From the Guidelines
Rotavirus management in adults primarily focuses on supportive care, with oral rehydration therapy and symptomatic relief being the mainstays of treatment, as the infection is typically self-limiting. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, the burden of acute gastroenteritis has been reduced since the implementation of rotavirus vaccines, and this reduction is also seen in adults through community protection.
Key Components of Management
- Oral rehydration therapy using balanced electrolyte solutions to replace fluid losses from diarrhea and vomiting, with adults drinking at least 2-3 liters of fluids daily, adjusting based on the severity of symptoms 1.
- Symptomatic relief can be achieved with anti-emetics such as ondansetron for nausea and vomiting, and loperamide for diarrhea, though these should be used cautiously to avoid masking symptoms.
- Acetaminophen can help manage fever and discomfort.
- Antibiotics are not indicated as rotavirus is viral 1.
- Strict hand hygiene with soap and water is essential to prevent transmission, as rotavirus is highly contagious.
Prevention and Public Health Measures
- General measures including use of hand hygiene, proper food preparation and storage, avoidance of high-risk foods, and avoidance of unsafe water can reduce the incidence of acute infectious diarrhea 1.
- People with diarrhea should refrain from recreational water activities, food preparation or service, and sexual activities while symptomatic.
- Specific preventive measures, in addition to routine use of rotavirus vaccine in infants, include typhoid and cholera vaccines for travelers when indicated 1.
Special Considerations
- Adults who are immunocompromised may experience more severe or prolonged illness requiring closer monitoring 1.
- Most adults recover within 3-7 days without complications, but it is essential to be aware of the potential for severe disease in certain populations.
From the Research
Rotavirus Management in Adults
- The management of rotavirus infection in adults focuses on supportive care, as symptoms are generally self-limiting 2.
- Clinicians caring for adults with gastroenteritis should consider rotavirus in the differential diagnosis 2.
- Treatment of rotavirus disease consists mainly of oral or intravenous rehydration, using World Health Organization-recommended oral rehydration solutions or lactated Ringer's solutions, respectively 3.
- Specific antivirals have been tried in animal models but are not used for human treatment at present 3.
Epidemiology and Prevention
- Rotavirus infections can lead to antigenaemia and viraemia, and rotavirus can replicate in systemic sites, although this is limited 4.
- Reinfections with rotavirus are common throughout life, although the disease severity is reduced with repeat infections 4.
- The development of rotavirus candidate vaccines is reviewed, one of which, the tetravalent, rhesus rotavirus-based human reassortant vaccine, was licensed for universal use in the US in 1998 3.
- The implementation of rotavirus vaccines requires careful surveillance of co-circulating rotavirus types (molecular epidemiology) as well as of any potential adverse effects not previously detected 3.
Treatment Options
- Oral rehydration solutions (ORS) are formulated to correct dehydration and acidosis, but do not promote intestinal healing 5.
- Investigators are examining the role of nutrition in promoting intestinal healing 5.
- The use of antiviral and anti-emetic drugs can be indicated in some cases of rotavirus infection 4.
- Loperamide and ondansetron may be used for the treatment of gastroenteritis and vomiting, respectively 6.