Rotavirus

Rotavirus is a common cause of viral gastroenteritis. It most often affects babies and preschool children but can affect people of all ages. Before rotavirus vaccines were introduced, the virus caused large numbers of hospital admissions and doctor visits each year among children under five. Since vaccination programs began, hospital presentations due to rotavirus in young children have fallen sharply.

Symptoms#

The symptoms and signs of rotavirus gastroenteritis range from mild to potentially life-threatening, and may include:

• vomiting
• sudden onset of diarrhoea
• fever
• dehydration
• drowsiness

How rotavirus spreads#

Rotavirus is highly infectious. It spreads by person-to-person contact, by touching contaminated hands, faeces (faecal-oral transmission) and vomit. In temperate regions it has traditionally been more common in the cooler months, although seasonal patterns vary from place to place.

Symptoms usually begin one to three days after infection. An infected person’s faeces are usually infectious for about 10 days, but can remain infectious for up to two months.

Repeat infection#

It is possible to be infected with rotavirus several times. The first infection is usually the most severe. After an initial infection, the risk of being infected again is reduced by about 40%, and children who are infected more than once generally have milder symptoms with each infection.

High-risk groups#

Some people are at increased risk of severe or even life-threatening symptoms. High-risk groups include:

• children and adults with immune system problems
• organ transplant recipients
• people with gastrointestinal problems such as short gut syndrome

Treatment#

Treatment depends on the severity of symptoms. Most children have a mild illness that can be managed at home and resolves within a few days to a week. The main aim is to make sure the child keeps drinking fluids often (depending on age, this may include breastmilk, formula, water, diluted apple juice or oral rehydration drinks) and gets plenty of rest.

See your doctor immediately, or go to the emergency department of your nearest hospital, if your child refuses to drink or has worrying symptoms – for example very frequent diarrhoea or vomiting, drowsiness, severe stomach pain, blood in the faeces, or green vomit. Children under six months old should always be seen by a doctor if they have gastroenteritis.

In severe cases, a child may need to be admitted to hospital to receive fluids through a tube in the nose or through a vein.

Preventing the spread#

Immunisation can greatly reduce the risk of infection. General tips to help prevent the spread when someone is infected include:

• washing your hands thoroughly, especially after changing a nappy and before handling, preparing or eating food or drink
• using disposable nappies while the child is sick, as the elasticised leg bands help prevent leakage of contaminated faeces
• disposing of nappies and used tissues carefully
• washing and disinfecting the change table often
• washing and disinfecting toys and other shared items regularly
• keeping sick babies and children at home, as rotavirus can spread quickly through childcare and kindergarten settings

Immunisation#

The rotavirus vaccine contains a weakened form of the virus and works by prompting the body to make antibodies. In most cases, immunised children are protected against infection, and those who do still become infected are less likely to become seriously unwell than children who are not immunised.

The vaccine is given by mouth as a course of doses in early infancy. Schedules differ between countries, so check with your doctor or immunisation provider for the schedule where you live. To ensure effectiveness, it is important that each dose is given as close as possible to the recommended ages, and there are upper age limits beyond which a dose should not be started or continued. Giving the vaccine to older children as a “catch-up” is not recommended, because its safety and effectiveness have not been confirmed in older children.

No special diet or dietary restrictions are required before or after vaccination, and the rotavirus vaccine can be given at the same time as other routine childhood vaccines.

Before immunisation#

Before your baby receives the vaccine, tell your doctor or nurse if your baby:

• is older than the recommended age range for the first or second dose
• is unwell, for example with a temperature over 38.5°C (101.3°F)
• has had a serious reaction to any vaccine, or a severe allergic reaction to anything
• has had intussusception or a congenital abnormality that may lead to intussusception (bowel blockage)
• has a history of chronic gastrointestinal disease
• is taking steroid medication
• has received a blood transfusion or blood products
• has lowered immunity due to immune deficiency, abnormal blood conditions, cancer, HIV or certain medications, or lives in a household with someone who has lowered immunity

A baby who has already had intussusception should not be given the rotavirus vaccine.

Side effects#

The oral rotavirus vaccine is generally effective and safe, although, like all medicines, it can have unwanted side effects. As with any vaccine, there is a very small risk of a serious allergic reaction called anaphylaxis. This is why you are advised to stay at the clinic for at least 15 minutes after immunisation, in case further treatment is needed.

There is also a very small risk of intussusception (a bowel blockage in which one part of the bowel slides into the next, like a telescope). This can rarely occur, mainly in the first one to seven days after the first or second dose. Take your baby to your doctor or to hospital if they:

• pass blood in their stools
• have repeated, sudden bouts of crying
• pull their legs up to their stomach
• look pale
• develop vomiting

See your doctor for further information if you are worried about your baby.

Key points#

• Symptoms usually begin one to three days after infection.
• After an initial infection, the risk of being infected again is reduced by about 40%.
• Children who are infected more than once generally have less severe symptoms each time.
• Some people are at increased risk of severe or even life-threatening symptoms.
• High-risk groups include people with gastrointestinal problems such as short gut syndrome.

Where to get help#