Rotavirus

  • Overview
  • In Depth
  • Vaccines
  • Video

Rotavirus is a highly contagious virus that infects the intestine (gut) causing gastroenteritis (diarrhoea and vomiting) in infants and young children. Without immunisation almost all children in the world are infected by rotavirus before five years of age. Rotavirus is recognised as the most common cause of diarrhoea and dehydration in infants and young children in all countries. Adults can also become infected.

A brief history

Rotavirus was first identified in 1973. It is named rotavirus because of its wheel-like appearance.

NZ Situation

Rotavirus occurs in every country in the world, including New Zealand. By the age of three years 90% of New Zealand children will have contracted rotavirus.

Death from rotavirus infection in New Zealand is very rare.

Symptoms

The illness begins with the sudden onset of vomiting and watery diarrhoea which can last from three to seven days.

Fever and abdominal pain may also occur.

How do you get it?

Rotavirus is spread by the faecal-oral route and generally occurs in winter and early spring. Spread of infection within families and institutions is common as large amounts of rotavirus are present in the faeces/poos/tütae of infected individuals. Contamination of hands, hard surfaces, toys, utensils and other objects is relatively easy.

What are the risks?

The major risk is dehydration from vomiting and diarrhoea.

  • Death from rotavirus infection is extremely rare in New Zealand.
  • Adult symptoms are usually mild.
Who is the most at risk?

Most infections occur in infants and children between 6-24 months of age.

Treating the symptoms

There is no specific treatment for a rotavirus infection. Replacing fluid loss from vomiting and diarrhoea is very important to prevent dehydration.

Continue breast feeding if appropriate. Alternatively, offer small frequent drinks of either clear fluids or a rehydration preparation such as Gastrolyte or Pedialyte – offering from a small cup or spoon or syringe sometimes helps.

The disease can cause a rapid and severe deterioration. Signs of dehydration include:

  • Dry mouth and tongue
  • No wet nappies
  • No tears when crying
  • Sunken fontanelle
  • Sunken eyes
  • Reduced skin turgor - Gently pinched skin remains ‘pinched’
  • Lethargic or irritable

Many children will require medical intervention and hospitalisation for dehydration.

Children can start eating solids whenever they feel ready. Bland foods e.g. toast, dry biscuits, are a good to start with.

Preventing the disease from spreading

The spread of rotavirus can be minimised by thorough hand washing after changing nappies or cleaning up vomit, after using the bathroom, before preparing food and before eating.

Children with diarrhoea or vomiting should not attend school or childcare centres until they have not had any loose poos/ tütae or vomiting for 24 hours.

Purifying water supplies and improving hygiene alone are unlikely to substantially reduce the incidence of this disease.

Risk of disease vs. vaccine side effects
Rotavirus Effects of disease Side effects of vaccine

Rotavirus is a highly contagious virus that infects the intestine (gut) causing gastroenteritis (diarrhoea and vomiting).

  • Vomiting.
  • Diarrhoea.
  • Abdominal pain.
  • Fever.
  • Dehydration.
  • Dehydration can lead to death.
Common side effects
  • Mild, temporary diarrhoea and/or vomiting within 7 days after the vaccine.
  • Fever.
  • Fussiness.
  • Crying.
Uncommon side effects
  • Flatulence.
  • Abdominal pain.
Rare/very rare side effects
  • Anaphylaxis.
  • Intussusception.
  • Blood in faeces/poos/tūtae.

Rotavirus infects the intestinal mucosa, altering the function of the intestinal epithelium resulting in malabsorptive diarrhoea. It has also been found in extra-intestinal sites including blood, lungs, and liver. Immunity after infection is incomplete but first infections are generally more severe than subsequent infections.

The incidence of rotavirus gastroenteritis typically peaks during winter in temperate climates whereas in tropical settings it occurs year round.

Causative organism

A segmented, double stranded RNA virus of the Reoviridae family.

The mature virus is a triple shelled capsid consisting of the outer, intermediate, and inner layers. The outer capsid contains two proteins. A binary classification is used to designate their neutralisation specificity, G and P.

Seven groups of rotavirus have been identified (named A-G); most strains affecting humans belong to group A but outbreaks of groups B and C rotaviruses have been identified. In 2007, 5 serotype combinations caused approximately 90% of all human rotavirus infections.

No correlation between rotavirus serotypes and  disease severity has been demonstrated.

Clinical signs, symptoms and complications

Incubation is approximately 1-3 days.

Vomiting and watery diarrhoea for 3 - 7 days, frequently with fever and abdominal pain.

For individuals with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days.

The most serious complication of rotavirus is dehydration, with an associated weight loss.

Severe dehydration can lead to death.

Method of transmission

Transmission is primarily by the faecal–oral route; person to person or via contaminated fomites, as rotaviruses are shed in large numbers for many days in vomit and diarrhoea.

Public health significance

Rotavirus is highly infectious, it can survive on hands for at least four hours and on hard surfaces for weeks.

New Zealand epidemiology

Ninety percent (90%) of New Zealand children will contract rotavirus by the age of 3 years. In a survey undertaken of children under 3 years of age with acute diarrhea admitted to eight NZ hospitals, rotavirus was detected in 42.6% of stool samples and varied significantly by age (26.8% for 0-5 months; 42.5% for 6-11 months; and 52.1% for 12-35 months; p<0.001) and by season (51.2% in winter/spring vs 24.5% in summer/autumn; p<0.001).

It has been estimated, in NZ, that the annual burden of rotavirus is 1506 hospitalisations (476 per 100,000), 3086 emergency department presentations not requiring hospitalization, plus 10,120 cases of rotavirus managed solely in primary care.

Prevention

The spread of rotavirus can be minimised by thorough hand washing after changing nappies or cleaning up vomit, after using the bathroom, before preparing food and before eating.

Children with diarrhoea or vomiting should not attend school or childcare centres until they have not had any loose poos/ tütae or vomiting for 24 hours.

The oral rotavirus vaccine RotaTeq® was added to the National Immunisation Schedule on 1 July 2014.

Treatment

There is no specific treatment for rotavirus infection.

Oral rehydration is very important, to hydrate the child and replace fluid lost through vomiting and diarrhoea. Mothers can continue to breastfeed, alternatively clear fluids or a rehydration fluid such as Gastrolyte or Pedialyte can be offered frequently using a small cup or spoon.

Parents need advice on early signs and symptoms of dehydration (dry mouth and tongue, no wet nappies, no tears when crying, sunken fontanelle, sunken eyes, reduced skin turgor, lethargic or irritable), and to be aware that a sudden deterioration may occur after a large, watery bowel motion.

Children can start solids as soon as they feel ready. It is recommended they start with bland foods such as toast or dry biscuits.

RotaTeq®

Rotavirus

RotaTeq® is an immunisation given to infants by mouth (orally) to protect them from severe rotavirus infection. RotaTeq® is free on the National Immunisation Schedule at 6 weeks, 3 months and 5 months of age - at the same visits as Infanrix®-hexa and either Synflorix® or Prevenar 13®.

Rotarix®

Rotavirus

Rotarix® is used for primary vaccination of infants to protect from rotavirus infection. The first dose is given between six and 14 weeks of age.

Listed below are the available videos for this disease