Rotavirus Infection

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Rotavirus infection facts

  • Rotavirus is the most common cause of inflammation of the stomach and intestines (gastroenteritis), leading to severe diarrhea in infants and children throughout the world.
  • Most unvaccinated children become infected with rotavirus by age 3.
  • There are different strains of rotavirus, and multiple infections by different strains may occur.
  • Rotavirus causes the following symptoms and signs:
  • Rotavirus infection is highly contagious. The incubation period is typically about two days.
  • Rotavirus illness typically resolves on its own after three to nine days.
  • Two vaccines to prevent rotavirus infection are available: RotaTeq and Rotarix. Vaccines should be completed before an infant reaches 8 months of age.

What is rotavirus?

Rotavirus is a virus that infects the bowels, causing a severe inflammation of the stomach and bowels (gastroenteritis). Rotavirus is the most common cause of severe diarrhea among infants and children throughout the world and causes the death of about 500,000 children worldwide annually. The name rotavirus comes from the characteristic wheel-like appearance of the virus when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel").

Since 2006, vaccination has been available for rotavirus infection. Prior to the availability of a vaccine, almost all children became infected with rotavirus by their third birthday. Repeat infections with different viral strains are possible, and most children had several episodes of rotavirus infection in the first years of life. After several infections with different strains of the virus, children acquire immunity to rotavirus. Babies and toddlers between 6-24 months of age are at greatest risk for developing severe disease from rotavirus infection. Adults sometimes become infected, but the resulting illness is usually mild.

Worldwide, rotavirus infection is still a significant cause of death in infants and children. Rotavirus affects populations in all socioeconomic groups and is equally prevalent in industrialized and developing countries, so differences in sanitation practices or water supply are not likely to affect the incidence of the infection.

In the U.S., rotavirus infections usually peak in the fall months in the Southwest and spread to the Northeast by spring, so infections are most common during the winter months from November to May. However, infection with rotavirus can occur anytime of the year.

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Learn about rotavirus infection prevention and vaccination.

Rotavirus Infection

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Rotavirus infection is responsible for significant morbidity and mortality in children in less developed countries where access to the rotavirus vaccine is limited. The infection causes significant fever, vomiting, and diarrhea in children. This can often lead to serious problems with dehydration, especially in very young children and infants.

What causes rotavirus infections?

The rotavirus is a member of the Reoviridae family of viruses and contains double-stranded RNA enclosed by a double-shelled outer layer (capsid). Infection with different strains of the virus is possible, so it is common to have several separate rotavirus infections in childhood. Adults may also become infected, but the resulting illness is usually less severe than that in infants and young children.

Rotavirus vs. norovirus

Norovirus is the most common cause of gastroenteritis in the U.S. About 50%-70% of cases of gastroenteritis in adults are caused by noroviruses, whereas rotavirus most typically affects young children. Like rotavirus, norovirus is highly contagious and spreads rapidly. Noroviruses can be transmitted by consuming contaminated food and liquids, touching objects contaminated with norovirus and then placing the hands or fingers in the mouth, direct contact with an infected individual, and contact with infected individuals and objects in day-care centers and nursing homes.

What are risk factors for rotavirus infection?

Infants and children are most commonly infected with rotavirus. Since rotavirus infection is highly contagious, those who are around infected people are at high risk of infection. For this reason, children in group day-care settings are at risk. However, most children will become infected with rotavirus by 3 years of age.

Can adults get a rotavirus infection?

Yes, it is possible for anyone to develop a rotavirus infection. However, most adults who become infected have only minor symptoms, or may not have symptoms at all. Since neither vaccination nor previous infection provides full immunity, it is possible to get rotavirus infection more than once. The first infection tends to produce more severe symptoms than subsequent infections, and vaccination is very effective in infants in preventing severe symptoms (see below).

What is the incubation period for rotavirus?

The time period from initial infection to symptoms (incubation period) for rotavirus disease is typically around two days, but varies from one to three days.

What are rotavirus infection symptoms and signs?

Symptoms of the disease include fever, vomiting, and watery diarrhea. Abdominal pain may also occur, and infected children may have profuse watery diarrhea up to several times per day. Symptoms generally persist for three to nine days. Immunity from repeated infection is incomplete after a rotavirus infection, but repeated infections tend to be less severe than the original infection.

Rotavirus infection can be associated with severe dehydration in infants and children. Severe dehydration can lead to death in rare cases, so it is important to recognize and treat this complication of rotavirus infection. In addition to the symptoms of rotavirus infection discussed above, parents should be aware of the symptoms of dehydration that can occur with rotavirus infection or with other serious conditions.

Symptoms of dehydration include

  • lethargy,
  • dry, cool skin,
  • absence of tears when crying,
  • dry or sticky mouth,
  • sunken eyes or sunken fontanel (the soft spot on the head of infants), and
  • extreme thirst.

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Is rotavirus contagious? How long is rotavirus contagious?

Rotavirus infection is highly contagious. Contamination of hands or surfaces with the stool of an infected person and then touching the mouth is the main method of spread. Rotavirus infection is contagious (can be spread to other people) from the time before diarrhea develops until up to 10 days after symptoms have disappeared.

How is rotavirus transmitted?

The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of another child. This is known as a fecal-oral route of transmission. Children can transmit the virus when they forget to wash their hands before eating or after using the toilet. Touching a surface that has been contaminated with rotavirus and then touching the mouth area can result in infection.

There also have been cases of low levels of rotavirus in respiratory-tract secretions and other body fluids. Because the virus is stable (remains infective) in the environment, transmission can occur through ingestion of contaminated water or food and contact with contaminated surfaces. Rotavirus can survive for days on hard and dry surfaces, and it can live for hours on human hands.

What specialists treat rotavirus infection?

Rotavirus infection is most commonly treated by primary-care specialists, including pediatricians and family medicine specialists. Severe or complicated cases may require the intervention of other specialists, including emergency and intensive-care physicians.

How do health-care professionals diagnose a rotavirus infection?

The diagnosis of rotavirus may be made by rapid detection of rotavirus in stool specimens. Strains of rotavirus may be further characterized by special testing with enzyme immunoassay or polymerase chain reaction, but such testing is not commonly available or necessary.

What is the treatment for a rotavirus infection?

There is no specific treatment for rotavirus. For people with healthy immune systems, rotavirus infection of the bowel (gastroenteritis) is a self-limited illness, lasting for only a few days. The treatment consists of increased fluid intake (oral rehydration) to prevent dehydration. About one in 40 children with rotavirus infection of the bowel requires hospitalization for intravenous fluid.

What is the prognosis of a rotavirus infection?

Rotavirus infection is a self-limited disease that resolves after three to nine days of symptoms. Rarely, severe dehydration accompanying rotavirus infection has led to death. Recognition of the condition and proper supportive treatment (rehydration) can prevent serious complications.

Can a vaccine prevent rotavirus infections? Are any side effects associated with the rotavirus vaccine?

Because the virus is so prevalent, it is very difficult or even impossible to prevent rotavirus infection in unvaccinated people. Even places with excellent standards of hygiene and sanitation can become contaminated. Vaccination is the most effective preventive measure and is very effective in preventing severe rotavirus disease in young children and infants.

There are two rotavirus vaccines are licensed for vaccinating infants in the United States, known as RotaTeq and Rotarix. Both are given orally and do not require an injection. The rotavirus vaccines are most effective if the first dose is given before age 15 weeks, and all doses should be complete by 8 months of age.

  • RotaTeq (RV5) is given on a schedule of three doses at ages 2 months, 4 months, and 6 months.
  • Rotarix (RV1) is given on a schedule of two doses at ages 2 months and 4 months.

Side effects of the vaccine are very uncommon. As with all vaccines, rare allergic reactions may occur. Other uncommon side effects are temporary and can include irritability, vomiting, and diarrhea.

REFERENCES:

Nguyen, David D. "Rotavirus." Medscape.com. Sept. 13, 2015. <http://emedicine.medscape.com/article/803885-overview>.

"Rotavirus: Questions and Answers." Immunization Action Coalition. <http://www.immunize.org/catg.d/p4217.pdf>.

United States. Centers for Disease Control and Prevention. "About Rotavirus." Aug. 12, 2016. <http://www.cdc.gov/rotavirus/about/index.html>.

United States. Centers for Disease Control and Prevention. "Rotavirus." Aug. 12, 2016. <http://www.cdc.gov/rotavirus/>.

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Reviewed on 10/21/2016
References
REFERENCES:

Nguyen, David D. "Rotavirus." Medscape.com. Sept. 13, 2015. <http://emedicine.medscape.com/article/803885-overview>.

"Rotavirus: Questions and Answers." Immunization Action Coalition. <http://www.immunize.org/catg.d/p4217.pdf>.

United States. Centers for Disease Control and Prevention. "About Rotavirus." Aug. 12, 2016. <http://www.cdc.gov/rotavirus/about/index.html>.

United States. Centers for Disease Control and Prevention. "Rotavirus." Aug. 12, 2016. <http://www.cdc.gov/rotavirus/>.

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