Clinical Overview of Rotavirus

Key points

• Rotavirus spreads through direct contact between people; symptoms include vomiting and watery diarrhea for three to eight days.
• Infants and young children are most at risk for rotavirus disease.
• Since rotavirus vaccine was introduced in 2006, disease rates have since dropped significantly. However, outbreaks still occur.

Introduction

Rotavirus has a characteristic wheel-like appearance when viewed by an electron microscope. The name rotavirus is derived from the Latin word rota, meaning "wheel."

Rotaviruses are non-enveloped, possess a triple-layered capsid, and have a segmented RNA genome. The virus is stable in the environment.

Who is at risk

Children are most at risk for getting rotavirus disease.

Among U.S. children, those in childcare centers or other settings with many young children are most at risk for infection. The most severe rotavirus disease occurs primarily among unvaccinated children aged 3 months to 3 years old.

Some adults also have a higher risk of getting rotavirus including:

• Older adults
• People who care for children with rotavirus disease
• Adults with weakened immune systems (body's ability to fight germs and sickness), such as people with human immunodeficiency virus (HIV)

Incubation period

The incubation period for rotavirus disease is approximately 2 days.

How it spreads

Rotavirus is primarily transmitted through the fecal-oral route, usually from direct contact between people.

Because the virus is stable in the environment, transmission also can occur through:

• Ingestion of contaminated water or food.
• Contact with contaminated surfaces or objects.

A person can get rotavirus disease at any time during the year. In the United States and other countries with a temperate climate, rotavirus is more common in the winter and spring.

Disease rates

Prior to vaccine introduction:

Rotavirus was the leading cause of severe diarrhea among infants and young children in the United States.

Almost all U.S. children were infected with rotavirus before their 5th birthday. Each year, among those children, the disease led to:

• More than 400,000 doctor visits
• More than 200,000 emergency room visits
• 55,000 to 70,000 hospitalizations
• 20 to 60 deaths

Clinical features

Rotavirus disease is characterized by vomiting and watery diarrhea for three to eight days. Fever and abdominal pain also are common. Additional symptoms include loss of appetite and dehydration.

Symptoms of dehydration include:

• Decreased urination
• Dry mouth and throat
• Feeling dizzy when standing up
• Crying with few or no tears and
• Unusual sleepiness or fussiness

Children may develop rotavirus disease more than once because neither vaccine nor natural infection provide full immunity from future infections. A child's first infection with rotavirus tends to cause the most severe symptoms.

Prevention

Advise parents to vaccinate and protect their infants against rotavirus and help reduce disease prevalence.

Rotavirus vaccination

Rotavirus disease among infants and young children has decreased significantly in the United States since vaccine introduction. CDC recommends that infants receive either of two available rotavirus vaccines to protect against the disease.

Keep Reading:Rotavirus Vaccine Recommendations

Testing and diagnosis

To rapidly detect rotavirus RNA or antigens and make a diagnosis, conduct either of the following on stool specimens:

• Nucleic acid detection PCR assays
• Antigen-detection immunoassays

You can conduct nucleic acid detection PCR assays for rotavirus alone or in multipathogen panels. You can further characterize strains by nucleic acid sequencing. However, such tests are usually carried out only by laboratories engaged in surveillance testing or research.

Patient management

Treatment is nonspecific and consists primarily of oral rehydration therapy to prevent dehydration. For people with healthy immune systems, rotavirus disease is self-limited, lasting only a few days.

Trends

Before rotavirus vaccine was introduced in 2006, U.S. cases of rotavirus disease peaked in the winter and spring months. Rotavirus illness peak would begin in the Southwest part of the country during December; then move to the Northeast by April and May.

After rotavirus vaccine, rotavirus illness has changed to a biennial season (taking place every other year); with even years having higher peaks. Rotavirus seasons have also gotten shorter since the introduction of rotavirus vaccine.

Low vaccination rates lead to outbreaks‎

Rotavirus is very contagious and causes outbreaks. Fewer children get rotavirus vaccine compared with other childhood vaccines, even though the vaccines are very effective against severe disease. Learn about past rotavirus outbreaks that affected unvaccinated and vaccinated children.

Read MMWR article

CDC surveillance systems

CDC and partners use the following surveillance systems to monitor trends in rotavirus activity; estimate the burden of rotavirus disease; and evaluate the impact of rotavirus vaccination in the United States:

• National Respiratory and Enteric Virus Surveillance System (NREVSS)
• New Vaccine Surveillance Network (NVSN)

Resources

• Pink Book: Rotavirus
• Rotavirus | Vaccine Preventable Diseases Surveillance Manual
• Rotavirus: Surveillance Standards | WHO

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