Rotavirus
Rotavirus: Excerpt from The 5-Minute Pediatric Consult
Suzanne Dawid, MD, PhD
Rotavirus - BASICS
Rotavirus - description
Infection with rotavirus causes high fever, profuse nonbloody diarrhea, and vomiting lasting 4–8 days. It is the most common cause of severe gastroenteritis in children in both the developed and developing worlds. All children have serologic evidence of infection by 4 years of age.
Rotavirus - general prevention
- Reduction of person-to-person transmission by proper hygiene, especially in child care settings
- A tetravalent simian/human rotavirus reassortant vaccine was licensed in 1998 and recommended as part of the routine infant immunization schedule. The vaccine was withdrawn from the market in 1999 after administration of the vaccine was linked to a small but significant increase in the incidence of intussusception.
- A live, oral human/bovine reassortant pentavalent vaccine was licenced for use in infants in 2006. Vaccination is indicated at 2, 4 and 6 months of age.
- A large multicenter trial has demonstrated that vaccination is associated with a 76% reduction in rotavirus gastroenteritis and a 98% reduction in severe illness associated with infection.
- There was no increased incidence of intussuseption associated with receipt of the vaccine.
- Small studies on hospitalized patients have suggested that the prophylactic use of probiotics may decrease the incidence of nosocomially acquired rotavirus infection.
Rotavirus - epidemiology
- Rotavirus is the most common cause of severe gastroenteritis throughout the world.
- Rotavirus has a predictable seasonality depending on location:
- In North America, peaks occur in the late summer in the south, moving northward and eastward.
- In the northeastern US and Canada, the highest incidence of disease occurs in late winter.
- In tropical regions, disease occurs throughout the year.
- Majority of disease occurs in children 6–24 months old.
- All children have serologic evidence of disease by the age of 4 years.
- Incubation period is 12 hours to 4 days.
- Exposure to as few as 200 viral particles can result in disease. The virus can persist on surfaces for prolonged periods of time.
- Virus can be shed asymptomatically, but shedding may precede disease by 2 days and typically persists for 10 days.
Rotavirus - incidence
- Infection accounts for 20–50% of pediatric hospitalizations for gastroenteritis.
- Causes >500,000 deaths per year in developing countries
- In the US, rotavirus infection causes at least 50,000 hospitalizations per year and 20–40 deaths per year.
Rotavirus - pathophysiology
The cause of diarrhea is unknown but is believed to be a result of multiple disruptions in the normal mechanisms of water reabsorption in the gut:
- Peptides encoded in the viral genome disrupt the transport of glucose and salt, resulting in increased water within the gut.
- Decreased levels of intestinal disaccharidases, including lactase, result in malabsorption of sugars.
- Viral replication within enterocytes results in atrophy and ischemia of small intestinal villi.
- Infection with rotavirus results in activation of the enteric nervous system, resulting in abnormal stimulation of water secretion into the GI tract.
Rotavirus - DIAGNOSIS
Rotavirus - signs & symptoms
Rotavirus - history
- Presents with high fever and vomiting, with as many as 20 watery stools a day
- Diarrhea may test heme positive, but is not grossly bloody.
- Up to 10% of children present with vomiting and/or fever without diarrhea.
- 50% of parents of infected infants are also infected; however, only 1/3 of these are symptomatic.
Rotavirus - physical exam
Consistent with dehydration
Rotavirus - tests
Rotavirus - lab
- Rotavirus ELISA for the presence of viral protein in the stool is highly sensitive and specific.
- Stool tends to be negative for leukocytes; however, this testing is rarely useful.
- Testing for malabsorption via stool assays for reducing substances or by d-xylose absorption assays is often positive.
- 67% of hospitalized children have mild elevations in their transaminases.
Rotavirus - differencial diagnosis
- Viral infections:
- Adenovirus
- Astrovirus
- Calicivirus (Norwalk virus)
- Bacterial infections:
- Salmonella
- Shigella
- Campylobacter
- Escherichia coli
- Yersina
- Vibrio
- Plesiomonas
- Aeromonas
- Clostridium difficile
- Parasitic infections:
- Giardia
- Cyclospora
- Isospora
- Cryptosporidium
Rotavirus - TREATMENT
Rotavirus - initial stabilization
- Supportive care with either oral or IV rehydration, depending on disease severity
- Limited studies have suggested that the addition of lactobacillus early in infection may decrease the duration of symptoms.
Rotavirus - FOLLOW UP
Rotavirus - complications
- Disease is typically self-resolving; however, 20% of 1st-time infections are moderate to severe and require medical attention. Severe dehydration may occur, resulting in acidosis and electrolyte disruptions.
- Diarrhea may be more severe and protracted in immunocompromised hosts.
Rotavirus - bibliography
- Centers for Disease Control and Prevention. Prevention of rotavirus gastroenteritis among infants and children. MMWR. 2006;55 RR12:1–13.
Offit PA, Clark HF. Rotavirus. In: Mandell GM, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia: Churchill Livingstone; 2000:1696–1700.
- Rosenfeldt V, Michaelsen KF, Jakobsen M, et al. Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea. Pediatr Infect Dis J. 2002;21:411–416.
- Szajewska H, Kotowska M, Mrukowicz JZ, et al. Efficacy of Lactobacillus GG in prevention of nosocomial diarrhea in infants. J Pediatr. 2001;138:361–365.
Rotavirus - CODES
Rotavirus - icd9
- 008.8 Gastroenteritis viral NEC
- 558.3 Gastroenteritis
- 558.9 Gastroenteritis (acute) (catarrhal) (congestive) (hemorrhagic) (noninfectious) (see also Enteritis)
Rotavirus - FAQ
- Q: When should children with rotavirus infection resume feeding?
- A: Feeding early in the course of disease promotes intestinal healing and should be instituted within 24 hours of illness. Infants should be given breast milk or diluted or regular-strength formula. Children should be given lactosefree carbohydrate-rich foods. Juices and sodas should be avoided because of their high sugar content.
- Q: Are antiemetics or antidiarrheal agents useful in the treatment of children with rotavirus infection?
- A: No. There have been no studies demonstrating efficacy of these medications in children.
- Q: Is natural infection protective against subsequent infections?
- A: Somewhat. The 1st episode of rotavirus infection tends to be the most severe; however, reinfection may occur, although it is often asymptomatic.
Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
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