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
Pathophysiology
- Mucosal damage and villous atrophy in the gastrointestinal tract impair absorption of sodium and loss of 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)
-
Rotavirus vaccination (a live attenuated vaccine) is recommended for all infants unless there is a contraindication. Contraindications include:
References:[9][10][11]