Rotavirus

By Pamela Samille Stovall, LVN

Rotavirus is a viral infection in the digestive tract (4), the most common cause of severe and potentially fatal diarrhea in children. Rotaviruses belong to the Reoviridae family. They are segmented, double-stranded RNA viruses. To survive and cause disease, RNA viruses must directly replicate their RNA in a living host. The virus is replicated in the lumen of the small intestine causing the villi to fuse and the mucosal layer to thicken. (1, 6) The rotaviruses are double-layered, cube-shaped, and measure between 55-75 nm in diameter. They resemble wheels with a wide hub, short spokes, and a narrow rim. Four of the six distinct human rotavirus serotypes are endemic in North America. (1)

Rotavirus is extremely easy to catch and is transmitted mainly by the fecal-oral route. It is commonly passed directly from an infected person to another person, or by a contaminated surface. It can be passed before and after the onset of diarrhea. (1, 3, 4, 8) Respiratory transmission has not been proved, but rotaviruses can be detected in respiratory tract secretions. (1, 7) For diagnosis, the specimen of choice is the stool culture (1, 4, and 7) which has been collected during the first 3-5 days of illness. If collected 8 or more days after onset of symptoms the specimen will rarely contain virus. Diagnosis of the virus may be made by rapid antigen detection in stool specimens, electron microscopy, staining of enzyme immunoassays, or serology. (1, 7)

Rotaviruses were discovered about 25 years ago (5) in Australia, by Ruth Bishop and her colleagues. (8) It was named because of how it looks (wheel-like) under the electron microscope. (5, 7, 8) "Rota" is from Latin which means wheel. (7) 

Patients with rotavirus are infectious from 1 day before the onset of symptoms, to 8-10 days afterwards. (1) The onset of the illness usually begins 3 days after exposure to the virus. (4) Rotavirus usually starts with fever, upset stomach, and 1-3 days of vomiting, followed by 5-8 days of watery diarrhea which has an extremely foul odor. (1) The symptoms usually last between 3 and 5 days. (5)

Children can lose body fluids and electrolytes very rapidly with this disease. This is especially dangerous for children under 2 years of age. (3) Without rehydration and restoring the electrolyte balance this disease can be life-threatening. (4, 5, 8) The most effective treatment for rotavirus is rehydration with an electrolyte-balanced fluid supplement. (4, 7, 8) A diet of bland foods, such as bananas, applesauce, cereal and toast is also recommended. Mothers who are breastfeeding a child with the virus should be encouraged to continue to do so. (5) Considered essential for recovery and immunity against this virus is the presence of intestinal IgA and IgG antibodies and of IgA in mother's milk. (1) Viral infections do not respond to antibiotic treatment. (8)

Rotavirus is the primary cause of severe diarrhea young children and infants worldwide. (3,8) In the United States, four out of five children will develop rotavirus in the first 5 years of life (3), approximately 50,000 children are hospitalized each year due to the life-threatening loss of fluids caused by this virus, and another 500, 000 are seen in physicianís offices. (3, 4) Rotavirus is responsible for one-third of all hospitalizations in children under 5 years of age. Though it occurs in all age groups, it occurs mostly in children 6 to 24 months of age. (1, 5) It is responsible for one million deaths worldwide each year. (1, 2, 4, 5)

One of the best preventions for any viral illness is good hand washing and avoiding contact with infected persons. This will not eliminate the virus, but it will help reduce the spread of the virus. There is no vaccination available at this time to eliminate rotavirus disease or its transmission. (3, 4) Rotashield, a vaccine for the disease was licensed on August 31, 1998. Due to the possible side effect of intussusception in the first 2-3 weeks among children receiving the vaccine, the Rotasom an infected person to another person, or by a contaminated surface. It can be passed before and after the onset of diarrhea. (1, 3, 4, 8) Respiratory transmission has not been proved, but rotaviruses can be detected in respiratory tract secretions. (1, 7) For diagnosis, the specimen of choice is the stool culture (1, 4, and 7) which has been collected during the first 3-5 days of illness. If collected 8 or more days after onset of symptoms the specimen will rarely contain virus.

References

1.http://bugs.uah.ualberta.ca/biologos/9803rota.htm Accessed on 2/17/2002.

2. Palkhivala, Alison, WebMD Medical News reviewed by Dr. Tonja Wynn Hampton. New Vaccine Against Rotavirus in the Works. Sept. 13, 2000. Available from http://webmd.lycos.com/content/article/1728.61270 Accessed on 2/17/2002

3. San Francisco Department of Public Health. Rotavirus and Intussusception, Questions and Answers. Available from http://www.dph.sf.ca.us/HealthInfo/RotavirusQA.htm Accessed on 2/17/2002

4. Rotavirus. Available form http://www.astdhpphe.org/infect/rot.html Accessed on 2/17/2002.

5. WebMD Live Chat Transcript: FDA Withdrawal of Rotashield Vaccine with Robert Hamilton, MD. Available from http://my.webmd.com/printing/asset/chat_transcript.526377 Accessed on 2/17/2002.

6. ViroPharma Incorporated. Viral Disease Focus. RNA Viruses. Available from http://www.viropharma.com/Diseases/RNAVirus.htm Accessed on 2/24/2002.

7. Beuret, Christian, compiler. Rotaviruses Fact Sheet. Available from http://www.nlv.ch/Rotafactsheet.html Accessed on 2/24/2002.

8. Glass, Dr. Roger I., Compiler. Rotavirus In Depth. Available from http://www.childrensvaccine.org/html/v_rota_id.htm Accessed on 2/24/2002.

9. MMWR Weekly. July 16, 1999/48(27); 577-581. Intussusception Among Recipients of Rotavirus Vaccine ñ United States, 1998-1999. Available from http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827al.htm Accessed on 2/17/2002.

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