In the United States nursing homes look after about 3.3 million residents annually, and gastroenteritis outbreaks are common. Noroviruses are the most common cause of gastroenteritis. They are highly contagious bugs that cause vomiting and diarrhea. There is no specific cure but treatment is targeted towards avoiding dehydration, preventing its spread to others with good hygiene practices, patient comfort, and more aggressive treatment of any life threatening effects of the disease.
Over 1000 outbreaks of acute gastroenteritis are reported by nursing homes to US public health authorities each year and this is estimated to be only a small portion of actual cases because of underreporting. Norovirus is implicated in 86% of etiologically (cause of the disease) confirmed outbreaks. Ninety per cent of the 800 annual norovirus associated deaths occur in people over the age of 65 years.
Twenty two per cent of all deaths in the USA occur in nursing homes and in a large study looking at years 2009 to 2010 researchers found that norovirus outbreaks were associated with 101 more hospitalizations and 45 excess deaths in the 1257 nursing homes in 3 States, Pennsylvania, Wisconsin and Oregon.
These statistics have a lot to tell us given that Tarak Trivendi, BS and his team found similar outcomes of mortality and hospitalizations across all three states. Their information can be used to reduce implement earlier intervention and to highlight the seriousness norovirus outbreaks can be.
- They found that the risk of hospitalization and death was at its highest in the first two weeks of an outbreak
- That people over the age of 90 years are a particularly high risk population and earlier hospitalization may help reduce death rates
- They found nursing homes with fewer than 0.75 daily registered nurse (RN) per resident and lower RN staff adequacy ratings, showed higher mortality rates supporting a 2001 report to Congress on appropriate of minimum RN staff levels to patients ratios
Medical and nursing staff in nursing homes need to be vigilant. Norovirus is common in cold but it can occur at any time of year. Infection control to prevent and control outbreaks is vital. Symptoms of raised temperature (over 38C/100.4F), headaches, aching limbs and stomach cramps in a few patients should ring alarm bells.
Dehydration is dangerous in elders but its early treatment will prevent death. Symptoms include dizziness or light headedness, tiredness, headache, dry mouth, lips and eyes, dark, concentrated urine and passing only small amounts of urine (fewer than three or four times a day).
A norovirus vaccine should be considered if efficacy and safety of immunization can be demonstrated say the authors.
Trivedi, T. K. et al. (2012). Hospitalizations and Mortality Associated with Norovirus Outbreaks in Nursing Homes, 2009-2010. JAMA, (308(16):1-8), 10.1001/jama.2012.14023.