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Norovirus Acute Gastroenteritis Diagnosis Treatment Prevention

Diagnosis Treatment and Prevention of Norovirus acute gastroenteritis

Noroviruses are a group of caliciviruses that were previously referred to as "Norwalk-like viruses". Norovirus mutates quickly, has strong environmental resistance, low infection dose, short incubation period after infection, long detoxification time, short immune protection time, and multiple transmission routes. The ability to spread quickly.

Norovirus infection affects the stomach and intestines, causing gastroenteritis or "gastrointestinal flu". The main manifestations are diarrhea and / or vomiting, which we usually call acute gastroenteritis.

TCM disease name:    Norovirus acute gastroenteritis

Visiting department:    Gastroenterology

Common locations:    Intestine, stomach

Common symptoms:    Diarrhea or vomiting

Contagious:    Strong

Way for spreading:    People, food, water, etc.

    How Norovirus Propagates?

    Propagation Mechanism of Norovirus Acute Gastroenteritis: Norovirus is highly contagious and susceptible to all populations. Norovirus can be detected in the feces before the onset of the patient and up to 2 weeks after recovery, but the period of illness and three days after recovery are the most infectious periods.

    The fecal-oral route is the main mode of transmission and can also be transmitted through contaminated water, food, items, air, etc. Because the patient's vomit and feces can form aerosols, contact with the patient can be contagious. 
    Both occult infections and healthy carriers can be the source of infection. 
    Patients' vomit and feces contaminate water or indirectly contaminate food in nature, which can easily cause an outbreak.

    Air and pollutants are also non-negligible mediators during the outbreak. 
    The foods involved in the outbreak were extensive, mainly direct foods such as shellfish, salads, sandwiches, cakes, frost, ice cubes, drinking water, and raspberries. Among them, shellfish are likely to come from contaminated waters.

    Norovirus can be found in shellfish. It accumulates in organisms, and cannot be purified by the method of eliminating E. coli, and raspberries are also polluted by sewage irrigation.

    Infection is usually obtained by:
    1. Eating or drinking food or water contaminated with norovirus;
    2. Touch an object or surface contaminated with Norovirus and put your finger in your mouth;
    3. Patients who have been exposed to Norovirus infection, such as taking care of patients, sharing food with patients or sharing tableware.
    4. Norovirus spreads quickly in confined places (such as childcare institutions, kindergartens, schools, nursing homes, cruise ships, etc.) and easily causes outbreaks.

    Clinical Manifestations and Diagnosis of Norovirus

    What is the Clinical Manifestation of Norovirus?

    The incubation period is mostly 24-48 hours, with the shortest 12 hours and the longest 72 hours. Sudden onset of infection, the main symptoms are nausea, vomiting, fever, abdominal pain and diarrhea.

    Vomiting is common in children, diarrhea is more common in adult patients, diarrhea 4 to 8 times within 24 hours, stool is watery stool or watery stool, no mucus pus and blood. Stool routine microscopy WBC <15, no RBC was seen.

    Patients with primary infection have significantly more vomiting symptoms than those with secondary infection, and some patients only show symptoms of vomiting. 
    In addition, headaches, fever, chills, and muscle pain are also common symptoms, with severe symptoms of dehydration.

    What is the diagnosis of Norovirus Acute Gastroenteritis?

    1. Clinical diagnosis cases: Diagnosis is mainly based on epidemiological data such as epidemic season, regional characteristics, age of onset, clinical manifestations, and routine laboratory test results. 
    Norovirus infection can be preliminarily diagnosed if one meets the following criteria in an epidemic of diarrhea:

    •  Incubation period of 24 to 48 hours
    •  Vomiting of more than 50%
    •  Duration of disease of 12 to 60 hours
    •  Stool and blood. No special findings were found in routine inspections
    • Exclude common bacterial, parasitic and other pathogenic infections.

    2. Confirmed cases: In addition to meeting the conditions of clinical diagnosis, norovirus was detected in stool samples or vomit.

    What is the Treatment of Norovirus Acute Gastroenteritis?

    There are no effective antiviral drugs. Symptomatic or supportive treatment is needed. No antibiotics are needed. The prognosis is good. 
    Dehydration is the main cause of death of norovirus gastroenteritis, so in severe cases, especially young children and frail people, timely infusion or oral rehydration should be done to correct water, electrolyte disorders and acid-base balance disorders.
    Preventive control measures for Norovirus Acute Gastroenteritis Chart Image

    What are the Preventive control measures for Norovirus Acute Gastroenteritis?

    Prevention of Norovirus Disease: There are no specific antiviral drugs and vaccines against Norovirus. T
    he main prevention and control measures are non-drug preventive measures, including case management, hand hygiene, environmental disinfection, food and water safety management, and health education.

    1. Case management

    In view of the highly contagious nature of Norovirus, standardized management of Norovirus-infected persons is an effective control method to block transmission and reduce environmental pollution. 
    In the childcare institution, strict morning inspections and daily inspections should be passed to detect the children in time and isolate them in a timely and effective manner.


    2. Hand hygiene

    Maintaining good hand hygiene is the most important and effective measure to prevent norovirus infection and control transmission. Wash your hands properly, using soap and running water for at least 20 seconds.

    It is important to note that sanitizing paper towels and hands-free sanitizers are not a substitute for standard hand-washing procedures. Care should also be taken not to touch the ready-to-eat food directly with bare hands.


    3. Environmental disinfection

    Collective units and medical institutions such as schools, childcare institutions, old-age care institutions and medical institutions should establish a daily environment cleaning and disinfection system. Chemical disinfectants are one of the main methods to block the spread of Norovirus through a contaminated environment or the surface of an item. Chlorine-based disinfectants are the most commonly used. 

    When an epidemic of epidemics occurs, the surface of environmental objects, daily necessities, food processing tools, and drinking water, etc., contaminated by pollutants such as vomit and feces of patients should be focused on disinfection.

    4. Food safety management

    Strengthen the health management of food practitioners. Patients with acute gastroenteritis or recessive infection should be temporarily removed from work and isolated. 
    There should be thoroughly clean and disinfect disinfection of canteen utensils, facilities and equipment, and production and processing environment. Avoid all aspects of food preparation Cross-contamination.

    5. Water safety management

    Suspend the use of contaminated water sources or secondary water supply facilities, and sterilize by appropriately increasing the amount of chlorine input; suspend the use of contaminated barrel water and direct drinking water, and immediately disinfect the barrel water machine and direct drinking water machine.
     Relevant drinking water can only be used after passing the hygienic evaluation.

    6. Health education

    Make full use of radio, television, newspapers, Internet, WeChat, mobile phone text messages, leaflets / bulletins, etc. to carry out the promotion of Norovirus infection prevention and control knowledge, improve the community's awareness of prevention and control, and develop hand washing and not drinking.
    Separate raw water from raw food, avoid cross-contamination and other healthy living habits.

    What causes gastrointestinal virus infections?

    Enteroviruses include poliovirus, Cooksaki virus, and orphan virus (ECHO virus) that causes cytopathic changes in the human intestine. 

    These viruses belong to the Enterovirus genus of the Picornaviridae family in 1970. 

    Enteroviruses discovered after the 67 types of the three enteroviruses named above are named after the enterovirus ordinal number, that is, enteroviruses 68, 69, 70, 71, 72, etc. 

    Enterovirus particles are small, 20-hedron, diameter 24-30nm, lipid-free, core with single-stranded ribonucleic acid, resistant to ether and other lipid solvents, acid resistant and resistant to various antibiotics, antivirals, detergent Resistance. 

    Most viruses develop cytopathic effects in cell culture. Enteroviruses are usually parasitic in the intestine and, in rare cases, enter the bloodstream or nervous tissue.
     Normal virus carriers are rare, recessive infections are very common, and clinical symptoms after infection are few.

     Humans are the only natural host of human enteroviruses. The virus spreads through close contact between humans (through fingers, tableware and food).

    Viruses are present in the throat and intestines of infected people, and it takes longer to remove the virus from feces, which can last for several weeks. 
    Fecal-mouth is the main route of transmission. It can also be spread by droplets by accident. The virus lives in sewage for a long time.

    Onset and clinical manifestations

    After ingestion of the virus in humans, after 7 to 14 days, the virus that is present in lymphoid tissues of the pharynx and intestine passes through the bloodstream to proliferate into mononuclear phagocytes, and finally reaches the target organ (such as spinal cord, brain, Meninges, heart, liver, skin, etc.), cause corresponding clinical symptoms in different organs.

    Type 70 enterovirus-induced acute hemorrhagic conjunctivitis usually occurs suddenly, with severe eye pain, photophobia, blurred vision, subconjunctival bleeding, and the degree of bleeding ranges from small bleeding points to large bleedings.
     Full recovery takes place within 10 days.

     A rare neurological complication can be associated with acute lumbar spinal spinal radiculopathy, which is more common in adult men and occurs several weeks after eye disease.

    The main symptoms are similar to polio and can lead to sequelae such as paralysis and muscle atrophy. Another complication is facial paralysis.

    Enterovirus 71 mainly causes hand-foot-mouth disease and aseptic meningitis. Enterovirus 72 can cause hepatitis A.

    What is the distinction between bacterial and viral gastroenteritis?

    Bacterial gastroenteritis

    Bacteria can be eliminated through diarrhea.

    Bacterial gastroenteritis is mainly caused by bacterial infections, including Staphylococcus aureus, E. coli, typhoid, and salmonella. Dr. Lin said, "Salmonella is the most common in clinical practice." As for gastroenteritis caused by Staphylococcus aureus, as this bacteria is more acute, symptoms will appear in about 4 hours, usually in severe food poisoning.

    As for the main symptoms of bacterial gastroenteritis, in addition to vomiting and diarrhea, the scope of abdominal pain is relatively concentrated, unlike viral gastroenteritis, which includes pain in the large and small intestines. 
    The excreta will carry mucus or blood, have a rotten smell, and may be a bit green.

    Transmission: fecal-oral infection

    The cause may be unclean food. In addition, Staphylococcus aureus also exists on the skin surface of the human body. 
    If hands and nails are not cleaned, it will also contaminate food and cause severe food poisoning.


    Usually antibiotics are given as appropriate. If the condition does not improve within 3 days and you have a high fever, vomiting, or diarrhea, you must seek medical treatment immediately. 
    Dr. Lin Jianhong pointed out that severe cases of bacterial gastroenteritis may lead to intestinal perforation, peritonitis, and even toxic megacolon disease. 
    Clinically, it has also experienced cases that progressed to systemic infections such as meningitis and osteomyelitis.

    The antidiarrheal effect is too strong, the intestines cannot move

    Therefore, the antidiarrheal medicine prescribed by the doctor when taking the medicine should not be too strong. 
    If the antidiarrheal effect is too strong, not only will the intestines not be able to move, bacteria will continue to breed, but it will also cause severe flatulence and even thin the intestines.
    Therefore, the principle of medication is to prevent the child from diarrhea to the point of dehydration, but not to prevent him from having diarrhea at all.
    Dr. Lin said: "Bacteria can be excreted only through diarrhea."

    Viral gastroenteritis

    Prion gastroenteritis is mainly caused by viral infections. Rotavirus and Norovirus are common. Although there are many infections in autumn and winter, they still occur in summer. 
    The clinical symptoms are vomiting, high fever, dehydration, and excreta without mucus. 
    In addition, the range of abdominal pain is wide, including the large and small intestines.

    The incubation period is about 1 to 3 days. If the amount of virus is small, the incubation period may reach one week. Other viral gastroenteritis, like Norovirus during the Chinese New Year period, can also cause severe vomiting, fever, and abdominal pain. 
    However, Norovirus occurs in autumn and winter.

    Transmission: fecal-oral infection

    Pupae are predominantly fecal-oral infections, however, some viral gastroenteritis can be transmitted by flying droplets.


    Use supportive therapy to improve symptoms. If your child has severe diarrhea and vomiting, you can add electrolyte water.

    In particular for rotavirus infections, "Typical symptoms are vomiting and then pulling, combined with poor appetite, and even inability to drink water, which can lead to severe dehydration. Therefore, if the symptoms have not resolved, hospitalization is recommended."

    In addition, it is recommended that children be given a rotavirus vaccine to prevent rotavirus infection.

    Still in doubt? Please leave your question and answer you within 15 minutes.

    Don't confuse gastroenteritis virus with enterovirus

        Many people confuse viral gastroenteritis virus with enterovirus. Although both of them involve the intestine and are viruses, they come from different pathogens, and their pathogenesis and clinical symptoms are different, which ultimately leads to different disease. The main lesions of gastroenteritis caused by viral gastroenteritis virus are in the intestine, causing watery diarrhea, and the course of disease is generally self-limiting.

     Although enterovirus is also infected by feces and mouth, the virus invades the whole body, and the main lesion is not in the intestine. Instead, it affects the skin, mucous membranes, myocardium, respiratory system, and central nervous system, and a few serious patients even die.

        Viral gastroenteritis, also known as viral diarrhea, is an acute intestinal infectious disease caused by rotavirus, adenovirus, astrovirus, and calicivirus. Urgent onset, nausea, vomiting, abdominal pain, diarrhea, drainage or loose stools, fever and general discomfort, short duration, and low mortality.

        Enterovirus infection is often a recessive infection that rarely causes diarrhea. Infants and young children and adults with low immunity are susceptible. 
    The same enterovirus can cause different clinical manifestations and can easily cause polio, aseptic meningitis, and brain Inflammation, hand, foot and mouth disease, myocarditis, respiratory infections, diabetes and other diseases.

    Author's Bio

    Doctor Shawna Reason, Virologist
    Dr. Shawna Reason
    Name: Shawna Reason

    Education: MBBS, MD

    Occupation: Medical Doctor / Virologist 

    Specialization: Medical Science, Micro Biology / Virology, Natural Treatment

    Experience: 15 Years as a Medical Practitioner

    About Me | Linkedin | Quora Profile | Medium Profile | Twitter


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