Age, Viral Copy Number, and Immunosuppressive Therapy Affect the Duration of Norovirus RNA Excretion in Inpatients Diagnosed with Norovirus Infection

Abstract

Norovirus is one of the leading causes of acute gastroenteritis worldwide. Although it is becoming clear that viral excretion in the stool continues even after the clinical symptoms have disappeared, the factors that determine its duration remain unknown. Between 2007 and 2009, all inpatients and medical staff at our hospital who showed symptoms of a new onset of gastroenteritis were asked to submit a sample for norovirus testing by real-time RT-PCR. One of the 273 patients included tested positive for GI norovirus, and a further 89 were positive for GII norovirus. Of these 90 norovirus-positive individuals, 76% excreted norovirus RNA in the stool for more than 7 days. The inpatient group contained more long shedders than the medical staff group (5/32 versus 1/39, P<0.05). The median viral shedding duration was 19.3 and 15.2 days for inpatients and medical staff, respectively. Among hospitalized patients, younger individuals, those with a higher viral copy number, and individuals receiving immunosuppressive therapy tended to require a longer time to eliminate the virus. These patients should therefore be monitored and managed carefully to prevent nosocomial spread of the disease.