Duration of Vomiting in Norovirus Infection
In immunocompetent patients, vomiting from norovirus typically lasts 12-72 hours, with complete symptom resolution occurring within 1-3 days. 1, 2
Expected Timeline in Healthy Adults
- Incubation period: Symptoms begin 12-48 hours after exposure with acute, rapid onset 1, 2
- Active vomiting phase: Most patients experience vomiting for 12-72 hours before self-resolution 1
- Complete recovery: The majority of immunocompetent individuals recover fully within 1-3 days 2, 3
Prolonged Courses in Vulnerable Populations
Young children, elderly persons, and hospitalized patients commonly experience longer symptom duration of 4-6 days. 1, 2
High-Risk Groups:
- Pediatric patients: May have symptoms extending to 4-6 days 1, 2
- Elderly patients: Experience prolonged courses of 4-6 days, with increased risk of mortality in long-term care facilities 1, 4
- Hospitalized patients: Duration can extend to 4-6 days 1, 2
When Vomiting Persists Beyond Expected Duration
Vomiting lasting more than one week is atypical and requires immediate evaluation for alternative diagnoses. 2, 5
Red Flags Requiring Further Investigation:
- Symptoms beyond 7 days: The IDSA classifies this as "prolonged" and warrants diagnostic workup 2
- Severe dehydration: Approximately 10% of norovirus patients require medical attention for dehydration, potentially including hospitalization and IV fluid therapy 4, 5
- Immunocompromised patients: Can experience chronic infection lasting months to years, with mortality rates up to 25% in stem cell transplant recipients 1, 6
Clinical Pitfall to Avoid
Do not assume all cases resolve within 1-3 days—elderly, pediatric, and hospitalized patients frequently have 4-6 day courses that are still considered typical for these populations. 2 However, symptoms persisting beyond one week should trigger evaluation for complications, alternative diagnoses, or immunocompromised status 2, 5
Viral Shedding vs. Symptom Duration
- Peak viral shedding: Occurs 2-5 days after infection with approximately 100 billion viral copies per gram of feces 4, 1
- Prolonged shedding: Virus can be detected in stool for an average of 4 weeks following infection, though this does not necessarily indicate ongoing symptoms or contagiousness 4, 1, 5