportive Care

• Oral or intravenous fluid therapy to prevent or treat dehydration is the cornerstone of treatment 1, 2
• Electrolyte replacement to correct imbalances caused by vomiting and diarrhea 3, 4
• Maintenance of nutrition during the illness period 2

Infection Control Measures

• Isolate ill patients during their illness and for 24-48 hours after symptom resolution in healthcare and institutional settings 1
• Exclude ill staff in food service, childcare, and healthcare positions until 48-72 hours after symptom resolution 1
• Promote proper hand hygiene 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 should not substitute for soap and water 1

Environmental Cleaning

• Disinfect potentially contaminated surfaces using a chlorine bleach solution with a concentration of 1,000-5,000 ppm (1:50-1:10 dilution of household bleach [5.25%]) or other EPA-approved disinfectant 1
• In healthcare settings, use EPA-registered cleaning products and disinfectants with label claims for healthcare use 1

Special Populations

Immunocompromised Patients

• Immunocompromised individuals are at risk for more severe and prolonged illness, sometimes lasting weeks to years 2, 4
• These patients may require more intensive supportive care and hospitalization 5
• Experimental treatments that have been used in case reports include nitazoxanide, ribavirin, and enterally administered immunoglobulin, though with varying results 4

Children and Elderly

• These populations are at higher risk for dehydration and may require more aggressive fluid management 2, 6
• Early correction of dehydration and maintenance of fluid status is particularly important 2

Prevention of Transmission

• Norovirus is highly contagious, with an estimated infectious dose as low as 18 viral particles 1
• Proper hand hygiene is the most effective preventive measure 1
• No bare-hand contact with ready-to-eat foods is recommended to prevent foodborne transmission 1
• In outbreak settings, cohort ill patients together with dedicated staff providing care 1

Common Pitfalls to Avoid

• Relying solely on alcohol-based hand sanitizers without soap and water handwashing 1
• Returning to work or school too soon after illness (should wait 48-72 hours after symptom resolution) 1
• Inadequate environmental cleaning during outbreaks 1
• Failing to recognize the potential severity in vulnerable populations such as the very young, elderly, or immunocompromised 1, 2

Currently, there are no FDA-approved vaccines for norovirus, though several candidates are in development 6. Treatment remains focused on supportive care, with emphasis on hydration and infection control measures to prevent spread to others 2, 6.