What are the treatment recommendations for a patient diagnosed with Norovirus?

Treatment of Norovirus Infection

Norovirus treatment is entirely supportive, focused on preventing and correcting dehydration through oral or intravenous fluid therapy, as there are no specific antiviral medications or treatments available. 1, 2

Primary Treatment Approach

Hydration Management

• Oral rehydration therapy is the first-line treatment for patients who can tolerate oral intake 3, 2
• Escalate to intravenous fluid therapy when oral intake is inadequate or signs of severe dehydration are present 3
• Approximately 10% of norovirus patients require medical attention, including hospitalization for dehydration management 3

Nutritional Support

• Maintain adequate nutrition during illness, particularly in prolonged cases 2
• Focus on early correction of dehydration and maintenance of fluid status 2

Clinical Course Expectations

Typical Illness Duration

• Most healthy individuals experience self-resolving illness lasting 24-48 hours 4, 5
• Symptoms typically resolve within 1-3 days in healthy adults 3
• Prolonged courses of 4-6 days can occur, particularly in young children, elderly persons, and hospitalized patients 3

When to Hospitalize

• Severe dehydration unresponsive to oral rehydration requires hospitalization 3
• Elderly patients and those in long-term care facilities warrant lower threshold for admission given higher mortality risk 3
• Immunocompromised patients may require hospitalization as they can develop chronic infection lasting months to years with severe complications including villous atrophy, malnutrition, and electrolyte imbalances 4

Infection Control During Treatment

Patient Isolation

• Isolate patients until 24-48 hours after complete symptom resolution 1, 3
• In healthcare settings, cohort ill patients together with dedicated nursing staff 6
• Do not transfer ill patients to unaffected units except for medical necessity 1

Hand Hygiene Requirements

• Handwashing with soap and running water for at least 20 seconds is mandatory and the single most effective prevention method 1, 6
• Alcohol-based hand sanitizers (≥70% ethanol) may serve only as an adjunct between proper handwashings but should never substitute for soap and water 1, 6
• The limited efficacy of alcohol-based sanitizers against norovirus makes soap and water essential 6

Environmental Decontamination

• Disinfect surfaces with chlorine bleach solution at 1,000-5,000 ppm concentration (1:50 to 1:10 dilution of household bleach) after initial cleaning 1, 6
• Focus particularly on bathrooms and high-touch surfaces like door knobs and handrails 6
• Use EPA-approved disinfectants in healthcare settings with adherence to manufacturer's instructions 1

Special Population Considerations

Immunocompromised Patients

• These patients are at risk for chronic norovirus infection lasting months to years 4
• Several treatment strategies have been attempted in case reports including nitazoxanide, ribavirin, and enterally administered immunoglobulin with varying results, though no standard treatment exists 4
• Monitor closely for severe malnutrition, dehydration, electrolyte imbalances, and continuous viral shedding 4

Pediatric and Elderly Patients

• Young children and elderly persons have higher risk for prolonged illness and severe outcomes 3, 2
• Deaths from norovirus predominantly occur in developing countries and vulnerable populations 2

Critical Pitfalls to Avoid

• Never rely on alcohol-based hand sanitizers as primary hand hygiene - they have limited efficacy against norovirus 6, 7
• Do not require negative stool results before returning to work or normal activities 6, 7
• Recognize that viral shedding can continue for an average of 4 weeks following infection, though this does not necessarily indicate ongoing contagiousness 3
• Do not use bare hands when handling ready-to-eat foods during recovery period 1, 6

Work and Activity Exclusion

Healthcare and Food Workers

• Exclude ill staff until 48-72 hours after complete symptom resolution 1, 6
• In licensed food establishments, approval from local regulatory authority may be necessary before reinstating workers 1
• Sick pay policies that do not penalize ill workers facilitate appropriate staff exclusion 6

General Population

• Maintain isolation in closed settings (long-term care, hospitals, cruise ships) until 24-48 hours after symptom resolution 1, 6