Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings

MacCannell, Taranisia; Umscheid, Craig A.; Agarwal, Rajender; Lee, Ingi; Kuntz, Gretchen; Stevenson, Kurt B.

doi:10.1086/662025

Cited by 154 publications

(167 citation statements)

References 160 publications

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“…Control of norovirus outbreaks is complicated by the relatively low infectious dose (21) and by the high level of norovirus shedding in vomitus (21) and feces (22). Routine norovirus prevention and control measures utilize a combination of staff-and patientlevel strategies, including hand hygiene, assigning of patient cohorts, use of appropriate protective equipment, and effective environmental disinfection (23,24). The implementation of such measures requires the prompt identification of norovirus-infected patients.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of the Xpert Norovirus Assay for Detection of Norovirus Genogroups I and II in Fecal Specimens

et al. 2016

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Norovirus is the most common cause of sporadic gastroenteritis and outbreaks worldwide. The rapid identification of norovirus has important implications for infection prevention measures and may reduce the need for additional diagnostic testing. The Xpert Norovirus assay recently received FDA clearance for the detection and differentiation of norovirus genogroups I and II (GI and GII), which account for the vast majority of infections. In this study, we evaluated the performance of the Xpert Norovirus assay with both fresh, prospectively collected (n ‫؍‬ 914) and frozen, archived (n ‫؍‬ 489) fecal specimens. A Centers for Disease Control and Prevention (CDC) composite reference method was used as the gold standard for comparison. For both prospective and frozen specimens, the Xpert Norovirus assay showed positive percent agreement (PPA) and negative percent agreement (NPA) values of 98.3% and 98.1% for GI and of 99.4% and 98.2% for GII, respectively. Norovirus prevalence in the prospective specimens (collected from March to May of 2014) was 9.9% (n ‫؍‬ 90), with the majority of positives caused by genogroup II (82%, n ‫؍‬ 74). The positive predictive value (PPV) of the Xpert Norovirus assay was 75% for GI-positive specimens, whereas it was 86.5% for GII-positive specimens. The negative predictive values (NPV) for GI and GII were 100% and 99.9%, respectively. G lobally, norovirus is the most common cause of endemic and epidemic gastroenteritis in all age groups (1). Within the United States, it is estimated that norovirus infections account for 400,000 emergency room visits, 56,000 to 71,000 hospitalizations, and 570 to 800 deaths annually (2). In countries that have implemented rotavirus vaccination programs, norovirus has become the leading cause of gastroenteritis in young children, in both outpatient and hospitalized individuals (3-6).Norovirus, originally called Norwalk virus, was identified from a gastroenteritis outbreak in Norwalk, OH, when the viral particles were visualized using electron microscopy (7). Genomic sequence data place norovirus in the genus Norovirus in the family Caliciviridae, which also includes Sapovirus, Lagovirus, Nebovirus, and Vesivirus, which are all small, nonenveloped, positive-sense RNA viruses. Currently, there are 7 known genogroups of norovirus, designated genogroup I (GI) to GVII, and over 40 genotypes (8). The majority of norovirus infections in humans are caused by GI and GII viruses (9). Norovirus can be transmitted via the fecaloral route, through aerosolization of viral particles in vomitus (10, 11), and through contaminated food, water, and environmental sources (12).Norovirus infections are characterized by a variety of symptoms, including vomiting, nonbloody diarrhea, abdominal pain, nausea, and a low-grade fever. In otherwise healthy individuals, norovirus infections are typically self-limiting and resolve within a few days of symptom onset. However, norovirus symptoms can be more severe and prolonged in the elderly, young children, and immunocompromised individual...

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Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of the Xpert Norovirus Assay for Detection of Norovirus Genogroups I and II in Fecal Specimens

et al. 2016

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“…Many of these results are summarized in the HICPAC (Healthcare Infection Control Practices Advisory Committee) guidelines for the prevention and control of norovirus gastroenteritis outbreaks in health care settings published in 2011 and in a recent review of norovirus infection control measures (233,234). The three main strategic areas included staff and patient policy development, hand hygiene, and proper environmental disinfection.…”

Section: Norovirus Prevention and Controlmentioning

confidence: 99%

“…This was coupled with a comprehensive communication strategy for informing staff, patients, and visitors of up-to-date outbreak information (238). No studies have definitely demonstrated which education policies and practices are most effective in sustaining good infection control practice, although the HICPAC recommends staff, patient, and visitor education on symptoms, transmission, and prevention strategies during suspected or confirmed norovirus outbreaks (233).…”

Section: Staff and Patient Policiesmentioning

confidence: 99%

Norovirus

2015

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SUMMARY Norovirus, an RNA virus of the family Caliciviridae , is a human enteric pathogen that causes substantial morbidity across both health care and community settings. Several factors enhance the transmissibility of norovirus, including the small inoculum required to produce infection (<100 viral particles), prolonged viral shedding, and its ability to survive in the environment. In this review, we describe the basic virology and immunology of noroviruses, the clinical disease resulting from infection and its diagnosis and management, as well as host and pathogen factors that complicate vaccine development. Additionally, we discuss overall epidemiology, infection control strategies, and global reporting efforts aimed at controlling this worldwide cause of acute gastroenteritis. Prompt implementation of infection control measures remains the mainstay of norovirus outbreak management.

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“…Rapid and accurate laboratory diagnosis is critical to avoid further spread of disease due to the complexity of gastroenteritis cases. It also aids in judicious antibiotic therapy use while minimizing costs from presumptive isolation and hospital stay (3)(4)(5)(6).…”

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confidence: 99%

Site-Specific Clinical Evaluation of the Luminex xTAG Gastrointestinal Pathogen Panel for Detection of Infectious Gastroenteritis in Fecal Specimens

2014

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We evaluate the clinical performance of the Luminex xTAG gastrointestinal (GI) pathogen in vitro diagnostic (IVD) assay in a comparison between clinical and public health laboratories. The site reproducibility study showed 98.7% sensitivity with high positive and negative agreement values (96.2% and 99.8%, respectively), while assay performance against confirmatory methods resulted in 96.4% sensitivity with similar positive and negative agreement values (90.1% and 99.5%, respectively). Highthroughput detection of multiple GI pathogens improved turnaround time, consolidated laboratory workflow, and simplified stool culture practices, thus reducing the overall cost and number of specimens processed.

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Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings

Cited by 154 publications

References 160 publications

Multicenter Evaluation of the Xpert Norovirus Assay for Detection of Norovirus Genogroups I and II in Fecal Specimens

Multicenter Evaluation of the Xpert Norovirus Assay for Detection of Norovirus Genogroups I and II in Fecal Specimens

Norovirus

Site-Specific Clinical Evaluation of the Luminex xTAG Gastrointestinal Pathogen Panel for Detection of Infectious Gastroenteritis in Fecal Specimens

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