[No headline]

January 12th, 2015

Norovirus a threat

to frail paients

Bok K, Green KKY. Norovirus gastroenteritis in immu

nocompromised

patients.

New Eng J Med 2012;

367:2126-2132

Norovirus has become a scourge, particularly in

closed populations like those in hospitals and on

threat of resistant infections.

• To work with regulatory, veterinary and industry

partners to promote the judicious use of antibiotics

in food animals.

• To reinforce the judicious use of antibiotics in

agriculture by: limiting the use of medically important

human antibiotics in food animals; supporting

the use of such antibiotics in animals only for those

uses that are considered necessary for assuring animal

health; and having veterinary oversight for such

antibiotics used in animals

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January 2013 /

HOSPITAL INFECTION CONTROL & PREVENTION® 11

Coming in future months

CNE/CME Objectives

U

pon completion of this educational activity, participants should

be able to:

• Identify the clinical, legal, or educational issues encountered by

infection preventionists and epidemiologists;

• Describe the effect of infection control and prevention issues on

nurses, hospitals, or the health care industry

in general;

• Cite solutions to the problems encountered by infection

preventionists based on guidelines from the relevant regulatory

authorities, and/or independent recommendations from clinicians

at individual institutions.

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CNE/CME Instructions

T

o earn credit for this activity, please follow these

instructions.

1. Read and study the activity, using the provided references

for further research.

2. Log on to www.cmecity.com to take a post-test; tests

can be taken after each issue or collectively at the end

of the semester. First-time users will have to register on

the site using the 8-digit subscriber number printed on

their mailing label, invoice or renewal notice.

3. Pass the online tests with a score of 100%; you will

be allowed to answer the questions as many times as

needed to achieve a score of 100%.

4. After successfully completing the last test of the

semester, your browser will be automatically directed

to the activity evaluation form, which you will submit

online.

5. Once the completed evaluation is received, a credit

letter will be e-mailed to you instantly.

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cruise ships. There is another aspect of the disease

profile of this emerging virus, namely its ability

to cause unexpected severe illness in immunosuppressed

patients. Two investigators from the

Calicivirus Section at the NIH have done an excep

tional

job of summarizing the mechanisms, scope

and treatment of norovirus gastroenteritis in immu

nosuppressed

patients. Vigilant hand hygiene, of

course, is the best method to prevent transmission

and protect these patients. Here are other major

points in the paper:

• Norovirus infection can include symptoms of

fever, diarrhea, projectile vomiting, and mimic graft

versus host disease in transplant patients.

• Noroviruses have a small RNA genome that can

mutate readily. There are six major geno groups,

labeled GI-GVI.

• The genome has only 2 structural proteins along

with 7 nonstructural proteins. VP1 is the major structural

protein, VP2 the minor one.

• As compared to the disease in immunocom

petent

hosts, in the immunocompromised host the

disease last for years and shedding of the virus may

be indefinite.

• Disease is usually self-limited in the immuno

competent,

but little therapy may available for the

more severe illness in the immunocompromised

host.

• Infection in the immunocompromised host can

cause malnutrition, dehydration and worsen the

underlying immunocompromising illness.

• There are several assays available in the clini

cal

microbiology laboratory including those based on

RT-PCR, but not all labs will offer these tests. More

study is required to understand the utility of the different

diagnostic assays.

• Immunocompromised patients may have a

diverse population of mutating noroviruses, including

many so called “low-frequency variants” in chronic

infection.

• New studies will be necessary to determine

when and how new strains are introduced to currently

infected immunocompromised patients.

• Both T-cell and B-cell responses seem neces

sary

for adequate immune surveillance and viral

clearance. Increasing CD4 cell count in HIV patients

improved symptoms.

• Commonly used antiviral agents do not allow

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Joint Commission:

No patient safety

without worker safety

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Working class

heroes: IPs weather

tough economy

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CMS revises its

infection control

survey – find out

where

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Be not tempted:

Drug shortages and

unsafe injections

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Infection prevention

and Obama Care: Just

reward?

viral clearance. Some success with improving symptoms

has been reported with nitazoxanide, an antiprotozoal

drug.

• In one study 80% of surfaces in a children’s unit

were contaminated with 21 different noroviruses.

• Norovirus testing should result more often from

the c