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Rotavirus is the major cause of diarrhea and vomiting in young children worldwide. The infection is highly contagious and may lead to severe dehydration (loss of body fluids) and even death. In the United States, more than 50,000 children are hospitalized and up to 125 die each year as a result of rotavirus infection.
Gastroenteritis, or inflammation of the stomach and the intestine, is the second most common illness in the United States, after the common cold. More than one-third of such cases are caused by viruses. Many different viruses can cause gastroenteritis, but the most common ones are the rotavirus and the Norwalk virus.
The name rotavirus comes from the Latin word "rota" for wheel and is given because the viruses have a distinct wheel-like shape. Rotavirus infection is also known as infantile diarrhea, or winter diarrhea, because it mainly targets infants and young children. The outbreaks are usually in the cooler months of winter.
The virus is classified into different groups (Group A through group G), depending on the type of protein marker (antigen) that is present on its surface. The diarrheal infection of children is caused by the Group A rotaviruses. Group B rotaviruses have caused major epidemics of adult diarrhea in China. Group C rotavirus has been associated with rare cases of diarrheal outbreaks in Japan and England. Groups D through G have not been detected in humans.
Causes and symptoms
The main symptoms of the rotavirus infection are fever, stomach cramps, vomiting, and diarrhea (this could lead to severe dehydration). The symptoms last anywhere from four to six days. If a child has dry lips and tongue, dry skin, sunken eyes, and wets fewer than six diapers a day, it is a sign of dehydration and a physician needs to be notified. Because of the excellence of healthcare in this country, rotavirus is rarely fatal to American children. However, it causes deaths of up to a million children in the third world countries, every year.
The virus is usually spread by the "fecal-oral route." In other words, a child can catch a rotavirus infection if she puts her finger in her mouth after touching toys or things that have been contaminated by the stool of another infected child. This usually happens when children do not wash their hands after using the toilet, or before eating food.
The viruses can also spread by way of contaminated food and drinking water. Infected food handlers who prepare salads, sandwiches, and other foods that require no cooking can spread the disease. Generally, symptoms appear within 4-48 hours after exposure to the contaminated food or water.
Children between the ages of six months and two years, especially in a daycare setting, are the most susceptible to this infection. Breastfed babies may be less likely to become infected, because breast milk contains antibodies (proteins produced by the white blood cells of the immune system) that fight the illness. Nearly every child by the age of four has been infected by this virus, and has rotavirus antibodies in their body. The disease also targets the elderly and people who have weak immune systems.
Children who have been infected once can be infected again. However, second infections are less severe than the first infections. By the time a child has had two infections, the chances of subsequent severe infection is remote.
The rotavirus infection is diagnosed by identifying the virus in the patient's stool. This is done using electron microscopy. Immunological tests such as ELISA (Enzyme-linked immunosorbent assay) are also widely used for diagnosis, and several commercial kits are available.
"Oral rehydration therapy," or drinking enough fluids to replace those lost through bowel movements and vomiting, is the primary aim of the treatment. Electrolyte and fluid replacement solutions are available over the counter in food and drug stores. Dehydration is one of the greatest dangers for infants and young children. If the diarrhea becomes severe, it may be necessary to hospitalize the patient so that fluids can be administered intravenously.
Anti-diarrheal medication should not be given to children unless directed to do so by the physician. Antibiotic therapy is not useful in viral illness. Specific drugs for the virus are not available.
Most of the infections resolve spontaneously. Dehydration due to severe diarrhea is one of the major complications.
The best way to prevent the disease is by proper food handling and thorough hand washing, after using the toilet and whenever hands are soiled. In child care centers and hospital settings, the staff should be educated about personal and environmental hygiene. All dirty diapers should be regarded as infectious and disposed of in a sanitary manner.
Vaccines that prevent rotavirus in young children have been tested in nationwide trials. Researchers report that the vaccines appear to prevent the infection in 80% of the tested children. The vaccine is intended to be given orally (by mouth) at two, four, and six months of age. The only side effect of the vaccine is a low-grade fever in a small percentage of the children, three to four days after the vaccination. Within the next few years, a rotavirus vaccine may become part of every child's immunization schedule.
Fauci, Anthony S., et al., editors. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1997.