When should I consider referring a patient with norovirus for further

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient with norovirus for further investigation or management if any of the following apply:

There are symptoms or signs suggesting an alternative serious diagnosis, such as high fever (≥38°C in children under 3 months or ≥39°C in older children), blood or mucus in stool, bilious vomiting, severe or localized abdominal pain, abdominal distension, altered consciousness, neck stiffness, bulging fontanelle, non-blanching rash, or respiratory distress .
The patient is at high risk of dehydration or shows clinical signs of dehydration (e.g., lethargy, decreased urine output, pale or mottled skin, cold extremities) .
The diarrhoea has not improved by day 7 or there is uncertainty about the diagnosis .
The patient is immunocompromised or suspected to have septicaemia .
Social circumstances make remote assessment unreliable or ongoing healthcare involvement is required .
There are red flag symptoms or signs indicating shock or severe illness, necessitating emergency transfer to secondary care .

In these cases, referral for face-to-face assessment or emergency transfer to secondary care should be arranged to ensure appropriate management .

When should I consider referring a patient with norovirus for further investigation or management?