Rotavirus

Symptoms

Possible symptoms of rotavirus gastroenteritis include watery diarrhea, nausea, vomiting, abdominal pain, fever, and feeling sick. Blood in the stool is rare. The course varies, but the disease leads to complications and hospitalization more frequently compared with other gastroenteritis. Fluid loss, especially in children, can lead to dangerous dehydration, convulsions and, in the worst cases, death. The infection is among the most common causes of severe diarrhea in children and is estimated to kill up to 600,000 children under 5 years of age worldwide each year, primarily in developing countries. Rotaviruses are also the leading cause of hospitalizable diarrhea in young children in many countries, resulting in several thousand infections each year. However, deaths can be virtually eliminated due to good medical care. Compared with noroviruses, the illness lasts longer, 3-9 days, so it can persist for more than a week.

Causes

Rotaviruses (Latin , the wheel) are nonenveloped RNA viruses of the reovirus family (Reoviridae). They consist of a three-layer capsid with numerous spikes containing 11 segments of double-stranded RNA (dsRNA) and are approximately 70-100 nm in diameter. The viruses are transmitted fecal-orally, often as a smear infection via objects (e.g., toys, clothing) and surfaces, or directly from person to person. Infection is also possible through inhalation of contaminated aerosols after vomiting, via water, and food. Rotaviruses are relatively resistant and can remain infectious on surfaces for days to weeks and on hands for several hours. The disease is highly contagious. Already 1 to 10 viruses are said to be sufficient. They multiply in the intestinal cells (enterocytes) of the small intestine and are excreted in very large quantities in the stool. The first symptoms appear after a short incubation period of 1-3 days. The diseases are more frequent during the cold season. Infection leads to immunity. Secondary infection is milder or asymptomatic.

Diagnosis

Suspicion may already be possible based on clinical symptoms and transmission (children, fever, severe diarrhea, vomiting, long duration), but acute diarrheal illness can also be caused by numerous other pathogens and causes (e.g., noroviruses, bacteria, food poisoning). Laboratory methods are available to confirm the diagnosis.

Prevention and vaccination

Hygiene measures are essential for prevention: frequent and careful hand washing, hand disinfection, and cleaning and disinfection of surfaces and objects can help prevent spread. Isolation of those who have contracted the disease is also advisable. For example, children should not be sent to a daycare center or kindergarten under any circumstances so that their peers do not become infected. In many countries, the oral vaccination Rotarix is available. It has not yet been included in the vaccination schedule. According to the Federal Office of Public Health and the Federal Commission on Immunization, although it is well efficacious and tolerated, it is expensive and does not show a very large public health benefit because rotavirus gastroenteritis is readily treatable in many countries, with no deaths or long-term complications (as of 2010).

Nonpharmacologic treatment

The primary focus is fluid and electrolyte replacement and appropriate symptomatic therapy to prevent dehydration. If the patient’s condition permits, broth, tea, and light food may be administered. Breastfeeding may have a beneficial effect.

Drug treatment

Oral rehydration solution:

Antipyretic agents:

Anti-diarrheal agents:

  • A number of medicines are available for the treatment of diarrhea.The well-tolerated probiotics are often administered. Among the most effective antidiarrheal agents is loperamide, but it is contraindicated in children under 2 years of age. Alternatively, herbal remedies can be used. Charcoal is an old home remedy.

Remedies for nausea:

  • Prokinetics such as the like domperidone can be used to treat nausea and vomiting. Domperidone inhibits nausea and promotes gastric emptying and is approved for infants 12 months of age and older. It should be used with caution in infants because the bloodbrain barrier is not yet fully formed and neurologic disturbances may occur.
  • Antihistamines such as meclozine are not motility-enhancing, but may be effective against nausea. Meclozine is approved by physician prescription for use at 3 months of age and older, but the potential adverse effects of antihistamines in children pose a problem.

Anticonvulsants:

Skin care products:

Antiviral agents:

  • Are not yet available. Treatment so far is based on symptoms. Antibiotics are not indicated because it is not a bacterial infection.