Most patients with norovirus have just one health care encounter, study finds
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Key takeaways:
- Overall, 80% of patients who sought care for diarrhea or vomiting had only one health care encounter.
- Patients with norovirus most often received oral rehydration therapy.
Most patients with all-cause and norovirus-associated acute gastroenteritis have only one health care encounter, primarily in the outpatient setting, researchers found in a study.
“Norovirus causes diarrhea and vomiting, and for most people, this will usually resolve within 1 to 3 days,” Jordan Cates, PhD, an epidemiologist in CDC’s Division of Viral Diseases, told Healio. “However, we wanted to examine some of the range of engagements that could occur with the health care system. For example, are patients with norovirus using telehealth, being admitted to the hospital or not, and are they interacting with the health care system just once or multiple times?”
Cates said there are no specific treatments for norovirus, so she and colleagues were also interested in learning about how these patients were having their symptoms managed, including learning if they receive IV or oral rehydration therapy, or if they took medications to help reduce their vomiting and diarrhea.
To do so, the researchers extracted data from electronic health records of patients with all-cause and norovirus-associated acute gastroenteritis (AGE) who were in the Kaiser Permanente Northwest health system between April 1, 2014, through Sept. 30, 2016. According to the study, an age-stratified, random sample of patients completed surveys and provided stool samples for norovirus testing.
In total, 40,348 patients had 52,509 AGE episodes during the study period. Of these patients, 3,310 were included in the substudy, 460 (14%) of whom tested positive for norovirus. Among the patients in the substudy group, 35% of all-cause AGE and 29% of norovirus-associated AGE episodes had two or more health care encounters.
Overall, the study demonstrated that most patients who sought care for diarrhea or vomiting (80%) had only one health care encounter, most often in the outpatient setting. However, patients with diarrhea or vomiting caused by norovirus received medical care at all levels of the health care system — 22% in the urgent care setting, 10% in the virtual setting, 10% in the ED setting and 2% in the inpatient setting.
In terms of therapeutic use among norovirus-positive compared with norovirus-negative episodes, the study demonstrated that 13% and 10% of patients received IV hydration, respectively, 65% and 50% received oral rehydration, 7% and 14% received empiric antibiotic therapy and 33% and 18% received antiemetics.
Although these data are from nearly 10 years ago, Cates said they still hold weight for informing treatment today.
“As was true during the time of this study, there are still no antivirals to treat norovirus today,” she said. “Clinicians must rely on therapies that promote rehydration and help reduce symptoms.”
Because of this, she explained, these data represent “valuable real-world evidence” on how people with diarrhea and vomiting are seeking care and how their symptoms are being managed.
“Clinicians should continue to follow guidelines for clinical management of patients with sudden onset of diarrhea or vomiting, especially prioritizing oral rehydration therapy to reduce the risk of dehydration,” Cates concluded. “Infection control measures, such as thorough hand-washing, cleaning and disinfecting surfaces with bleach, and patient isolation and contact precautions in congregate or health care settings are the best ways to prevent norovirus and keep it from spreading to others.”
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