Norovirus Infection

Norovirus gastroenteritis

Noroviruses occur worldwide. A norovirus infection leads to inflammation of the gastrointestinal tract (gastroenteritis). Sick people are very contagious. This is why norovirus gastroenteritis outbreaks often occur, especially in community facilities. These are characterized by a rapid infestation of many people in a short time. Children up to the age of five and adults from the age of 70 are particularly susceptible. Careful hand and food hygiene, as well as isolating the sick, can limit the spread of the virus. Adequate fluid intake is the top priority during treatment. Norovirus gastroenteritis is stressful, but severe courses and complications are rare. Medical treatment is necessary if there is significant loss of fluid.

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• What are the causes of norovirus gastroenteritis?
• What are the symptoms?
• How is the diagnosis made?
• How is the treatment carried out?
• How can norovirus gastroenteritis be prevented?
• Whom can I ask?
• How are the costs going to be covered?

What are the causes of norovirus gastroenteritis?

Noroviruses, which are contagious to humans, only affect humans. The risk of infection may already exist shortly before the symptoms occur and last for at least two days after the symptoms have stopped. In some cases, noroviruses can still be detected in the stool for weeks after the acute illness. Noroviruses are very resistant and therefore easy to transmit.

The ingestion of very few viruses is sufficient for an infection. The smallest, invisible amounts of stool or vomit from a sick person are usually ingested through the mouth. This can happen through contact with the sick. Transmission is also possible if objects or food contaminated with noroviruses are put into the mouth or come into contact with the hand and the mouth is touched with it. Norovirus infections often lead to gushing vomiting. Viruses can also be transmitted through the air.

What are the symptoms?

After infection, it takes between six hours and about two days (50 hours) for the disease to begin (incubation period). It is characterized by a sudden onset of symptoms. These include:

• gushing vomiting and
• Diarrhea accompanied by
• severe abdominal pain,
• a serious feeling of illness with
• Muscle aches,
• Headache and
• pronounced exhaustion.

Often the body temperature rises a little too. A high fever is rare. Some people experience only very slight symptoms or even no symptoms at all, probably due to genetic factors.

Even if a norovirus infection is very uncomfortable and stressful, complications are rare. Infants, the elderly, and people with diseases that weaken the immune system or take immunosuppressants are more likely to develop complications.

A norovirus infection often leads to a lack of fluids (dehydration). This can be so pronounced that the circulation and the kidneys are stressed. Blood pressure drops and acute kidney failure can occur. Signs of dehydration are dizziness and dry mouth. In addition, very little urine is produced, which is very dark in color.

Note With babies, it is a sign to be taken seriously if the diaper only gets slightly wet or stays dry at all. Then a doctor must be contacted quickly.

Bleeding in the gastrointestinal tract can occur, and extensive blood loss is rare. The stool will either turn black or contain red blood. Vomiting of blood is very rare. Another rare complication is bacterial superinfection.

How is the diagnosis made?

If a norovirus infection is suspected, a stool sample must be tested for noroviruses. Possible examinations are nucleic acid detection (polymerase chain reaction - PCR), detection of virus components in the stool (antigen detection - ELISA) or electron microscopy. A norovirus rapid test is also available. Norovirus PCR is the most accurate method.

How is the treatment carried out?

Due to the high fluid loss, a lot of fluids should be consumed. It should ideally contain sufficient electrolytes (e.g. soup or electrolyte solutions).

Diarrhea and vomiting are helpful body responses to norovirus infection. This means that noroviruses are excreted more quickly. An increase in body temperature also counteracts the infection. Therefore, if these complaints are not too distressing, they do not necessarily need to be treated.

The doctor can prescribe what is known as an antiemetic to prevent vomiting. Drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs / NSAIDs) are effective against fever and pain. Paracetamol is very suitable because it puts the least strain on the stomach and intestinal mucosa. In addition, if you have severe abdominal pain, the doctor can prescribe a drug that counteracts stomach and intestinal cramps. Medications for diarrhea that limit bowel motility should be avoided. This means that the noroviruses cannot be excreted well. There is no drug that can kill noroviruses.

Note A doctor must be contacted if there are signs of pronounced fluid loss or other complications.

How can norovirus gastroenteritis be prevented?

There is no vaccine against norovirus. Since they are transmitted very easily, prevention is not easy. The spread of noroviruses can be prevented by isolating the sick and taking other hygiene measures - especially thorough hand hygiene. Sick people should only leave home after two symptom-free days. Parents of sick children should be made aware of this directly in day-care centers or schools.

Employers should support this procedure with their employees in order to prevent infections of colleagues or customers. This is particularly important in food production and processing companies as well as in the catering industry. Particularly thorough hand hygiene should be observed after using the toilet for up to two weeks after the illness.

Community facilities such as retirement homes and hospitals have precise guidelines on how to deal with a norovirus gastroenteritis outbreak. Sick people are isolated, objects and floors are cleaned with virus-killing (virucidal) surface disinfectants, and particular attention is paid to hand disinfection and the wearing of mouth and nose protection, disposable gloves and protective gowns in hospital rooms. There are also precise regulations on how to proceed in the event of a (possible) outbreak for food-producing companies and passenger ships.

Thorough hand hygiene is particularly important for people who care for a sick person at home. Clothing, towels or bedding contaminated with stool or vomit should be washed with at least 60 ° C or a hygienic cleaner and soiled items should be thoroughly cleaned. Hand and surface disinfectants with virus-killing effects for the household from the pharmacy can reduce the risk of transmission.

It is best if infected people should not receive a visit or close contact with the sick person should be avoided as far as possible. Hands must be disinfected before leaving the room or apartment. In hospitals or retirement homes, it is necessary for visitors to discuss with the nursing staff before entering the room of the infected person what they have to consider to prevent the spread of noroviruses.

A norovirus gastroenteritis outbreak, suspected outbreak or death must be reported. The report is made by the treating doctor, the public health officer or the laboratory doctor who is involved in the diagnosis. Detailed tests are then carried out to find the source of the infection and prevent it from spreading further.

Whom can I ask?

In the event of an acute gastrointestinal inflammation, the family doctor or the pediatrician can be contacted. This person initiates treatment and sends a stool sample to the laboratory. In the event of significant fluid loss or other complications, an emergency room should be visited or the ambulance called (Europe: 112 / Austria: 144).

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Costs and Deductibles.

The prescription fee has to be paid for medication on a “prescription”. For information on the respective provisions, please contact your health insurance provider, which you can find on the social security website.