title: Norovirus in healthcare settings.
abstract: OBJECTIVE
  To provide an overview of the burden of norovirus disease in healthcare settings and the factors responsible for outbreaks in these institutions; to assess progress on interventions aimed at reducing the burden of norovirus disease.
  
  
  RESULTS
  Norovirus outbreaks in healthcare settings are driven by confluence of viral diversity, the built environment, and host factors. Some of these characteristics may be modifiable and the target of successful interventions.
  
  
  CONCLUSIONS
  Most norovirus outbreaks in hospital and residential care institutions are associated with a particular genotype, known as GII.4. The persistence of norovirus is associated with strain diversity, which is driven by immune evasion and viral adaptation to interaction with a variety of human histo-blood group antigens. The healthcare environment presents serious challenges for control, both because of the physical structure of the built space and the high levels of contact among patient populations who may have compromised hygiene. Increased vulnerability among the populations in healthcare institutions is likely to be multifactorial and may include the following: nutritional status, immunodeficiency or senescence, chronic inflammation, and microbiome alterations. Current control measures are based on general infection control principles, and treatment is mainly supportive and nonspecific. Vaccines and antiviral agents are being developed with promising results, but none are currently available.
authors.affiliation: aInstitute of Infection and Global Health, and NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK bDivision of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Miren
authors.initials: M
authors.lastname: Iturriza-Gómara
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lopman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D017250:Caliciviridae Infections / Q000235:genetics / Q000517:prevention & control* / Q000635:transmission; D003428:Cross Infection; D004196:Disease Outbreaks / Q000191:economics / Q000517:prevention & control*; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006761:Hospitals; D006801:Humans; D016867:Immunocompromised Host; D017053:Infection Control / Q000191:economics / Q000379:methods / Q000458:organization & administration; D008969:Molecular Sequence Data; D029322:Norovirus / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D009735:Nursing Homes; D009752:Nutritional Status; D010802:Phylogeny; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents
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