From the Guidelines
Norovirus infection is typically diagnosed based on clinical presentation and laboratory testing is not usually warranted, but in certain cases, such as outbreaks or severe illness, diagnostic methods like TaqMan-based real-time reverse transcription-PCR (RT-qPCR) may be used.
Diagnostic Methods
- Clinical presentation: acute watery diarrhea, vomiting, and fever
- Laboratory testing:
- Stool specimen collection for RT-qPCR or other molecular diagnostic techniques
- Genotyping on norovirus-positive stool specimens to identify the strain
Treatment Options
- Supportive care: hydration, electrolyte replacement, and rest
- Prevention of dehydration: ensuring adequate fluid and electrolyte intake
- Infection control measures:
- Hand hygiene with soap and water or alcohol-based hand sanitizers
- Exclusion of ill staff and isolation of ill patients in certain settings
- Proper cleaning and disinfection of environmental surfaces with a chlorine bleach solution or EPA-approved disinfectant 1
- Outbreak management: prompt investigation, collection of clinical and epidemiologic information, and implementation of control measures to prevent further transmission 1 It is essential to note that antimicrobial agents and antimotility drugs should be used judiciously, as they can contribute to the development of antibiotic resistance and worsen the illness 1.
Prevention
- General measures:
- Hand hygiene
- Proper food preparation and storage
- Avoidance of high-risk foods and unsafe water
- Use of infection prevention and control measures in hospitals, childcare, and nursing home settings
- Vaccination: rotavirus vaccine for infants, which has been shown to reduce the burden of acute gastroenteritis 1 In settings like long-term care facilities and hospitals, strict control measures, including isolation or cohorting of symptomatic patients, exclusion of affected staff, and restricting new admissions into affected units, may be necessary to curtail outbreaks 1.
From the Research
Diagnostic Methods for Norovirus Infection
- The diagnostic methods for norovirus infection include:
- Electron microscopy 2, 3
- Antigen ELISA 2, 3
- Polymerase chain reaction (PCR) 2, 3
- Real-time reverse transcription-polymerase chain reaction (RT-PCR) 4, 5, 3
- Real-time reverse transcription-quantitative PCR (RT-qPCR) 5
- Nucleic acid sequence-based amplification 3
- Immunoassay 4, 5
- Nanotechnology array-based assays 4
- These methods have varying degrees of sensitivity and specificity, with PCR having the highest sensitivity (94.1%) and transmission electron microscopy (TEM) having the highest specificity (98.0%) 2
Treatment Options for Norovirus Infection
- The treatment options for norovirus infection are primarily focused on managing symptoms, as the infection is usually self-limiting 6, 2
- There is no specific antiviral treatment for norovirus infection, and treatment is mainly supportive, aiming to prevent dehydration and electrolyte imbalances 6
- The use of diagnostic tests can help prevent or limit the spread and duration of outbreaks, and define norovirus-associated morbidity and mortality 6, 4
Laboratory Diagnosis and Epidemiology
- Laboratory diagnosis of norovirus is critical for outbreak investigation, disease surveillance, and management 4, 5
- The latest advances in laboratory methods for detection and typing of norovirus include real-time RT-PCR and commercially available immunological assays, as well as multi-gastrointestinal-pathogen platforms 5
- Molecular epidemiology of human noroviruses is important for understanding the spread of the virus and identifying outbreaks 5