COMMENTARY

Norovirus: Protecting the Vulnerable

Ben Lopman, PhD, MSc

Disclosures

February 19, 2013

Editorial Collaboration

Medscape &

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Hello. I am Dr. Ben Lopman. I am an epidemiologist at the Centers for Disease Control and Prevention (CDC). I am speaking with you as part of the CDC Expert Commentary Series on Medscape.

Today I will talk about norovirus outbreaks in nursing homes, the risks to elderly and vulnerable residents, and what clinicians can do to protect them.

Let's start with some basics.

Norovirus is a highly contagious virus that causes acute gastroenteritis. It spreads through the fecal-oral or vomitus-oral routes. Your patients can get norovirus by having close contact with infected people, or by consuming food and drinks or touching surfaces that are contaminated with these viruses.

Each year, an estimated 21 million people in the United States are infected with norovirus and develop acute gastroenteritis. In fact, norovirus is the leading cause of acute gastroenteritis in this country.

Outbreaks of norovirus are very common and occur in many different settings. However, healthcare facilities, including nursing homes and hospitals, have the most reported norovirus outbreaks. Nearly two thirds of all norovirus outbreaks reported in the United States occur in nursing homes. In these settings, most outbreaks are caused by person-to-person transmission. This is due to the high levels of personal contact in closed spaces. Also, the hygiene of some residents, such as those who are physically or mentally impaired, may not be adequate.

A new strain of norovirus has emerged this winter and, as in the past, most outbreaks are being reported from nursing homes. So, what are the risks to elderly and vulnerable patients?

Healthy people who get norovirus infection usually recover in 1-3 days. However, elderly and vulnerable people, especially those in nursing homes, can suffer from severe illness leading to hospitalization and death. Each year, approximately 800 people in the United States die from norovirus infection. Most of these people are 65 years of age or older.

In a recent study,[1] CDC found that hospitalization and death rates among nursing home patients in 3 states were 10% higher during norovirus outbreaks. Also, the risk for hospitalization and death among patients 90 years of age or older increased by 20%-30%.

As a clinician, you can help protect your nursing home patients from norovirus infection by always following standard infection prevention measures. This includes practicing proper hand hygiene and avoiding patient care when you have gastroenteritis and for 48 hours after you recover. Also, remind visitors to practice proper hand hygiene and general cleanliness, and exclude visitors with gastroenteritis.

If you suspect a norovirus outbreak, notify your health department to help with diagnostics and outbreak management. During outbreaks, you should:

  • Wash hands carefully with soap and water after touching patients with norovirus infection;

  • Use gowns and gloves when touching or caring for patients;

  • Make sure that high-touch patient surfaces and equipment are routinely cleaned and disinfected, and

  • Ensure that contaminated clothing or linens are removed and washed.

You should aim to quickly identify patients who might have norovirus infection. Patients who have symptoms may be placed in private rooms, or they can share rooms with other patients with norovirus infection.

You can help prevent severe illness in your patients by starting rehydration therapy as soon as it's needed. You should pay close attention to the oldest and most vulnerable patients who are at highest risk for severe illness and may require earlier transport to the hospital.

Norovirus can cause serious illness in nursing homes residents. Clinicians can help protect them by following infection prevention and control measures. Learn more by visiting the links listed on this page.

Web Resources

CDC Norovirus: For Health Care Providers

CDC Norovirus: Norovirus in Healthcare Settings

CDC Norovirus: CDC Toolkit for Responding to Norovirus Outbreaks in Health Care Settings

CDC Features: Surveillance for Norovirus Outbreaks

Dr. Ben Lopman is an infectious disease epidemiologist with the Viral Gastroenteritis Team, Division of Viral Diseases at the US Centers for Disease Control and Prevention (CDC). He is also an Adjunct Assistant Professor in the Departments of Global Environmental Health and Epidemiology at Emory University. Prior to joining CDC in 2009, he was the head of the Viral Gastroenteritis Epidemiology group at the UK Health Protection Agency and a Senior Lecturer at the London School of Hygiene and Tropical Medicine. Dr. Lopman earned his PhD in Epidemiology conducting research at the Health Protection Agency, his MSc (Demography) at the London School of Hygiene and Tropical Medicine, and completed his post-doc at the Department of Infectious Disease Epidemiology at Imperial College London, working on HIV epidemiology in sub-Saharan Africa. Dr. Lopman's research is directed at understanding the epidemiology and transmission of viral gastroenteritis (mainly norovirus and rotavirus) as well as developing effective methods for their control. He has authored over 90 peer-reviewed publications in addition to invited editorials, book chapters, and conference presentations.

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