Rotavirus: The basics

Rotavirus is the leading cause of severe diarrhea and dehydration in young infants worldwide. It is estimated to be responsible for the deaths of more than 500,000 infants around the world each year, primarily in low- and middle-income countries.

Before the introduction of a rotavirus vaccine, rotavirus resulted in an estimated 55,000-70,000 hospitalizations and dozens of deaths in the US each year.
What is rotavirus?

Rotavirus is a virus that causes gastroenteritis. Symptoms include severe diarrhea, vomiting, fever, and dehydration. It’s very common — in fact, almost all children in the US are likely to be infected with rotavirus at some point before their 5th birthday.

Infections happen most often in the winter and spring, and once a child gets the virus, it takes about two days to become sick. From that point, vomiting and diarrhea may last from three to eight days.

Transmission electron micrograph of intact rotavirus particlesRotavirus disease is most common in infants and young children, however, older children and adults and can also become infected with rotavirus. It is very easy for children with the virus to spread it to other children, and sometimes even to adults.

Rotavirus is named after its characteristic wheel-like appearance when viewed under an electron microscope.  The viral genome is composed of 11 segments of double-stranded RNA that code for six structural and five nonstructural proteins.  It can be diagnosed through commercially-available tests that detect the virus in stool.

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What are the symptoms of rotavirus infection?

Rotavirus causes the following:

  • Fever
  • Watery diarrhea
  • Vomiting
  • Stomach pain

Rotavirus infects the intestines. The disease usually starts with fever, an upset stomach, and vomiting, followed by diarrhea.

Unfortunately, there is no medicine to treat the illness. It’s also important to know that even vaccinated children may develop rotavirus disease more than once, because neither natural infection with rotavirus, nor rotavirus vaccination, provides full immunity from future infections. Usually a person’s first infection causes the most severe symptoms. Adults who get rotavirus disease tend to have milder symptoms.

Additional symptoms include loss of appetite and dehydration (loss of body fluids), which can be especially harmful for infants and young children.

Symptoms of dehydration include:

  • decrease in urination
  • dry mouth and throat
  • feeling dizzy when standing up
  • child cries with few or no tears
  • may be unusually sleepy or fussy

To prevent dehydration, have your child drink plenty of liquids. Your healthcare provider may recommend oral rehydration drinks. If dehydration becomes severe, some children need to go to the hospital for IV fluids.

How does rotavirus spread?

Rotavirus spreads easily, usually when children touch or place in their mouths small, usually invisible amounts of fecal matter found on surfaces such as toys, doorknobs, changing tables, books and clothing, or on the hands of parents and caregivers.  The virus can also be transmitted through contaminated water or food, and possibly by respiratory droplets in a sneeze, cough, or exhalation.  The virus is very contagious, and commonly spreads in families, hospitals, and child care centers. Before the symptoms appear and for up to two weeks after, the virus may be already spreading via feces.

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Rotavirus is a tough virus. It can live on objects for several days unless it is killed by a disinfectant. It is very hard to prevent rotavirus with just hand washing and cleaning with a disinfectant.

In a medical research paper*, the authors noted that rotavirus can survive for up to seven months on surfaces, for weeks in water, and for up to 4 hours on human hands. It is also resistant to many antibacterial agents.

The CDC suggests that vaccination is the best way to keep children safe from rotavirus.

When should a baby get the rotavirus vaccine?

Babies should get the first dose of the rotavirus vaccine at 2 months of age. For both currently-available vaccine brands, babies get a second dose at 4 months. A third dose of RotaTeq is given at 6 months.

The rotavirus vaccine should not be started after a baby is 15 weeks old. Babies should get all doses by 8 months of age, and they can get the rotavirus vaccine at the same time as other vaccines.

The vaccine prevents almost all cases of serious diarrhea from rotavirus. Most children who get the vaccine will not get rotavirus diarrhea at all, as the vaccines are very effective in preventing rotavirus gastroenteritis, the accompanying diarrhea and other symptoms.

* Steps to Reduce Nosocomial Infections in Children, by Alexis M Elward, MD, Kathleen A McGann, MD (2002 Cliggott Publishing)

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