From the Guidelines
Rotavirus A is a common viral pathogen that causes severe diarrhea and vomiting, primarily affecting infants and young children worldwide, and prevention primarily relies on vaccination, with two effective vaccines available: Rotarix (given in two doses at 2 and 4 months) and RotaTeq (given in three doses at 2,4, and 6 months) 1.
Key Points
- Rotavirus A is the most prevalent strain of rotavirus causing gastroenteritis in humans, and it damages the cells lining the small intestine, leading to watery diarrhea, vomiting, fever, and abdominal pain that typically lasts 3-8 days 1.
- The virus spreads through the fecal-oral route, with transmission occurring through contaminated hands, surfaces, food, and water 1.
- Prevention of rotavirus gastroenteritis is crucial, and vaccination is the most effective way to prevent severe rotavirus infections, with two vaccines available: Rotarix and RotaTeq 1.
- Treatment focuses on preventing dehydration through oral rehydration solutions or, in severe cases, intravenous fluids, and good hygiene practices, including handwashing and proper sanitation, also help reduce transmission 1.
Vaccine Administration
- Rotarix is administered orally in a 2-dose series, with doses administered at ages 2 and 4 months 1.
- RotaTeq is administered orally in a 3-dose series, with doses administered at ages 2,4, and 6 months 1.
Importance of Vaccination
- Vaccination has dramatically reduced severe rotavirus infections globally, and it is essential to follow the recommended vaccination schedule to ensure optimal protection against rotavirus gastroenteritis 1.
- The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of U.S. infants with rotavirus vaccine, and both RV5 and RV1 are effective in preventing rotavirus gastroenteritis 1.
From the Research
Rotavirus Infection
- Rotavirus infections are a leading cause of severe, dehydrating gastroenteritis in children <5 years of age, resulting in >200,000 deaths annually, mostly in low-income countries 2.
- The infection primarily affects enterocytes, inducing diarrhoea through the destruction of absorptive enterocytes, intestinal secretion stimulated by rotavirus non-structural protein 4, and activation of the enteric nervous system 2.
Treatment and Prevention
- The management of rotavirus infection focuses on the prevention and treatment of dehydration, using oral or intravenous rehydration with World Health Organization-recommended oral rehydration solutions or lactated Ringer's solutions 3, 4.
- Oral rehydration treatment has been shown to be successful in 95% of rotavirus patients, with no serious side effects 3.
- Specific antivirals have been tried in animal models but are not used for human treatment at present, although recent advances in the development of antivirals for rotavirus infection have been made 4, 5.
Epidemiology and Vaccination
- The epidemiology of rotaviruses is complex, with different types co-circulating at any one time and in any geographical area 4.
- The development of rotavirus candidate vaccines has been reviewed, with one vaccine licensed for universal use in the US in 1998 4.
- Reinfections with rotavirus are common throughout life, although the disease severity is reduced with repeat infections 2.
Future Directions
- Recent research has highlighted the potential use of Chinese medicine and natural compounds as therapeutic agents for rotavirus infection 5.
- The role of nutrition in promoting intestinal healing is being examined, with oral rehydration solutions being formulated to correct dehydration and acidosis 6.