Norovirus in Healthcare Settings
Norovirus in Healthcare Settings
As such a wide range of the population is affected by norovirus, defining a target group for interventions, and vaccination in particular, is a challenge. Targeting a norovirus vaccine to protect the populations at higher risk of disease may include infants, the elderly, and the immunocompromised. The majority of outbreaks occur among the elderly in hospitals or in long-term residential care facilities; therefore, a vaccine to protect this population is a priority. Vaccination of infants will address the most common cause of pediatric hospitalization due to gastroenteritis in countries in which rotavirus vaccine is in use. In addition, immunizing children could have important indirect benefits by limiting the transmission of norovirus in the general population. Before vaccines are ready to be rolled out for widespread use, there are still important questions that need to be answered such as the immunogenicity in infants and the elderly, which may be substantially reduced because of differences in exposure history and immune state and duration of protection.
As immunocompromised hospital patients may have chronic diarrhea and norovirus excretion, development of effective antiviral treatments and/or passive immunotherapy is a priority. Such therapies may not only benefit the affected patient directly, but may also benefit efforts to control transmission in the hospital, especially in transplant and oncology care units, in which most patients are immunosuppressed and at high risk of severe norovirus disease outcomes.
Given the high economic burden of nosocomial norovirus outbreaks, second only in the United Kingdom to the cost associated with urinary tract infections, a full cost–benefit analysis should inform refurbishment initiatives and future hospital design in that country, and perhaps others with similar hospital design structures. More generally, we advocate for a stronger evidence base for infection prevention and control of norovirus in healthcare settings, well designed controlled trials, or, where that is impractical or unethical, observational studies should be conducted on interventions, including ward closure, disinfection regimes, and cohorting strategies.
Conclusion
As such a wide range of the population is affected by norovirus, defining a target group for interventions, and vaccination in particular, is a challenge. Targeting a norovirus vaccine to protect the populations at higher risk of disease may include infants, the elderly, and the immunocompromised. The majority of outbreaks occur among the elderly in hospitals or in long-term residential care facilities; therefore, a vaccine to protect this population is a priority. Vaccination of infants will address the most common cause of pediatric hospitalization due to gastroenteritis in countries in which rotavirus vaccine is in use. In addition, immunizing children could have important indirect benefits by limiting the transmission of norovirus in the general population. Before vaccines are ready to be rolled out for widespread use, there are still important questions that need to be answered such as the immunogenicity in infants and the elderly, which may be substantially reduced because of differences in exposure history and immune state and duration of protection.
As immunocompromised hospital patients may have chronic diarrhea and norovirus excretion, development of effective antiviral treatments and/or passive immunotherapy is a priority. Such therapies may not only benefit the affected patient directly, but may also benefit efforts to control transmission in the hospital, especially in transplant and oncology care units, in which most patients are immunosuppressed and at high risk of severe norovirus disease outcomes.
Given the high economic burden of nosocomial norovirus outbreaks, second only in the United Kingdom to the cost associated with urinary tract infections, a full cost–benefit analysis should inform refurbishment initiatives and future hospital design in that country, and perhaps others with similar hospital design structures. More generally, we advocate for a stronger evidence base for infection prevention and control of norovirus in healthcare settings, well designed controlled trials, or, where that is impractical or unethical, observational studies should be conducted on interventions, including ward closure, disinfection regimes, and cohorting strategies.
