Rotavirus infection

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.

• 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.

• 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]

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

• 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]

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

References:^[7]

• Norovirus infection
• Bacterial gastroenteritis
• Food poisoning

The differential diagnoses listed here are not exhaustive.

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

References:^[8]

• 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]

1. Norovirus - Burden of Norovirus Illness and Outbreaks. https://www.cdc.gov/norovirus/php/illness-outbreaks.html. Updated: July 8, 2014. Accessed: March 22, 2017.
2. Healthwise Staff. Mild, Moderate, or Severe Diarrhea: Topic Overview. Mild, Moderate, or Severe Diarrhea: Topic Overview. New York, NY: WebMD. http://www.webmd.com/a-to-z-guides/tc/mild-moderate-or-severe-diarrhea-topic-overview. Updated: August 21, 2015. Accessed: March 27, 2017.
3. Epidemiology and Prevention of Vaccine-Preventable Diseases - Rotavirus.
4. Le T, Bhushan V,‎ Sochat M, Chavda Y, Abrams J, Kalani M, Kallianos K, Vaidyanathan V. First Aid for the USMLE Step 1 2019. McGraw-Hill Medical
5. Rotavirus - Transmission. https://www.cdc.gov/rotavirus/about/transmission.html. Updated: August 12, 2016. Accessed: March 27, 2017.
6. Haaheim LR, Pattison JR, Whitley RJ. A Practical Guide to Clinical Virology. John Wiley & Sons ; 2002
7. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5802a1.htm. Updated: February 6, 2009. Accessed: March 27, 2017.
8. Rotavirus - Treatment. https://www.cdc.gov/rotavirus/about/treatment.html. Updated: August 12, 2016. Accessed: March 27, 2017.
9. Centers for Disease Control and Prevention. Addition of history of intussusception as a contraindication for rotavirus vaccination. MMWR Morb Mortal Wkly Rep. 2011; 60 (41): p.1427.
10. Information Sheet Observed Rate of Vaccine Reactions Rotavirus Vaccine.
11. Vaccine Information Statements (VISs): Rotavirus VIS. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rotavirus.html. Updated: October 18, 2016. Accessed: March 27, 2017.