Rotavirus

What is Rotavirus?

Rotavirus is the main cause of severe stomach and intestinal inflammation in children younger than 5 years old. The virus was first identified in 1973 from small intestine tissue samples and stool samples from individuals experiencing severe diarrhea. Despite having a vaccine, the virus still causes more than 200,000 deaths per year worldwide.

In developed countries where regular vaccination is common, fewer people are affected by rotavirus than in less developed countries. In these lesser-developed areas, rotavirus remains a leading cause of severe, often life-threatening, diarrhea in infants and young children under the age of 5.

Symptoms of a rotavirus infection include intense diarrhea, vomiting, fever, feeling unwell, and in rare instances, neurological issues like convulsions, inflammation of the brain, or brain conditions causing confusion or disorientation. The most common symptoms are diarrhea and vomiting, which can cause significant dehydration and decrease oral intake. This could lead to a need for hospitalization and, in severe cases, if left untreated, could result in death.

What Causes Rotavirus?

Rotavirus is a type of virus that resembles a wheel when viewed under a microscope. This virus usually spreads when someone consumes matter that has come into contact with infected feces, which is known as the fecal-oral route. It can also spread through touching contaminated hands or objects, or, less commonly, through eating contaminated food or drinking contaminated water.

Before the regular use of rotavirus vaccines, the number of children getting sick from rotavirus was similar in less wealthy and more wealthy countries. However, since the introduction of vaccines against the rotavirus, a different virus called norovirus has become the main cause of a condition called acute viral gastroenteritis in higher income countries. This condition is commonly known as stomach flu, and it results in inflammation of the stomach and intestines. However, in less wealthy countries and globally, rotavirus remains the leading cause of the stomach flu in children.

Risk Factors and Frequency for Rotavirus

Rotaviruses are a worldwide concern and by the age of 5, most kids have been infected. These infections are evenly spread worldwide but are more likely to be fatal in low-income areas due to inadequate healthcare, higher malnutrition rates, and the absence of clean, sanitary fluids. Interestingly, rotavirus is often linked with winter, especially in areas with a temperate climate. In tropical climates, however, this trend isn’t as pronounced and infections can take place throughout the year. Some research also suggests that in areas with temperate climates, the number of rotavirus infections may be linked with how much it rains. For instance, one study found that more hospitalizations for rotavirus occurred after months with little rain.

• There are ten different categories of rotavirus (A-J).
• Type A rotaviruses are the main cause of infections in children, but type B and C also cause a substantial number of infections worldwide.
• The strains of the Type A rotaviruses vary based on location.

Since vaccines were developed, the patterns of rotavirus disease have changed significantly. Before the vaccines, the virus was most common in children under 5. Now, it seems that older, unvaccinated children are more likely to get infected. In low-income countries where vaccines aren’t as common, the number of infections remains constant. Being malnourished tends to make the disease worse in these areas.

Signs and Symptoms of Rotavirus

Rotavirus is a contagious virus that can cause stomach and intestinal inflammation. After an incubation period of 1 to 3 days, people infected with rotavirus can experience symptoms similar to other stomach bugs, but usually more severe. The most common symptoms are fever, diarrhea, and vomiting. Duration of the illness is typically between 5 to 7 days from start to full recovery.

These symptoms can vary widely from person to person. Some people may just have mild diarrhea for a short period of time. Others could experience severe diarrhea with fever and vomiting. Babies under 3 months old usually have milder symptoms than older children or adults. However, some infants can develop a potentially serious intestinal inflammation called necrotizing enterocolitis.

The usual sequence of rotavirus symptoms starts with vomiting, then watery diarrhea. About one-third of patients have a fever. During a physical exam, doctors might also find signs of abdominal cramping, fatigue, and dehydration such as dry mouth and throat, decreased skin elasticity, faster heart rate, lower urine output, and longer time for color return in the nail bed when pressed.

• Fever
• Diarrhea
• Vomiting
• Abdominal Cramping
• Fatigue
• Dehydration

Testing for Rotavirus

Rotavirus is a common cause of diarrhea and is hard to distinguish from other bugs that upset the stomach like noroviruses, enteric adenoviruses, astroviruses, Escherichia coli, and Salmonella. Usually, a doctor can tell if it’s rotavirus based on the symptoms you tell them about and their physical examination. Typical symptoms of rotavirus include a mild fever, vomiting, and watery diarrhea. Rotavirus often also causes an increase in acid-reducing substances in the stool and can potentially lower bicarbonate levels in the blood. Bloody diarrhea usually suggests that a different bug is the cause of your trouble.

While a lab test is not generally done, it is the only way to confirm rotavirus for certain. In serious, stubborn cases where symptoms won’t go away, it might be necessary to do laboratory testing to confirm rotavirus. For such tests, stool samples are usually examined using techniques like an enzyme-linked immunosorbent assay (ELISA) or immunochromatography to detect rotavirus antigens (foreign substances that cause your body to produce an immune response). Sometimes, more sensitive tests like reverse transcription PCR (RT-PCR) are needed, especially in studies to understand the disease more. Electron microscopy, polyacrylamide gel electrophoresis, antigen detection assays, and virus isolation are other methods that can detect rotavirus.

Generally, these confirmation tests are only carried out if they could potentially reduce the cost by shortening the hospital stay or preventing the need for unneeded procedures.

Treatment Options for Rotavirus

Rotavirus infection treatment focuses on soothing symptoms and managing or preventing dehydration. Initially, it’s recommended to try oral rehydration salt solutions, which help replace fluids and electrolytes lost due to diarrhea. In adults, medicines like codeine, loperamide, and diphenoxylate can be useful to ease symptoms and slow down diarrhea. Bismuth salicylate is another medication found beneficial for treating rotavirus symptoms, but should be considered only after ruling out other infecting agents. If these oral treatments don’t improve symptoms and the patient is becoming dehydrated, hospital admission and fluid treatment via an intravenous drip might be necessary.

One study conducted by Guarino and his team showed promising benefits of orally administered human serum immunoglobulins (antibodies found in blood plasma) in treating rotavirus. The study included 98 children with acute gastroenteritis, who were split into a treatment group and control group. The children in the treatment group received a single dose of human serum immunoglobulin. The findings reveal that children who received this treatment showed notable improvement in their condition and stool consistency compared to the control group. The total duration of diarrhea caused by rotavirus was also significantly shorter, and the hospital stay duration was reduced. This suggests that oral administration of human serum immunoglobulins can be beneficial in treating hospitalized children with rotavirus disease.

Additional research highlights the potential effectiveness of probiotics, zinc, and ondansetron in treating acute gastroenteritis, which is inflammation of the stomach and intestines primarily caused by bacterial or viral infections.

Most patients receiving outpatient care or visiting the emergency room with rotavirus can be safely sent home. Adults may benefit from anti-nausea medications, but these aren’t recommended for young children. Hospital admission might be necessary for patients showing signs of dehydration, severe vomiting, electrolyte imbalances, abdominal pain, ileus (disruption in the normal movement of the digestive tract), renal failure, or for pregnant individuals.

What else can Rotavirus be?

If someone has stomach problems (like diarrhea) that seem to be caused by a rotavirus infection, there are many other illnesses that can be similar. These include other viral, bacterial, and parasitic infections, as well as different conditions related to the stomach. Let’s break down what else these symptoms could be a sign of:

• Other viral infections, like norovirus, adenovirus, and astroviruses, can also cause severe diarrhea. Norovirus, in fact, is now the most common cause of acute stomach problems since a vaccine for rotavirus was developed.
• There are also several types of bacteria that can result in similar symptoms, like Shigella, Salmonella, Campylobacter, E. coli, Yersinia, Vibrio, Listeria, and Clostridium difficile. These might be especially important to rule out in severe cases, as these bacteria often lead to a harsher case of gastroenteritis. If a patient has severe symptoms like dehydration, abdominal pain, or needs to be hospitalized, the doctor might test their stool to check for these bacteria. This is especially true for pregnant women, those over 70 years old, and anyone with a weakened immune system.
• Parasitic infections can also cause symptoms like these. Examples include Giardia, Cryptosporidium, Cyclospora, Isospora, and several kinds of Mycobacterium. If the doctor suspects a parasitic infection, they would test stool samples and start treatment if the tests come back positive.
• Finally, there are other medical conditions not necessarily related to an infection that could have the same symptoms. These include things like appendicitis, diverticulitis, different types of bowel diseases, irritable bowel syndrome, diabetes, problems with absorbing nutrients from food, and celiac disease (an issue with digesting gluten). If the doctor can’t figure out the cause of the diarrhea from tests for infections, they might consider these other causes.

Identifying the correct cause out of all these possibilities is essential to making sure the patient gets the best treatment for their condition.

What to expect with Rotavirus

Rotavirus typically causes stomach-related symptoms. However, it can spread throughout the body and cause other symptoms beyond the gut, such as meningitis (an infection of the membranes covering the brain and spinal cord), encephalitis (inflammation of the brain), and seizures. Children are more likely to develop symptoms like fever, dehydration, and metabolic acidosis (a condition that occurs when the body produces too much acid or the kidneys aren’t removing enough acid) compared to other viruses that cause stomach flu.

In a study conducted in the United Kingdom, researchers found that seizures and slight neurological signs are surprisingly common with rotavirus infections. In this study, encephalitis was only seen in patients with rotavirus. However, how rotavirus leads to these neurological symptoms remains unknown. Some patients with symptoms affecting the brain and spinal cord were found to have rotavirus present in the fluid surrounding their brain and spinal cord, suggesting the virus may directly invade these areas.

Rotavirus might also affect the body’s calcium balance. Changes in this balance could trigger seizures or make a person more prone to them. However, a direct link between changes in calcium balance and seizure activity has not been clearly established.

Possible Complications When Diagnosed with Rotavirus

Each year, it’s estimated that about 500,000 children under the age of five die due to diarrhea, with rotavirus as the main culprit. Rotavirus-related deaths also total around 200,000 people annually. The main cause of these deaths is severe dehydration brought on by the rotavirus infection. There can also be additional complications like neurological issues, but these typically clear up once the rotavirus infection is treated.

Key Facts:

• Annually, approximately 500,000 children under five die from diarrhea
• Rotavirus is the main cause of these deaths
• An estimated 200,000 people die annually from rotavirus infection
• Severe dehydration is the main cause of death in rotavirus infections
• There can be additional complications like neurological issues, which commonly clear up once the infection is treated

Preventing Rotavirus

Over the years, various vaccines have been made to help prevent rotavirus, a virus that can cause severe diarrhea in children. Most of these vaccines are made from live but weakened forms of the virus found in nature. However, an early vaccine for rotavirus was discontinued because it increased the risk of intussusception, which is a condition where part of the intestine slides into another part, like a telescope.

Today, there is a vaccine that’s made from a single strain of human rotavirus and is given in two doses between the ages of 6 and 24 weeks. There’s also a vaccine made from a combination of human and animal (bovine) strains and given in three doses between the ages of 6 and 32 weeks. When testing the recent vaccines, it was found that they were less effective in places that had high death rates compared to places with lower death rates. But both vaccines are considered safe and there’s no noticeable increase in side effects compared to a placebo (a harmless substitute for the vaccine).

Additionally, countries like China, India, and Vietnam have their own rotavirus vaccines and more vaccines are being tested around the world. It’s important to note that all existing vaccines for the rotavirus are made from live, weakened viruses and hence, are not completely without risk. This was evident when the first vaccine led to an increased risk of intussusception.

Since that early vaccine was discontinued, researchers have been trying to understand what increases the risk of developing intussusception. It was found that the risk went up between 3 to 14 days after the vaccine was given, particularly after the first dose. Even more, they found that the risk of intussusception was highest in infants who were older than 90 days at the time they got vaccinated.

On the whole, even with the risks such as intussusception, the benefits of getting vaccinated against rotavirus far outweigh the risks. To further reduce the risk of intussusception, it’s recommended to give the vaccine in two doses to children who are younger than 60 days old.