Rotavirus
Rotavirus is a contagious virus and, among children, is the leading cause of severe diarrhea. In some infants and children, diarrhea may be so severe that they become dehydrated and may require emergency care or hospitalization.
- Across the world, rotavirus is thought to be responsible for about 115 million cases of diarrhea each year in children and infants.
- 60,000 children are hospitalized each year in the U.S. due to rotavirus infections.
- Across the world, rotavirus is responsible for the death of approximately 530,000 children each year.
- The virus occurs primarily during the cooler months of the year starting in the winter and ending in the late spring.
- Most children have been infected with rotavirus by the time they are 2 years old. 95% of children will have been infected by the age of 5.
- The majority of children are infected by the virus between3 months and 35 months.
- A child or adult may become infected with rotavirus more than once, but, usually, the initial case is the most severe and subsequent infections are more mild.
How is rotavirus spread?
Transmission of rotavirus occurs primarily through fecal-oral contact. Usually, this occurs from poor hand washing or from ingestion of contaminated food or water. The virus may live on inanimate surfaces, such as doorknobs, toys, and hard surfaces, for quite some time. For this reason, outbreaks can occur in child care centers and within families or individuals living within the same home. The hospitalized child will need to be isolated from other children to prevent transmission of the virus.
- After coming in contact with the virus, it may take up to two days for symptoms to develop.
What are the symptoms of rotavirus?
The symptoms for rotavirus can range from mild to severe. The following are the most common symptoms of rotavirus. However, each child may experience symptoms differently. Symptoms may include.
- Fever, which usually subsides within the first couple of days
- Nausea and vomiting
- Abdominal pain
- Diarrhea, which is usually watery and frequent and may last for three to eight days. Infected children can pass 30 loose bowel movements in a day.
- Dehydration, which can occur quickly, especially in infants.
Symptoms of dehydration may include:
- Lethargy or sleepiness
- Irritability
- Thirst
- Pale color to skin or mottling
- Less elasticity in the skin
- Eyes appear deeply sunken
- Baby's fontanelle (or soft spot) may feel sunken
- Decreased or absent tears
- Decreased urine output or fewer wet diapers
- Dry mouth
How is rotavirus diagnosed?
In addition to a complete medical history and physical examination, a stool test may be used to detect the virus.
Treatment for rotavirus
Specific treatment for rotavirus will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
There is no cure for rotavirus, so treatment of the disease is supportive (aimed at treating the symptoms). Treatment may include:
- Oral rehydration with water, formula, breast milk and/or special electrolyte-containing fluids (fluids containing sugars and salts) such as Pedialyte® (very young children should NOT be rehydrated with water, soda, juices, or sports drinks)
- Continue feeding your child solid foods (if she is able to tolerate it)
The combination of vomiting and diarrhea can sometimes lead to severe dehydration. About one in every seven children with rotavirus will see their health care provider. About one in every 80 children will become so severely dehydrated that they will require hospitalization. In these children treatment may include:
- Intravenous (IV) fluids
- Nasogastric (NG) tube feedings - a small tube may be place into your child's stomach through their nose so that formula or fluids may be administered.
- Blood work (to measure your child's electrolyte levels: sugar, salt, and other chemicals in the blood).
How can rotavirus be prevented?
100 rotavirus particles are all that is needed to cause an infection. A teaspoon (5mL) of stool from a child contains about 50,000,000,000 rotavirus particles. Thus, a very small amount of stool can transmit enough virus to infect another individual. The following will help to prevent the spread of the rotavirus:
- Proper hygiene and hand washing technique
- Cleaning hard surfaces, toys, and doorknobs
- Proper handling and disposal of dirty diapers, even after your child no longer has symptoms
If your child develops rotavirus, she should not attend daycare or school while she is ill. If your child is hospitalized, she will be isolated from other children to prevent an outbreak in the hospital.
A rotavirus vaccine (RotaShield) that was approved by the U.S. Food and Drug Administration (FDA) in 1998 was pulled from the market in 1999 because of an association between the vaccine and an increased risk of intussusception (telescoping of the intestine upon itself) in infants shortly after they received the vaccine.The vaccine was associated with an increase in intussusception in one in every 10,000 infants that received the vaccine.
Two vaccines have subsequently been approved by the FDA since that time. Both of these vaccines are completely different from the vaccine that had been associated with intussusception. Both were safe and effective against rotavirus in large trials of over 60,000 infants. A new rotavirus vaccine (RotaTeq) was approved by the FDA in 2006. The risk for intussusception with the new vaccine was evaluated in a large clinical trial of over 70,000 children, and no increased risk was found. Over 50% of the children eligible to receive this vaccine are currently receiving it. Studies after licensure demonstrate no increase in the risk of intussusception. The vaccine appears to be dramatically decreasing the number of children infected with rotavirus. The manufacturer of the vaccine and the CDC will continue to closely monitor the vaccine's safety in additional clinical studies.
Another rotavirus vaccine (Rotarix) was approved by the FDA in 2008. The risk for intussusception with this vaccine was evaluated in a large clinical trial of over 60,000 children, and no increased risk was found. This vaccine has been used outside of the U.S. since 2006 with no documented increase in the risk of intussusception. The manufacturer of the vaccine and the CDC will continue to closely monitor the vaccine's safety in additional clinical trials.
Vaccination of infants meeting criteria for rotavirus vaccination is strongly encouraged.