What to do when a patient (pt) presents with symptoms consistent with norovirus infection?

From the Guidelines

For patients with symptoms consistent with norovirus, focus on supportive care and preventing dehydration, as most cases resolve without treatment after 1–3 days in otherwise healthy persons 1. When managing norovirus symptoms, consider the following key points:

• Encourage oral rehydration with clear fluids like water, diluted fruit juices, and sports drinks, aiming for frequent small sips.
• Patients should rest and follow the BRAT diet (bananas, rice, applesauce, toast) or other bland foods when able to eat.
• Over-the-counter medications like loperamide (Imodium) can help control diarrhea in adults, while acetaminophen (Tylenol) can manage fever and body aches.
• Avoid dairy products, caffeine, alcohol, and fatty or spicy foods until recovery.
• Practice strict hand hygiene with soap and water, as alcohol-based sanitizers are less effective against norovirus, and clean contaminated surfaces with bleach-based disinfectants 1. Some important considerations include:
• Patients should stay home from work or school until at least 48 hours after symptoms resolve to prevent transmission.
• Seek medical attention if there are signs of severe dehydration (extreme thirst, dry mouth, decreased urination, dizziness), bloody diarrhea, high fever above 101.5°F, or if symptoms persist beyond 3 days.
• Norovirus is highly contagious and spreads through the fecal-oral route, so these measures help manage symptoms while preventing transmission to others. It's also worth noting that norovirus can have a significant impact on certain populations, such as the elderly and young children, and can lead to severe dehydration and even death in some cases 1. Therefore, it is crucial to prioritize supportive care and prevention of dehydration, while also taking steps to prevent transmission to others, especially in high-risk settings like healthcare facilities and long-term care facilities 1.

From the Research

Management of Norovirus Symptoms

When a patient has symptoms consistent with norovirus, the primary goal is to manage dehydration and prevent further complications.

• Oral rehydration is a crucial step in treating dehydration associated with viral gastroenteritis, including norovirus 2, 3.
• According to a study published in 2006, solutions like Pedialyte, Gatorade, and a New Oral Rehydration Solution (N-ORS) can be effective in correcting dehydration and improving bowel symptoms 2.
• It is essential to note that norovirus is highly contagious, and prompt implementation of infection control measures is necessary to prevent outbreaks 4.

Oral Rehydration Options

Several oral rehydration options are available, including:

• Pedialyte: often recommended for the treatment of dehydration in viral gastroenteritis 2.
• Gatorade: can be as effective as Pedialyte in correcting dehydration and improving bowel symptoms, but may be associated with persistent hypokalemia 2.
• New Oral Rehydration Solution (N-ORS): may be effective in the treatment of dehydration associated with mild viral gastroenteritis 2.
• Other alternatives like skim or low-fat cow's milk may also improve volume/hydration status compared to water, but the evidence is of very low certainty 5.

Infection Control

In addition to oral rehydration, infection control measures are critical in managing norovirus outbreaks.

• Prompt implementation of infection control measures remains the mainstay of norovirus outbreak management 4.