Most admissions from the community for viral diarrhoea, other
than in a food-related outbreak, occur in winter usually in
children under 3 years old. Rotavirus account for over 50% of
episodes of acute viral diarrhoea in children.
Standard "enteric precautions" or otherwise
known as "faecal-oral" isolation is required
for patients with viral diarrhoea. Cohort nursing is
acceptable as long as no patients are admitted to the
cohort unless infection is proven.
In infants and children, shedding of rotavirus,
adenovirus, and astrovirus continues for many days
following resolution of the symptoms and therefore they
should continued to be isolated for 5 days after the
symptoms have cleared.
In adults, less virus is shed once the acute episode has
passed. Therefore, they do not need to be isolated once
their symptoms have cleared.
Nursing personnel should be assigned to care for either
infected infants or uninfected infants, but not both
Eradication of rotavirus from a long-stay geriatric ward
or neonatal unit may be impossible partly as a result of
recolonization of the ward by chronic carriers such that
even closure and cleaning are ineffective
Since the advent of polio vaccination, the majority of
reported cases of paralytic poliomyelitis were due to vaccine
strain virus. However, cases of paralytic poliomyelitis are still
reported from time to time.
The polio isolate should be examined further to determine
whether it is vaccine or wild type. Initial testing may
include the RCT 40 testing. Reference testing may involve
the use of monoclonal antibodies and/or sequence analysis.
Detailed history should be obtained; such as vaccination
history, contact with any persons who may have been
The patient should be isolated with enteric precautions,
preferably contact isolation, since high-dependency
nursing will probably be required, and also that polio
may be transmitted through nasopharyngeal secretions
If wild virus is confirmed, then a single dose of OPV
should be given to all persons in the immediate
neighborhood of the case, regardless of a previous
history of immunization against poliomyelitis.
Individuals with genuine contraindications such as
immunodeficiency should be given IPV. In previously
unimmunized individuals, the 3-dose course must be
If there is laboratory confirmation that a vaccine-derived
polio virus is responsible for the case, immunization of
further possible contacts is unnecessary since no
outbreaks associated with vaccine virus have been
reported to date. If the source of the outbreaks
uncertain, it should be assumed to be a "wild"
virus and appropriate measures instituted.
3. Coxsackie and Echoviruses
In normal wards, enteric precautions would be sufficient after
the diagnosis of a coxsackie or echovirus infection, paying
particular attention to hand washing, disinfection of surfaces
with hypochlorite 1000 ppm, heat disinfection of bedpans and
instruments. However, coxsackie or echoviruses may cause severe
problems in a neonatal ward.
Pregnant women with a flu-like illness a few days before
delivery should be isolated with enteric precautions.
She should be investigated for enterovirus infection e.g.
throats swabs, stools, and possibly blood for serological
Her baby should be put in contact isolation after birth,
and given HNIG or IVIG if born within 7 days of maternal
The baby should be examined for enterovirus infection
Other babies in the neonatal wards should be given HNIG
or IVIG if supplies permit. (In fact, it is now routine
to give all premature babies weekly IVIG, IVIG is
probably preferable in babies because of the ease of
administration once an IV line is in place.)
4. Hepatitis A
Standard precautions should apply to patients with
hepatitis A. It may be advisable to put patients with a
poor standard of hygiene in a side room.
Staff constantly exposed to patients with hepatitis A
should be advised to be tested for immunity and
vaccinated if non-immune.
By the time jaundice appears, hepatitis A excretion is
probably well past its peak and may even be undetectable.
Therefore, HNIG would not be of any use in these
However, postexposure prophylaxis may be considered in
schools and institutions where personal hygiene may be
Hepatitis A vaccine may be given at the same time but its
efficacy in postexposure prophylaxis is uncertain at
During an outbreak in an institution, good hygiene
practices such as hand washing should be practiced.
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