Rotavirus Disease

Pathogen

Rotaviruses are reoviruses. It is possible to distinguish between a total of 7 different serogroups.

Rotaviruses are transmitted via faecal-oral smear infections and air-born infections. They have been spread all over the world. Up to age 3 more than 90% of all children have had a rotavirus infection at least once.

A person who has come down with the disease excrete about 100 billion (!!) rotaviruses in their stool. Before the clinical symptoms have set in the person who has been infected can excrete masses of the virus.

Transmission

The disease is primarily transmitted by smear infection; only a small number of viruses are necessary to cause an infection. The disease can also be transmitted by aerogen transmission, mainly when the patient is being cared for (e.g. when there is vomiting. The disease is frequently transmitted in hospitals, frequently to children.

Clinical picture

Infection with rotaviruses generally occurs faecal-orally. Contaminated food or in some countries contaminated drinking water play an important role. An acute gastrointestinal infection caused by rotaviruses is not very different from most “gastrointestinal infections”. The infection can occur almost unnoticed with only slight diarrhea but can also occur as a severe disease requiring treatment. The watery diarrhea which comes on suddenly is frequently accompanied by slightly elevated temperature and vomiting. In half of the cases it is accompanied by a cold or a cough, rarely is the brain affected ( encephalitis). The diarrhea can lead to exsiccosis which can lead to the person’s dying within a few hours. The disease generally lasts 6 to 8 days.

Generally the diarrhea lasts for 5 days and is accompanied by vomiting for 2 days.

Severe complications and death is very rare in industrial countries where the food situation is stable and medical treatment readily available.

Worldwide the annual number of deaths due to rotavirus infections in children up to an age of 5 years is estimated to be 440000 to 600000 (depending on raw data). Infants in Africa who live South of the Sahara or on the Indian subcontinent are the ones who are hit the hardest.

Diagnosis

Electron-microscopical proof of virus from the stool or virus antigen proof with the help of test kits from the stool.

Therapy

A specific therapy against the virus is not available. Antibiotics and medications that prevent gut motility are not expedient. The most important treatment is a timely and sufficient supply of liquids and electrolytes. Loss of fluids can lead to dehydration which is life-threatening. If this occurs, the loss must be replaced by infusions in the hospital.

Maintaining general hygiene standards serves as a prophylactic measure whereby disinfection measures generally are not very successful.

Complications

The main danger is that the patient can become severely dehydrated. The smaller the child is, the easier it can happen. Encephalitis does not occur very often.

Immunity

After having come down with a rotavirus disease patients have only partial immunity against certain serotypes of the virus. This means that children and adults can actually come down with a rotavirus infection more than once. The next manifestations of the disease are usually not as severe as the first time the patient came down with the disease. As a result of the mother’s antibodies serious infections in infants are the exception. (Bhan MK, Lew LF, Sazawal S, Das BK et al.: Protection conferred by neonatal rotavirus infection against subsequent rotavirus diarrhea. J Infect Dis 1993, 168(2):282-7).

Immunity diminishes in time.

Rotavirus vaccination