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Vol 2 | Issue 2 | Apr – Jun 2023                                                                                     Indian J Pharm Drug Studies | 37 

Review Article 

Exploring the Novel Norovirus: A comprehensive study and overview 

Varshini N1, Himasvi M M1, Ramdas Bhat2, AR Shabaraya3 

From 1 UG student, Department of pharmacy practice, 2 Assistant Professor, Department of Pharmacology, 3 Principal and Head of 

Department of Pharmaceutics, Srinivas College of Pharmacy, Valachil, Post Farangipete, Mangalore, Karnataka, India-574143   

Correspondence to: Ramdas Bhat, Assistant Professor, Department of Pharmacology, Srinivas college of Pharmacy, Valachil, Mangalore -

574143 India. Tel: +91 7795772463 Email: ramdas21@gmail.com  

ABSTRACT 

Norovirus is a highly contagious virus that is the leading cause of acute gastroenteritis worldwide. It is a small, non-enveloped RNA 

virus that is classified as a member of the Caliciviridae family. Norovirus is spread through contaminated food or water, close contact 

with infected individuals, or by touching contaminated surfaces and then ingesting the virus. Symptoms of norovirus infection include 

nausea, vomiting, diarrhea, and abdominal cramps. The virus primarily infects the epithelial cells lining the small intestine, leading to 

inflammation and damage of the intestinal lining, and decreased absorption of nutrients and fluid. The inflammation and damage can 

lead to dehydration, especially in young children, elderly individuals, and those with weakened immune systems. Norovirus also 

triggers an immune response in the body, which can further contribute to inflammation and damage of the small intestine. In severe 

cases, the inflammation and damage can lead to a temporary decrease in the body's ability to absorb nutrients, leading to malnutrition. 

Prevention measures include regular handwashing, proper food preparation and storage, and disinfection of contaminated surfaces. 

Those who are sick with norovirus should stay home and avoid close contact with others until they have been symptom-free for at 

least 48 hours. Additionally, it is important to educate the public about the importance of proper hygiene and the steps they can take to 

prevent norovirus transmission. In conclusion, norovirus is a highly contagious virus that is a leading cause of acute gastroenteritis 

worldwide. The virus primarily infects the small intestine, leading to inflammation and damage, and decreased absorption of nutrients 

and fluid. Prevention measures include proper hygiene, food preparation and storage, and avoiding close contact with infected 

individuals.  

Key words: Norovirus, Acute Gastroenteritis, Reverse Transcription Polymerase Chain Reaction, Diarrhoea

oroviruses are positive-sense, single-stranded RNA 

viruses that are non-enveloped and belong to the 

Caliciviridae viral family. The norovirus is a highly 

contagious virus that causes gastroenteritis (inflammation of 

the stomach and intestines). It is one of the leading causes of 

foodborne illness and gastroenteritis a norovirus infection. 

Contaminated food and drink, intimate contact with infected 

people, or touching contaminated surfaces and then putting 

your hand in your mouth are all ways for the virus to spread 

[1]. Norovirus is a worldwide epidemic, particularly in closed 

environments where it can spread quickly, such as schools, 

nursing homes and cruise ships. Economic losses from disease 

and quarantine measures can accompany outbreaks, causing 

great distress and suffering to individuals and communities. 

Routine hand washing, careful food preparation and storage, 

and appropriate disinfection and cleaning of contaminated 

surfaces are all effective preventative measures [2].  

Even though the majority of people recover within a few 

days from norovirus infection, it can be especially dangerous 

for vulnerable groups such as young children, the elderly, and 

people with weakened immune systems. To prevent the spread 

of the norovirus, if you experiencesymptoms, take care and 

seek medical attention if ecessary, especially if you belong to 

a high-risk group [3]. 

Definition and History 

Norovirus was named after being discovered in 1972 during a 

gastroenteritis outbreak in Norwalk, Ohio. Over 100 people 

were affected by the outbreak at a school, and researchers 

were able to identify the virus using electron microscopy. It 

was discovered that the virus was a small, round, structured 

virus that was resistant to common disinfectants. Norovirus 

has since been identified as a leading cause of gastroenteritis 

outbreaks worldwide. It is estimated that it kills over 200,000 

people each year, primarily in developing countries with 

limited access to clean water and sanitation. Norovirus 

outbreaks are common in developed countries in places where 

large numbers of people are in close contact, such as hospitals, 

nursing homes, cruise ships, and restaurants [4]. Despite the 

significant health and economic impact of norovirus, there is 

still much to learn about the virus and how it spreads. 

Researchers continue to study the virus to develop better 

N 

mailto:ramdas21@gmail.com


Varshini N et al.                                                                      A comprehensive study and overview of Novel Norovirus 

Vol 2 | Issue 2 | Apr – Jun 2023                                                                                     Indian J Pharm Drug Studies | 38 

methods for prevention, treatment, and control of norovirus 

outbreaks [5]. 

Epidemiology  

The norovirus, which is extremely infectious, is a major 

source of disease all over the world. Every year, the number of 

norovirus cases in the United States is expected to reach 21 

million. The true number of occurrences is likely to be higher 

because many people with mild symptoms may choose not to 

seek medical attention. Acute gastroenteritis-induced stomach 

and intestine inflammation accounts for approximately 18% of 

all cases worldwide. When comparing high and low mortality 

rates in developing countries, developed countries (20%) have 

a higher prevalence of it. In comparison to hospital inpatients 

(17%), who are frequently impacted by other factors, 

norovirus has a much greater impact in the community and 

among hospital outpatients (24% and 20%, respectively). To 

prevent the spread of the norovirus, good hygiene practises 

such as routine hand washing and avoiding direct contact with 

sick people are required. In addition to sanitising infected 

surfaces, proper food handling and preparation techniques can 

help to prevent the virus from spreading [6]. 

Transmission 

The norovirus virus is extremely contagious and spreads 

quickly from person to person. The virus can be transmitted 

through a number of routes, including contaminated food or 

drink, close contact with sick people, and touching 

contaminated surfaces. Foodborne norovirus transmission is a 

common mode of transmission. The virus can spread when 

sick food workers prepare food without properly washing their 

hands, or when food is contaminated with norovirus-infested 

faeces. This can happen as a result of contaminated product 

washing water or during food preparation. Close contact is 

another major mode of norovirus transmission. The virus is 

highly contagious and spreads quickly through close physical 

contact, such as shaking hands, hugging, or sharing utensils or 

food. This mode of transmission is most common in enclosed 

communities, such as schools, nursing homes, and cruise 

ships. Surface transmission is another important mode of 

norovirus propagation [7].  

The virus can survive on surfaces for several days, and 

touching your mouth after coming into contact with a 

contaminated surface can result in infection. This type of 

transmission is especially dangerous because multiple people 

may come into contact with contaminated surfaces in public 

places such as restrooms. Norovirus can also be transmitted 

through the air in tiny droplets released during vomiting, 

though this occurs less frequently. It is still possible in 

confined spaces such as aircraft, classrooms, or hospitals. To 

prevent the spread of the norovirus, it is critical to practise 

good hygiene, which includes routine handwashing, safe food 

preparation and storage, and disinfecting contaminated 

surfaces. People who are sick with the norovirus should stay at 

home and avoid close contact with others until they have been 

symptom-free for at least 48 hours. The general public must 

also be educated on the importance of good hygiene and the 

precautions they can take to prevent the spread of the 

norovirus [8]. 

Pathophysiology  

Noroviruses are among a class of viruses that are challenging 

to grow in a lab environment. It has been challenging to 

predict with accuracy how norovirus spreads among humans. 

Numerous studies have found that the complicated norovirus 

infection involves a wide variety of cell types in the human 

intestine. The single layer of intestinal epithelium made up of 

enterocytes, the main cell type lining the human gut, is present 

there. It comprises a range of immune cells and is hidden deep 

within the enterocytes. Numerous studies have shown that 

immune cells such B cells, dendritic cells, and macrophages 

are infected and where norovirus replicates. Theoretically, 

noroviruses may infect people without passing through 

enterocytes.  

Among the hypothesised entry sites are lymphoid follicles 

and M cells in the stomach (specialised cells that coat Peyer 

patches). Because M cells do not exude mucus and lack 

microvilli on their surfaces, norovirus may readily enter the 

host and infiltrate immune cells. Other research studies 

suggest that norovirus may actively infect enterocytes lining 

the gut lumen, while there isn't enough evidence to draw a 

definitive conclusion. There has also been research about how 

the host's gut flora affects norovirus spread. According to one 

theory, norovirus works with gut microorganisms to increase 

infection and multiplication. Norovirus symptoms typically 

last 1-3 days, with clinical symptoms presenting 1-2 days after 

viral injection. Even after their symptoms have subsided, 

humans may continue to excrete the virus for up to 60 days. 

Patients with weakened immune systems may be able to 

excrete the virus for months or even years [4]. 

Diagnosis 

Norovirus (NoV) is a prevalent cause of gastroenteritis, and 

recognising outbreaks and managing public health requires 

accurate diagnosis. The electron microscopy (EM) approach is 

the traditional NoV diagnosis method, but it is not widely used 

due to its high cost and technical limitations. The immune-

enzymatic approach (ELISA) detects the virus in faeces 

through an interaction between norovirus capsid proteins and 

an enzyme, although its diagnostic sensitivity is limited. The 

RT-PCR (real-time reverse transcriptase polymerase chain 

reaction) molecular technology, which is commonly used for 

detecting NoV and researching epidemics, is a more sensitive 

and specific method. The RT-PCR technology quantifies 



Varshini N et al.                                                                      A comprehensive study and overview of Novel Norovirus 

Vol 2 | Issue 2 | Apr – Jun 2023                                                                                     Indian J Pharm Drug Studies | 39 

particular DNA or RNA sequences in clinical samples in real 

time and offers various benefits over traditional PCR, 

including enhanced sensitivity, specificity, and repeatability, 

as well as lower contamination. The POL gene region's 

phylogenetic analysis can be utilised to detect NoV genotypes 

and aid in epidemiological research [4]. 

Management and Treatment  

The norovirus, commonly known as the winter vomiting bug, 

is a highly infectious virus that causes acute gastroenteritis, 

resulting in symptoms like vomiting, diarrhoea, and stomach 

cramps. Managing norovirus sickness necessitates a two-

pronged strategy that focuses on both treating the patient's 

symptoms and limiting the likelihood of an epidemic. In order 

to prevent the spread of disease, infection control is a key 

concern, and the foundations of infection management are 

hand washing, surface cleaning, and avoiding contact with 

human fluids.  

The most important issue in treating the patient's 

symptoms is managing the patient's hydration level. Because 

dehydration is a common complication of norovirus infection, 

oral rehydration therapy is the mainstay of treatment. To assist 

replace the body's fluids, both the American Academy of 

Paediatrics and the World Health Organization (WHO) 

recommend oral rehydration solutions including electrolytes 

and glucose. Oral rehydration treatments are suggested for 

paediatric patients over sports drinks and juices, which have a 

high osmotic and carbohydrate load and might aggravate 

diarrhoea [9]. 

In dire situations, such as when the patient is unable to 

stop vomiting or is very dehydrated, intravenous hydration 

and hospitalisation may be required. Antibiotics are normally 

not advised for norovirus, unless a bacterial infection is 

detected. Adults may benefit from anti-motility drugs, and 

antiemetics may help ease vomiting symptoms. Ondansetron, 

in particular, has been demonstrated to be useful in managing 

vomiting in youngsters. Because of the predicted economic 

and public health benefits, the development of a norovirus 

vaccine is a major priority. However, developing a vaccine 

has been difficult due to the virus's intricate structure, human 

immune responses, the difficulty of replicating the virus, and a 

lack of acceptable animal models for vaccine development 

[10]. Several vaccinations are now being tested in pre-clinical 

studies, and one has completed adult Phase II clinical trials. 

Because of the virus's capacity to mutate, development efforts 

have concentrated on multivalent immunisations, comparable 

to influenza vaccines [11]. 

Prevention 

Norovirus is a highly contagious virus that can cause acute 

gastroenteritis outbreaks with symptoms such as vomiting, 

diarrhoea, and stomach cramps. It is easily transmitted from 

person to person and through contaminated food, water, and 

surfaces. To prevent the spread of norovirus, it is critical to 

follow a set of guidelines that include frequently washing 

hands with soap and warm water, avoiding contaminated food 

and water, disinfecting contaminated surfaces, practising good 

hygiene, wearing gloves when caring for someone who has 

norovirus, staying home if you have norovirus, and avoiding 

self-medication with antibiotics [12]. Hand washing is a 

critical step in preventing the spread of norovirus, as it can be 

transmitted through fecal matter that can be present on 

contaminated surfaces. Avoiding contaminated food and water 

is also important, and it is recommended to cook shellfish 

thoroughly, wash fruits and vegetables, and only drink water 

that is safe and clean.  

Disinfecting contaminated surfaces, such as doorknobs, 

faucets, and countertops, with a chlorine bleach solution or a 

disinfectant that is effective against norovirus is also 

recommended. Additionally, it is important to practice good 

hygiene, such as avoiding close contact with people who are 

sick and covering your mouth and nose when coughing or 

sneezing. If caring for someone with norovirus, wearing 

gloves can help avoid contact with their vomit or feces. 

Finally, it is crucial to stay home and avoid contact with 

others if you have norovirus, as it can easily spread to others. 

It is important to avoid self-medication with antibiotics, as 

they are not effective against norovirus and can contribute to 

the spread of antibiotic-resistant infections [13]. 

Prognosis  

Despite the fact that the majority of patients have no 

significant side effects from norovirus infection. The biggest 

risk of negative outcomes, including death, is among elderly 

and immunocompromised people [14]. In particular, research 

demonstrate that elderly individuals with norovirus infection 

have an elevated death rate. Neonates with norovirus infection 

are at risk for necrotizing enterocolitis. Additionally, 

immunocompromised patients run the danger of having 

diarrhoea that lasts for months to years in some cases, as well 

as a sickness with greater severity and a longer clinical course 

[15]. 

CONCLUSION 

Norovirus is a highly contagious virus that causes acute 

gastroenteritis, characterised by symptoms such as vomiting, 

diarrhoea, and stomach cramps. There is no cure, and 

treatment consists of oral rehydration therapy. Norovirus 

spreads quickly in crowded areas, so good hygiene practises 

such as handwashing, avoiding close contact with infected 

people, and disinfecting contaminated surfaces can help 

prevent infection. Food that is properly cooked and stored can 

also reduce the risk of infection. High-risk groups should take 



Varshini N et al.                                                                      A comprehensive study and overview of Novel Norovirus 

Vol 2 | Issue 2 | Apr – Jun 2023                                                                                     Indian J Pharm Drug Studies | 40 

extra precautions, and in severe cases, hospitalisation for 

intravenous fluid replacement may be required. Overall, 

people must be vigilant and proactive in protecting themselves 

and their communities from norovirus. 

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How to cite this article: Varshini N, Himasvi M M, 

Ramdas Bhat, AR Shabaraya. Exploring the Novel 

Norovirus: A comprehensive study and overview. Indian J 

Pharm Drug Studies. 2023: 2(2) 37-40. 

Funding: None                  Conflict of Interest: None Stated 

 


