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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

[No headline]

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 /


Coming in future months

CNE/CME Objectives


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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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,

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


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


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

diagnostic assays.

• 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

improved symptoms.

• Commonly used antiviral agents do not allow


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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 from

the c