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Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, 2011

GRADE Table Q1 What person, virus or environmental characteristics increase or decrease the risk of norovirus infection in healthcare settings?

Person characteristics

Demographic characteristics

Comparison Outcome Quantity and type of evidence Findings Starting grade Decrease GRADE Increase GRADE GRADE of Evidence for Outcome Overall GRADE of Evidence Base
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Age Symptomatic norovirus infection* 3 OBS 62-64 Primary attack rate was significantly increased in adults when compared with children in 1 OBS in the community setting. Secondary attack rate was significantly increased in children aged 0-5 years compared with those aged 6-10 years. Children were a possible risk factor for household transmission when compared with adults62
 
Increase in age was an independent protective factor in 1 OBS among aircraft crew members 64Children who were affected were significantly younger in 1 OBS at a mother and child health clinic 63
Low 0 0 0 0 0 0 0 0 Low Low
Asymptomatic norovirus infection 1 OBS 60 Children were a possible risk factor for detection of CaCV and norovirus GII strain when compared with adults in 1 OBS in the community setting 60 Low 0 0 0 −1 0 0 0 0 Very Low
Duration of illness* 2 OBS 57,59 1 DES 58 Age ≥ 65 years was an independent risk factor for increased duration of diarrhea in 2 OBS in the healthcare setting 57,59
 
Recovery was slowest in the oldest age group ≥ 65 years in 1 DES in the nursing home setting 58
Low 0 0 0 0 0 0 0 0 Low
Gender Symptomatic norovirus infection* 1 OBS79 Gender was not a risk factor for symptomatic norovirus infection79 Low 0 0 0 0 0 0 0 0 Low Low
Acute kidney disease 1 OBS57 Gender was not a risk factor for acute kidney disease57 Low 0 0 0 0 0 0 0 0 Low
Duration of illness 1 OBS57 Gender was not associated with increased duration of illness57 Low 0 0 0 0 0 0 0 0 Low
Hypokalemia 1 OBS57 Gender was not a risk factor for hypokalemia57 Low 0 0 0 0 0 0 0 0 Low
Race Symptomatic norovirus infection* 1 OBS 64 Black race (compared with white) was an independent protective factor in 1 OBS among aircraft crew members 64 Low 0 0 0 −1 0 0 0 0 Very Low Very Low
Education Symptomatic norovirus infection* 1 OBS 61 Education level was not a risk factor in 1 OBS in the community setting 61 Low 0 0 0 −1 0 0 0 0 Very Low Very Low
Patient characteristics Symptomatic norovirus infection* 2 OBS 66,67 Patients who were exposed to case nurses had a greater risk than those who were not in 1 OBS in the healthcare setting. Respiratory care lack of nasogastric tube care and lack of wound care were possible risk factors 67
 
OBS in a long term care facility, physical dependence was a possible risk factor and use of diuretics was a possible protective factor 66
Low 0 −1 0 0 0 0 0 0 Very Low very Low
Staff characteristics Symptomatic norovirus infection* 1 SR 56 2 OBS 66,67 Patient-indexed outbreaks affected significantly more patients than staff-indexed outbreaks in 1 SR. Staff were similarly affected by both outbreak index category groups 56
 
Nurses who were exposed to case patients did not have a significantly different risk of infection from those who were not in 1 OBS in the healthcare setting. Being a staff member was a possible risk factor 67. Exposure to vomitus, gastroenteritis in household and exposure to residents with gastroenteritis were possible risk factors among employees in 1 OBS in a long term care facility 6
Low 0 0 0 0 0 0 0 0 Low Low
Duration of illness 1 OBS 58 Hospital patients had a significantly increased duration of illness compared to a combined group consisting of hospital staff, nursing home staff and nursing home residents in 1 OBS 58 Low 0 0 0 −1 0 0 0 0 Very Low

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