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Rotavirus is a virus that infects the bowels. It is the most common cause of severe diarrhea among infants and children throughout the world. The name Rotavirus comes from the characteristic wheel-like appearance of the virus when viewed in microscopy.
Rotaviruses are nonenveloped, double-shelled viruses. The genome is composed of 11 segments of double-stranded RNA, which code for six structural and five nonstructural proteins. The virus is stable in the environment.
Rotavirus is a member of the Reoviridae family.
For more information please visit http://www.cdc.gov/rotavirus/about/index.html
Epidemology
In the United States and other countries with a temperate climate, the disease has a winter seasonal pattern, with annual epidemics occurring from December through June. (1) The highest rates of illness occur among infants and young children, and most children in the United States are infected by 5 years of age. (2) Adults can also be infected, though disease tends to be mild. Rotavirus is the most common cause of severe diarrhea among children. Prior to the introduction of Rotavirus vaccines in the United Sates in 2006, Rotavirus resulted in the hospitalization of approximately 55,000 U.S. children each year (1,3). Globally, Rotavirus is estimated to cause 527,000 deaths in children annually. (2)
Pathogenesis
The primary mode of transmission is via fecal-oral route. Because the virus is stable in the environment, transmission can occur through ingestion of contaminated water or food and contact with contaminated surfaces or objects. People 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.
The pathogenesis of rotavirus-induced diarrhea is complex, and may be multifactorial. At least three components are thought to play a role: loss of brush border enzymes, the direct effect of the rotavirus enterotoxin NSP4, and activation of the enteric nervous system by infection ( 1 ).
Clinical Manifestations
Rotavirus predominantly infects children, but infection also occurs in adults. Immunosuppressed hosts, including children, appear to develop a more severe and protracted infection. The time period from initial infection to symptoms for Rotavirus disease is approximatrely two days. The disease is characterized by vomitting and watery diarrhea for 3 to 8 days, and fever and abdominal pain occur frequently (2). Immunity after infection is incomplete, but repeat infections tend to be less severe than the original infection.
Rotavirus disease is most common in infants and young children, but adults and older children can also become infected with Rotavirus. Once a person has been exposed to Rotavirus, it takes about 2 days for symptoms to appear
- Fever
- Vomiting
- Watery Diarrhea
- Abdominal pain
- Lethargy
- Dry, cool skin
- Absence of tears when crying
- Dry or sticky mouth
- Sunken eyes
- Sunken Fontanelle
- Extreme Thirst
Vaccinated and unvaccinated children may develop rotavirus disease more than once because there are many different types of rotavirus and because neither vaccine nor natural infection provides full immunity from future infections. Usually a person’s first infection with rotavirus causes the most severe symptoms.
Diagnosis
The diagnosis 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. (4)
Techniques for Rotavirus detection include
Electron Microscopy can also be used to detect Rotavirus.
Name of Specimen Used Reference Ranges Expected Results in Confirmatory or
Laboratory Test for Healthy People Patients with Rotavirus Screening Test
ELISA Stool Negative Positive Confirmatory
PCR Stool No Detection Detection of a specific Confirmatory
RNA strand
Latex Stool Negative Reaction Positive Reaction Screening
Agglutination
For persons with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days. Treatment is nonspecific and consists of oral rehydration therapy to prevent dehydration. About 1 out of 70 children with rotavirus gastroenteritis will require hospitalization for intravenous fluids. (3)
There are two rotavirus vaccines licensed for use in the United States, RotaTeq® and Rotarix®. These rotavirus vaccines have been shown to be safe and effective at preventing severe diarrhea. In March 2010, it was learned that a virus (or parts of a virus) called porcine circovirus (PCV) is present in both rotavirus vaccines. (3) There is no evidence that porcine circovirus is a safety risk or causes illness in humans.
The CDC recommends routine vaccination of infants. RotaTeq® (RV5), licensed in 2006, is given in 3 doses at ages 2 months, 4 months, and 6 months; Rotarix® (RV1), licensed in 2008, is given in 2 doses at ages 2 months and 4 months. (3,4) These vaccines also differ in how they are made and the number of doses, but both are given orally and both provide protection against the disease
1. Rotavirus Infection in Children. Doctor Tipster Website. Available at: http://www.doctortipster.com/5151-rotavirus-infection-in-children-transmission-manifestations-and-treatment.html. Accessed November 12. 2011
2. Rotaviruses. Website. Available at: http://www.nlv.ch/Rotavirus/Rotafactsheet.htm. Accessed November 12. 2011
3. Manual of rotavirus detection and characterization methods. Available at: http://whqlibdoc.who.int/hq/2008/WHO_IVB_08.17_eng.pdf. Accessed November 15. 2011
4. Clinical presentation and diagnosis of rotavirus infection. Available at: http://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-rotavirus-infection. Accessed November 15. 2011
