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Changes Made In UK’s Management of Norovirus

What the Brits so aptly call “the winter vomiting disease” is coming in for some new management just as the norovirus season ramps up.

The medical establishment in the United Kingdom has agreed to new guidelines for the management of norovirus, which increases from October to April and peaks during winter months.

In the U.S., where about half of the 21 million cases of norovirus experienced annually are attributed to foodborne transmission, the federal Centers for Disease Control and Prevention (CDC) issued new guidelines for managing and preventing the disease last spring.

The highly contagious norovirus — transmitted by contact with an infected person or by consuming contaminated food or water, or contact with a contaminated surface or object — is known for its rapid spread in confined spaces like schools, hotels, and cruise ships.  

The vomiting and diarrhea brought on by norovirus can cause dehydration and the need for hospitalization.  Recovery with no long-term effects usually follows in one to two days.  

In the UK, the new guidelines are the product of a working group that, in addition to the Health Protection Agency, includes the British Infection Association, Healthcare Infection Society, Infection Protection Society, National Health Service Confederation, Sowerby Center for Health Information, and National Concern for Healthcare.

Two factors “underpin the need for the new guidelines,” according to the norovirus working group. First, the new report says recent increases in norovirus are overwhelming the British National Health Service and other organizations.  And second, the organization and operation of the NHS must achieve “the need for the efficient and safe care of patients within a safe environment.”

“Managing norovirus outbreaks is very hard owing to the nature of the virus and how quickly it spreads, ” says Dr. Bharat Patel, HPA’s Lead Consultant Medical Microbiologist and one of the authors of the new guidelines.

“The guidance gives very clear recommendations how to manage outbreaks within the hospital and community setting,” he adds.  “It will be greatly beneficial to staff to know that there is no the option of trying to manage the outbreak at the single room and bay level which will reduce the pressure that closing wards has on both staff and patients.”  

The changes should mean that the UK will see fewer closures of entire wards and ultimately hospitals. The report says the new guidance is based on the principle of minimizing disruption to important essential services and maximizing the ability of health centers to deliver appropriate care to patients safety and effectively.

“There is a shift of focus towards a balance between the prevention of spread of infection and maintaining organizational activity,” the report says. “In effect, this means a move away from the traditional approach of complete ward closure and an adoption of a pragmatic, escalatory system of isolation using single rooms and cohort nursing without compromising patient care both for norovirus itself and other essential healthcare.”

In the first changes to the management of norovirus outbreaks in 11 years in the UK, the norovirus working group found one study and a lot of anecdotal evidence that the closure of smaller clinical areas can be effective in controlling the disease.  It is also emphasizing preparedness for outbreaks.

“The epidemiology of norovirus changes over time and geography,” the report continues.  “The emergence of new strains will continue to challenge us as populations at risk, including employees of affected organizations, will also change.”

The report calls for “robust surveillance of outbreaks” even though it isn’t like to prevent symptomatic norovirus infection or shorten outbreaks.

The 42-page document, “Guidelines for the management of norovirus outbreak in acute and community health and social care settings,” says hospitals should admit norovirus victims only as a last resort.

“The admission of residents with norovirus to hospital can lead to severe disruption of services,” the new guidelines say.  “Wherever possible, symptomatic residents should be managed in the home and hospital admission should only be contemplated for those who are at serious risk of complications.”

Instead, the document advises using home rehydration strategies, and when a hospital referral is made, the hospital and ambulance crew should be informed before the transport occurs.

The new guidelines make it clear that norovirus cannot be successfully managed in the so-called “Nightingale” wards where multiple beds are located in one room.  The spread of norovirus in such wards has frequently led to closures of entire hospitals in the UK.

The report also addresses NHS staff, calling for anyone showing norovirus symptoms to go off duty immediately.

According to NHS, up to one million people annually contract norovirus in the United Kingdom.  

NHS is UK’s publicly funded health care system. HPA is the independent agency for threats from infectious diseases and environmental hazards.

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