age. The most dangerous rotavirus infection is usually an infant’s first rotavirus infection.
Rotavirus infections in adults have been reported widely as well. Cases of Rotavirus infection have been reported amongst hospital employees, military personnel, cruise ship and travel personnel, and restaurant patrons. Fifty percent of parents whose infants are infected with rotavirus, also contract it as well. It is common for reinfection to occur in adults and children.
In North America, urban outbreaks typically begin in the south and progressing to the north and east. These rotavirus outbreaks usually last for 4-5 months and occur primarily in the winter months. Rotavirus usually doesn’t occur in the summer. In areas closer to the equator, rotavirus outbreaks occur in several times throughout the year, with peaks in infections occurring approximately every 2 months.
Symptoms include fever, vomiting, diarrhea, and dehydration. Symptoms are usually more sever in children. Children with rotavirus are admitted to the hospital when they show signs of fever and vomiting that persists for 2-3 days, or diarrhea for 4-5 days. Dehydration is usually isotonic. Rotavirus generally goes away on its own in adults after 4-8 days. The biggest problem is diarrhea. The diarrhea is usually watery and does not contain blood or mucous. It is important to consume plenty of liquids in order to keep hydrated.
Neurologic symptoms can occur in extreme cases as a result of an electrolyte imbalance or direct viral infection in the central nervous system. Rotavirus is also associated with aseptic meningitis, necrotizing enterocolitis, acute myositis, hepatic abscess, pneumonia, Kawasaki disease, Sudden Infant Death Syndrome and Crohn's disease. Gastroenteritis, resulting from rotavirus, can lasts for months in children with immunodeficiency.
Diagnoses of rotavirus involves taking a stool sample or performing a rectal swab. Detection of rotavirus is routinely done with an enzyme linked immunosorbent assay (ELISA) test for rotavirus. ELISA can be used to detect antigen late in the course of illness. For quick diagnosis, latex agglutination kits may be used. An enzyme immunoassay or (EIA) is the most widely used test used to screen stool samples. Electron microscopy (EM) and polyacrylamide gel electrophoresis (PAGE) are used in some laboratories in addition or as an alternative to EIA. There is also a reverse transcription-polymerase chain reaction (RT-PCR) that has been developed to detect and identify all three groups of human rotaviruses (A,B, and C.)
The incubation period for rotavirus is 1-3 days. Symptoms typically last for between 4-8 days. It is important for a person infected with diarrhea associated with rotavirus to taking in fluids and electrolytes lost due to the infection. The Committee on Nutrition of the American Academy of Pediatrics recommends feeding (breast milk or diluted formula in infants and lactose free carbohydrate rich foods in older children) and rehydration within 24 hours after first signs of illness. Fruit juices and soft drinks are not recommended due to their high sugar content and low electrolyte content.
It is important to note that antibiotics, antisecretory drugs, antimotility drugs, absorbents and antiemetics do not cure acute infection, prevent reinfection or reduce fluid losses during rotavirus induced gastroenteritis. Therefore, they are not used in treatment of rotavirus. Children that have immunodeficiency disorders can be treated with rotavirus-specific immunoglobulin treatments. This is administered orally to decrease infection of others.
Transmission of rotavirus is primarily fecal-oral. Infected infants have a high concentration of the virus in feces from the time they contract the disease for between 4-7 days after onset. People with a weak immune system can excrete the virus for up to 30 days. Changing of infected infants diapers should be done carefully and then hands should be washed carefully with soap and water. The virus survives on hard surfaces, hands, and in contaminated water for several days. It is relatively resistant to common disinfectants, but is inactivated by chlorine. In many hospitals, people with rotavirus are kept isolated from other patients.
Because the virus is so prevalent, it is very difficult or even impossible to prevent rotavirus infection. Even places with excellent standards of hygiene and sanitation can become contaminated. Vaccination is the most effective preventive measure.
An older vaccine to prevent rotavirus was withdrawn due to adverse side effects. The United States Food and Drug Administration approved a live virus vaccine for use in infants. However, this recommendation was withdrawn in 1999 because the vaccine appeared to increase the risk of intestinal problems. The vaccine was known as RotaShield.
In 2006, the FDA approved a new rotavirus vaccine. This vaccine RotaTeq is a live oral vaccine for use in children. The Advisory Committee on Immunization Practices (ACIP) voted to recommend a newly licensed vaccine to protect against rotavirus. Studies have shown that the vaccine prevents about 74% of all rotavirus cases, about 98% of severe rotavirus cases, and about 96% of hospitalizations due to rotavirus. Three doses of the rotavirus vaccine are recommended at 2, 4, and 6 months of age.
References:
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Bad Bug Book. Rotavirus. U.S. Food and Drug Administration, 4 May 2009. Web. 21 May 2011.
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CDC. ACIP Provisional recommendations for the prevention of rotavirus gastroenteritis among infants and children. 2008. Web. 23 May 2011.
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Mayo Clinic Staff. Rotavirus. The Mayo Clinic. 3 September 2010. Web. 23 May 2011. www.mayoclinic.com/health/rotavirus/DS00783