Rotavirus Infection

Rotavirus is an infection of the gut caused by viruses. It belongs to the Reoviridae family. It can present as a short period of mild watery diarrhea or severe dehydrating diarrhea with vomiting and low-grade fever. It is one of the common viruses known to cause self-limited gastroenteritis. Fluid stool losses may be troublesome, and deaths from severe dehydration are quite common, particularly in developing States.

Rotavirus fundamentally infects the cells of the small intestinal villi, particularly the cells that are close to the tips of the villi. As these specific cells have a role in the digestion of carbohydrates and the intestinal absorption of fluid and electrolytes, rotavirus infections result in malabsorption by defective hydrolysis of carbohydrates and fluid excretion from the intestine. Loose stools due to increased motility can further exacerbate the illness. This increased motility seems to be secondary to virus-induced pathological changes at the villus epithelium. Dissemination of the virus can occur in immunocompromised individuals, resulting in extraintestinal infections. The virus starts to shed in the stool even before the appearance of symptoms and remains for up to 10 days after symptom appearance.

Rotavirus germs are found in individuals' feces and can transmit to other surfaces by unclean hands after using the bathroom or diaper changes. If these viruses come into contact with someone’s mouth, this is known as the fecal-oral spread. People can transmit on rotavirus without even having symptoms. Though the fecal-oral spread is very common, one can likely get an infection if being exposed to or in contact with the bodily fluids of someone infected.

Transmission:  Spread can quickly occur if:

• Unwashed hands that are contaminated with poop are put in the mouth
• Exposure to contaminated objects or surfaces by touching
• Eating contaminated food

People who are infected will shed the virus in their stool. The virus gets into the environment and can infect the community by this route. People shed rotavirus heavily and are more likely to infect others, both when they have symptoms and during the first three days after they recover from the virus. So people with rotavirus can easily infect others in their symptom-free period. Transmission can occur among family members or with people in close contact. Hand washing and cleanliness can tremendously help but are not fair enough to control disease transmission. Vaccination is the safest way to be considered. Vaccinated children can also get infected and sick from the virus because there is no way to be immune from the virus, either naturally or from vaccination. But vaccinated children will likely have less severe symptoms than those not vaccinated.

Certain risk factors that can result in the development of a severe illness include:

·         Socioeconomic conditions

·         Breastfeeding

·         Prematurity

·         Neonates

·         Immunodeficiency (transplantation, HIV, malignancy)

·         CNS complications

·         Cardiac diseases

·         Gastroparesis

Rotavirus infection Is common in the winter months, from December to May, but it occurs throughout the year in developing countries. Every year, in the United States, it first appears in the Southwest and then spreads to the Northeast.  In both developed and developing countries, almost every child 5 years and younger are impacted by rotavirus infection. The incidence of rotavirus is estimated to exceed 125 million cases of infantile diarrhea annually worldwide. Rotavirus is the commonest cause of childhood dehydrating gastroenteritis throughout the world. Greater than 2 million children younger than 5 years of age are hospitalized due to rotavirus gastroenteritis, and approximately 500,000-527,000 children die from this disease every year. All these deaths result from hypovolemia. Overall morbidity is rare in the United States, but dehydration and shock can result in ischemic injury to the renal system or the central nervous system.

The common clinical features in adults and children include.

•             Watery diarrhea

•             Abdominal pain

•             Anorexia

•             Low-grade fever.

•             Non-bloody stool.

•             Vomiting.

•             Abdominal cramps.

•             Severe fatigue

•             A high fever

•             Irritability

•             Dehydration

•             Abdominal pain

The findings during the physical examination for rotavirus infection are not evident except for signs of dehydration. Other findings on general physical examination include :

·         Hyperactive bowel sound is a common finding

·         Sunken eyes

·         Sunk anterior fontanelle

·         Dry or sticky mucous membranes

·         Diarrhea-induced diaper dermatitis

·         Rough, flaky skin

·         Tachycardia

·         Rectal examination shows the production of watery, heme-negative stools

·         Depressed sensorium

·         Reduction in weight

Significantly reduced urine output is an important feature. It is difficult to identify in infants using nappies because the copious amount of watery stool excretion makes it difficult to determine the urine output.

Lab Tests: Rotavirus may be also be identified by the following:

·         Enzyme immunoassay

·         Latex agglutination

·         Electron microscopy

·         Culture

Other laboratory studies may reveal measurement of electrolyte levels in patients with severe dehydration, alterations in mental status, accompanied seizures, or oral replenishment with excessive water or salt, measurement of glucose levels in young infants and any age child with associated lethargy.

The other disorders that need to be excluded are;

• Salmonella infection in children
• Gastroenteritis in Emergency Department
• Giardiasis
• Pediatric dehydration
• Enteroviral infections of children
• Amebiasis

In the majority of cases, medication is not required for rotavirus infection. The focus should be directed to appropriate fluid intake and other conservative therapies.

Supportive Care: Supportive care in infants with rotavirus infection is as below:

·         The doctor will ensure a patent airway and normal breathing, identify any circulatory compromise, and maintain adequate circulation

·         Patients will be given IV fluids to correct dehydration.

·         Continue hydration:  Specific issue in children who are not dehydrated is a selection of an appropriate fluid. Ideally, commercially available infant solutions, such as Pedialyte and Rice-Lyte; small, repeated feedings work better in infants who are vomiting. In some cases, a standard soy-based infant formula may also be recommended where there is no vomiting.

·         Your doctor may give supplemental feedings of oral maintenance solutions to infants with excessive fluid excretion. They may also recommend Antiemetics for children older than 6 months of age who frequently vomit.

Home Remedies

• Drink a lot of fluids
• Intake of broth-based soups combat extensive dehydration
• Intake of Pedialyte or other fluids with electrolytes helps speedy recovery, but homemade electrolyte solutions are not recommended as the combination of ingredients may not be proper.
• Sugary or fatty foods or sugary juices can worsen diarrhea, s it's recommended to avoid it.
• The BRAT diet (bananas, rice, applesauce, toast) is not useful anymore. A healthy balanced diet helps to achieve adequate nutrition during the illness.

Many children recover from rotavirus without long-term health deterioration. Symptoms stay about a week or more. If the child is severely dehydrated, it can result in serious complications like brain swelling, coma, hypovolemic shock, seizures, kidney failure, and even death. Contact your healthcare provider straight away if the child shows symptoms of rotavirus infection. They can help you restore hydration due to fluid loss. Strictly follow the child’s immunization schedule. The school or daycare will probably let the parent know how long to keep the child home during infection. According to guidelines, the requirement is the child must be symptom-free for at least 24 hours before returning to a public setting. A vaccine is the best way to protect the child from infection.

The basic measures that significantly reduce the incidence of rotavirus include;

1. Proper hygiene with proper handwash

2. Vaccination

The rotavirus vaccine was introduced in 2006. It was common for young children to have at least one bout of rotavirus infection before the vaccine was introduced. After vaccination, hospitalizations and deaths from rotavirus have reduced significantly.

There are two types of rotavirus vaccine:

• Rotarix: It is given in 2-doses, one at two months whereas the other at 4-month-olds.
• RotaTeq: It is given in 3-doses at 2, 4, and 6 months old

These vaccines are given by mouth, which means orally, and not with an injection.

Currently, there is no vaccine available for older children and adults. Therefore, health professionals suggest getting the rotavirus vaccine for the child at a young age to stay protected. Rotavirus vaccine prevents almost all severe infection cases, but none of the vaccines is 100 percent effective. Consult with the pediatrician about the risks and benefits of this type of vaccine and whether it’s the best preventive measure for your child. Babies with severe combined immunodeficiency or intussusception (intussusception is bowel blockage resulting in severe abdominal pain, vomiting, and bloody diarrhea.) or severely ill must not take the vaccine. Some side effects of the vaccine are:

• Diarrhea
• Fever
• Fussiness
• Irritability

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 28, 2023.

References

Rotavirus infection - PMC (nih.gov)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858916/

Rotavirus Infection in Children - Health Encyclopedia - University of Rochester Medical Center

https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02540