Navigating the Norovirus Surge: Essential Updates for Clinicians

A notable norovirus surge is underway across parts of the country, producing higher caseloads in outpatient and institutional settings and raising demand for diagnostic testing and early oral or IV rehydration.

Wastewater and outbreak surveillance indicate elevated activity in the Midwest and Northeast during the typical winter window. In some localities activity is rising earlier than in prior years and the peak intensity is exceeding median seasonal baselines—signals that local surveillance and infection-control workloads will remain elevated.

Most patients present with rapid-onset vomiting, profuse watery diarrhea, and abdominal cramping; incubation is typically 12–48 hours and symptoms last about 1–3 days in otherwise healthy adults. Transmission occurs via contaminated food, surfaces and fomites, and direct person-to-person contact, so environmental disinfection and hand hygiene remain the central prevention measures emphasized in current guidance.

Younger children, older adults, and immunocompromised patients remain at highest risk for severe dehydration and electrolyte disturbance, accounting for higher rates of medical visits and admissions. Escalation thresholds include persistent vomiting, inability to retain oral fluids, orthostatic or hypotensive signs, and host factors that impair fluid recovery. Outpatient management focuses on aggressive oral rehydration and monitoring; IV fluids and inpatient observation are warranted for refractory dehydration or high-risk hosts. Prioritizing early rehydration and timely triage reduces progression to severe outcomes.