Summary

Rotaviruses are a common cause of viral gastroenteritis in infants and young children and are transmitted via the fecal-oral route. After a short incubation period of one to three days, patients present with vomiting, watery diarrhea, high-grade fever, and malaise. Diagnosis is established through antigen detection in stool. Treatment is supportive and mainly involves replacing fluids, although infection may be prevented altogether by vaccination.

Epidemiology

A major cause of severe diarrhea in infants and children in the US (especially during the winter) ^[1]
Leading cause of severe diarrhea among infants and children worldwide, although all age groups are susceptible to infection.
Most commonly occurs in daycare centers and kindergartens

References:^[2]^[3]^[4]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Pathogen: Rotavirus is a nonenveloped, segmented, double-stranded RNA reovirus.
Transmission: fecal-oral route (e.g., by contact with hands, objects, food, water contaminated with the virus)

References:^[5]^[6]

Pathophysiology

Mucosal damage and villous atrophy in the gastrointestinal tract impair absorption of sodium and loss potassium → nonbloody, watery diarrhea

Clinical features

Incubation period: 1–3 days
Fever, malaise
Abdominal pain
Vomiting and watery diarrhea
- Can be severe: > 10 loose, watery stools within 24 hours
- Usually lasts 3–7 days
Mild to severe dehydration: See clinical signs of significant dehydration.

References:^[3]

Diagnostics

Antigen detection in stool via enzyme immunoassay (EIA): a highly sensitive test that can be performed quickly and easily

References:^[7]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

Supportive
- Oral rehydration
- IV fluids in patients with severe dehydration

References:^[8]

Prevention

Vaccination
- Rotavirus vaccination (a live attenuated vaccine) is recommended for all infants unless there is a contraindication. Contraindications include:
  - Infants with severe combined immunodeficiency (SCID)
  - Infants with a history of intussusception: rotavirus vaccine is associated with intussusception
  - Individuals with a history of severe allergic reaction after exposure to a previous rotavirus vaccine or to any of its components
- Immunization schedule
  - Dose 1: 2 months of age
  - Dose 2: 4 months of age
  - Dose 3: 6 months of age (if required)

References:^[9]^[10]^[11]