Clinical Information

Español: Acerca del rotavirus

Clinical Features

Rotavirus disease is characterized by vomiting and watery diarrhea for 3 to 8 days. Fever and abdominal pain also frequently occur. Additional symptoms include loss of appetite and dehydration. Symptoms of dehydration include decrease in urination, dry mouth and throat and feeling dizzy when standing up. A dehydrated child may also

• cry with few or no tears and
• be unusually sleepy or fussy.

The incubation period for rotavirus disease is approximately 2 days.

Vaccinated and unvaccinated children may develop rotavirus disease more than once because neither vaccine nor natural infection provide full immunity (protection) from future infections. A child’s first infection with rotavirus tends to cause the most severe symptoms.

The Virus

Rotavirus has a characteristic wheel-like appearance when viewed by an electron microscopy. The name rotavirus is derived from the Latin word rota, meaning "wheel". Rotaviruses are nonenveloped, double-shelled viruses. The genome is composed of 11 segments of double-stranded RNA, which code for six structural and five nonstructural proteins. The virus is stable in the environment. See photos.

Epidemiologic Features

The primary mode of transmission is the fecal-oral route, usually through close contact between people. Because the virus is stable in the environment, transmission also can occur through ingestion of contaminated water or food and contact with contaminated surfaces or objects. In the United States and other countries with a temperate climate, the disease has a winter seasonal pattern, with annual epidemics occurring from December through June. The highest rates of illness occur among infants and young children, and most children are infected by 5 years of age. Adults can also be infected, though disease tends to be milder.

Diagnosis

Diagnosis may be made by rapid detection of rotavirus antigen in stool specimens. Strains may be further characterized by enzyme immunoassay or reverse transcriptase polymerase chain reaction, but such testing is not commonly done.

Treatment

For people with healthy immune systems, rotavirus disease is self-limited, lasting for only a few days. Treatment is nonspecific and consists primarily of oral rehydration therapy to prevent dehydration. About 1 out of 70 children with rotavirus disease will require hospitalization for intravenous fluids.

Vaccination

The two rotavirus vaccines approved for use in infants in the United States, were tested in large clinical trials and shown to be safe and effective. For about the first year of an infant’s life, rotavirus vaccine provided 85% to 98% protection against severe rotavirus illness and against hospitalization from rotavirus illness and 74% to 87% protection against rotavirus illness of any severity.

The CDC recommends routine vaccination of infants with either of the two available vaccines:

• RotaTeq® (RV5), licensed in 2006, is given in 3 doses at ages 2 months, 4 months, and 6 months
• Rotarix® (RV1), licensed in 2008, is given in 2 doses at ages 2 months and 4 months

The vaccines differ in how they are made and the number of doses, but both are given orally.

For more information, see

• Prevention of Rotavirus Gastroenteritis among Infants and Children: Recommendations of the Advisory Committee on Immunization Practices (ACIP).
• Rotavirus ACIP Vaccine Recommendations

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