This award-winning blog supplements the articles in Hospital Infection Control & Prevention.
January 12th, 2015
Norovirus a threat
to frail paients
Bok K, Green KKY. Norovirus gastroenteritis in immu
New Eng J Med 2012;
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
January 2013 /
HOSPITAL INFECTION CONTROL & PREVENTION® 11
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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
job of summarizing the mechanisms, scope
and treatment of norovirus gastroenteritis in immu
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,
• 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
hosts, in the immunocompromised host the
disease last for years and shedding of the virus may
• Disease is usually self-limited in the immuno
but little therapy may available for the
more severe illness in the immunocompromised
• Infection in the immunocompromised host can
cause malnutrition, dehydration and worsen the
underlying immunocompromising illness.
• There are several assays available in the clini
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
• Immunocompromised patients may have a
diverse population of mutating noroviruses, including
many so called “low-frequency variants” in chronic
• 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
for adequate immune surveillance and viral
clearance. Increasing CD4 cell count in HIV patients
• Commonly used antiviral agents do not allow
No patient safety
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Drug shortages and
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viral clearance. Some success with improving symptoms
has been reported with nitazoxanide, an antiprotozoal
• In one study 80% of surfaces in a children’s unit
were contaminated with 21 different noroviruses.
• Norovirus testing should result more often fromthe c