Rotavirus Infection

Symptoms of the rotavirus include fever, vomiting, and watery diarrhea.

• 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.
• Rotavirus infects most unvaccinated children by age 3.
• There are different strains of rotavirus, and multiple infections by different strains may occur.
• Rotavirus causes the following symptoms and signs:
  • Fever
  • Vomiting
  • Watery diarrhea
• Rotavirus-related symptoms can lead to severe and life-threatening dehydration.
• 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. There is no specific treatment, but it is important to maintain hydration.
• Two vaccines to prevent rotavirus infection are available: RotaTeq and Rotarix. Physicians recommend that patients receive immunization with rotavirus vaccines before an infant reaches 8 months of age.

Rotavirus is a virus that infects the bowels, causing severe inflammation of the stomach and bowels (known as 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 comes from the Latin rota, meaning "wheel").

Since 2006, vaccines have been available for rotavirus infection. Before the availability of a rotavirus vaccine, rotavirus infected almost all children 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 the 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 at any time of the year.

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.

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.

Norovirus is the most common cause of gastroenteritis in the U.S. Noroviruses cause about 50%-70% of cases of gastroenteritis in adults, whereas rotavirus most typically affects young children. Like rotavirus, norovirus is highly contagious and spreads rapidly. Contaminated food and liquids can transmit noroviruses, as can 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.

Rotavirus most commonly infects infants and children. 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, rotavirus infects most children by 3 years of age.

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).

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.

The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of another child, 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 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.

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

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 hydration with intravenous fluid.

Primary care specialists, including pediatricians and family medicine specialists, treat rotavirus infection. Severe or complicated cases may require the intervention of other specialists, including emergency and intensive care physicians.

Physicians diagnose rotavirus by the rapid detection of rotavirus in stool specimens. Physicians may further characterized strains of rotavirus may by special testing with enzyme immunoassay or polymerase chain reaction, but such testing is not commonly available or necessary.

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.

Because the virus is so prevalent, it is very difficult or even impossible to prevent rotavirus infection in people who did not receive the vaccine. Contamination is possible even in places with excellent standards of hygiene and sanitation. 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 licensed for vaccinating infants in the United States, known as RotaTeq and Rotarix. Both vaccines are given orally and do not require an injection. The rotavirus vaccines are most effective if administered before age 15 weeks, and all doses should be complete by 8 months of age.

• Health care professionals administer RotaTeq (RV5) on a schedule of three doses at ages 2 months, 4 months, and 6 months.
• Health care providers administer Rotarix (RV1) on a schedule of two doses at ages 2 months and 4 months.

Side effects of the rotavirus 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.