Clinical pictures, treatments, and resource use of norovirus gastroenteritis in long-term care facilities: a survey with a chart review in Japan

BACKGROUND: Outbreaks of norovirus infection can have detrimental impacts on long-term care facilities. This study investigated the incidence, clinical picture, treatment and resource use of norovirus gastroenteritis in long-term care facilities. METHODS: Nineteen facilities in Osaka and Kyoto, Japan participated in questionnaire surveys conducted between 2009 and 2011 regarding the incidence of norovirus gastroenteritis. From clinical charts, the characteristics, symptoms, and treatment of infected residents were analyzed. Total drug cost per infected resident was calculated by multiplying the unit price for each drug by the daily dose and the number of days administered and summing the costs for each drug (USD 1 = JPY 100). RESULTS: Over the 3-year period, 8 outbreaks of norovirus gastroenteritis occurred in 6 facilities. The mean clinical course of 107 infected residents in five facilities that granted permission to examine patients’ medical records was 4 days, with all but one resident presenting with vomiting and/or diarrhea, and 84 (79%) also presenting with associated symptoms. Of 107 infected residents, 72 (67%) were isolated. The proportion of infected residents isolated varied from 50 to 100% depending on the facility. Of the infected residents, 81 (76%) received some type of medication, the most common being infusion (67 patients, 63%) and antibiotics (30 patients, 28%). The median total cost of all drugs administered was USD 4.4, and the median drug cost per infected resident per day was USD 2.0. Total drug cost over the entire treatment period was the highest for antibiotics, at USD 8.6. CONCLUSION: Clinical course was similar to those of norovirus cases examined at other long-term care facilities. The majority of infected residents received some type of medication. Although the economic burden was not large, not a few infected residents were given antibiotics, which are ineffective for norovirus.