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Ten tips on managing norovirus infections

As the norovirus season gets into full swing, Dr John Harris, epidemiologist and expert on norovirus at the Health Protection Agency’s Centre for Infections, gives GPs advice on managing the problem

As the norovirus season gets into full swing, Dr John Harris, epidemiologist and expert on norovirus at the Health Protection Agency's Centre for Infections, gives GPs advice on managing the problem

1. The main symptoms of norovirus are a sudden onset of nausea and vomiting. These are often, but not always, accompanied by diarrhoea, which may be profuse and watery, but not bloody. Sometimes patients may also suffer from headache, fever and more general aches and pains.

2. The illness usually lasts for around 48 hours. Norovirus is generally self-limiting and although it is unpleasant and people often feel quite ill, patients should be reassured that the infection usually passes quickly. Some patients with more serious underlying conditions, the very young or the elderly are more at risk and may take longer to recover. If you are concerned about the symptoms, or if they are particularly severe or prolonged, stool samples should be sent for testing to confirm the diagnosis.

3. Where possible, avoid sending patients to hospital where the risk of spreading the infection is greater. Unless the patient presents with severe or prolonged symptoms and severe dehydration or other complications, it is better to keep them at home rather than send them to hospital where there is a risk of spreading the infection to other patients, who may be more vulnerable, or to staff in the hospital.

4. The virus is highly infectious. To prevent infection it is very important to wash hands with soap and water – do not rely on alcohol hand gels. If a patient has vomited in the surgery, clean it up straight away. Make sure that gloves and aprons are worn while cleaning it up. Clean hard surfaces with a bleach solution. Avoid vacuum-cleaning carpet where someone has vomited as this risks spreading the virus in the air. Clean any surfaces that have been touched by the patient such as door handles and bathroom facilities.

5. There is no treatment for norovirus infection. Patients should be encouraged to drink plenty of fluid while they are ill. This is especially important for elderly patients and young children, who are more at risk. If a patient becomes too dehydrated they may require hospital treatment.

6. Encourage patients to use good hand hygiene to help prevent further infections at home and in other settings. Good hand hygiene, especially after using the toilet, helps prevent the infection spreading to friends and relatives. For elderly patients or children this message should be emphasised to carers looking after these patients. Encourage patients or their carers to make sure they clean contaminated surfaces thoroughly and more frequently while they or someone in the home has norovirus infection. Particular areas for attention should be the toilet and toilet area, flush handles, taps and door handles.

7. People who are ill with norovirus should stay off work or school, and not visit hospital patients or people in nursing homes until symptoms have cleared up. People who have close contact with other people, such as healthcare workers, should stay off work until 48 hours after their symptoms have resolved. They may still shed virus in their stools for a short while after symptoms have resolved.

8. Patients should avoid preparing food for two days after symptoms have disappeared. Norovirus can be passed by consuming contaminated food or water.

9. Most cases occur during the winter months, mostly from October to March, although cases do occur all year round. Norovirus is the most common cause of GI illness in the UK. It is estimated that between 600,000 and one million cases occur each year. Outbreaks often occur in semi-closed settings such as nursing homes, hospital wards and cruise ships, where many people are in close proximity and share facilities. Outbreaks in healthcare settings are particularly disruptive, and hospital wards are often closed to prevent the infection spreading.

10. Not many people contact healthcare services with norovirus infections. Cases most likely to be seen in surgeries are among young children.

Dr John Harris is an epidemiologist at the Health Protection Agency with a particular interest in norovirus infection

Competing interests: none declared

Electron micrograph of norovirus particles

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