What is the treatment for Rotavirus infection?

Treatment of Rotavirus Infection

The mainstay of treatment for rotavirus infection is rehydration therapy to prevent and treat dehydration, as there are no specific antiviral therapies currently available for rotavirus. 1, 2

Clinical Presentation

• Rotavirus gastroenteritis typically begins with acute onset of fever and vomiting followed by watery diarrhea 24-48 hours later 1
• Symptoms generally persist for 3-8 days with 10-20 watery bowel movements per day 1
• Fever occurs in up to half of infected children and is usually low-grade, though one-third may have temperatures >39°C 1
• Vomiting is nonbilious, occurs in 80-90% of infected children, and typically lasts 24 hours or less 1
• Dehydration and electrolyte disturbances are the major complications, occurring most frequently in the youngest children 1

Treatment Approach

Rehydration Therapy

• Oral or intravenous rehydration is the cornerstone of treatment 2, 1
• Oral rehydration solutions (ORS) following World Health Organization recommendations should be used for mild to moderate dehydration 2
• Intravenous fluids (such as lactated Ringer's solution) are indicated for severe dehydration or when oral rehydration is not tolerated due to persistent vomiting 2
• Despite the widespread availability of oral rehydration solutions, hospitalizations for rotavirus diarrhea remain high, highlighting the importance of prevention through vaccination 1

Supportive Care

• Maintenance of proper fluid and electrolyte balance throughout the illness 3
• Anti-emetic medications may be indicated in some cases to control vomiting 4
• Antimotility drugs should be used with caution as they may worsen outcomes in some infectious diarrheas 1

What to Avoid

• Antimicrobial agents are not effective against rotavirus and may increase the risk of complications such as Clostridioides difficile-associated diarrhea 1
• Specific antiviral therapies for rotavirus are not currently available for clinical use, though some have been studied in animal models 2, 4

Special Populations

• Immunocompromised patients (including those with congenital immunodeficiency, HIV infection, or transplant recipients) may experience more severe or prolonged diarrhea and require more aggressive supportive care 1
• Premature infants are at higher risk for severe illness due to lack of transplacental maternal antibodies 1

Prevention Measures

• Vaccination is the primary public health intervention for preventing rotavirus infection 1, 5
• Two FDA-licensed rotavirus vaccines (RotaTeq and Rotarix) are recommended as part of routine infant immunization 5, 6
• Hygienic measures have limited effect on reducing rotavirus infection rates, unlike with other enteric pathogens 3, 7
• For infection control in healthcare and daycare settings:
  • Isolate infected children 7
  • Thoroughly clean and disinfect environmental surfaces 7
  • Practice strict handwashing before and after contact with infected persons or potentially contaminated surfaces 7

Laboratory Diagnosis

• Laboratory confirmation is not routinely necessary as it does not affect treatment approach 5
• When needed, enzyme immunoassay (EIA) for rotavirus antigen detection in stool is the most commonly used diagnostic method 1, 5
• Other techniques including electron microscopy, PCR, and nucleic acid hybridization are primarily used in research settings 1

Prognosis

• Most cases are self-limiting and resolve within 3-8 days 1
• Immunity from natural infection provides protection against subsequent severe disease, though mild reinfections may still occur 1, 4
• In the United States, mortality is low (approximately 20 deaths per year among children under 5), but rotavirus remains a significant cause of hospitalization and outpatient visits 5