Rotavirus is an RNA virus classified in the Reoviridae family. Rotavirus is a common cause of viral gastroenteritis and mainly affects young children, especially children between the ages of 6 months and 2 years.
Rotavirus causes a self-limiting infection. However, stool fluid losses may be dramatic and death from dehydration may occur, especially in developing countries.
Rotavirus vaccination is effective in reducing the incidence and severity of rotavirus infection. A new UK vaccination programme began in July 2013. See the 'Rotavirus vaccination' section at the end of this article for further information.
- Transmission of rotavirus is by person-to-person spread, either directly by faecal to oral route or by environmental contamination.
- Rotavirus infection is the most common cause of severe gastroenteritis in children.[2, 3]
- Rotavirus causes about 140,000 cases of diarrhoea a year in the under-5s in the UK. It has been estimated that approximately 18,000 children are hospitalised annually in England and Wales as a result of rotavirus-related disease.
- Rotavirus infection most often occurs during the winter months.
- Approximately 500,000 deaths in children younger than 5 years are seen worldwide due to rotavirus. Virtually all these deaths occur as a result of dehydration.
- Adults may become infected but repeat infections are generally much less severe than infections during childhood.
- Young children aged 4-24 months, particularly those in group daycare settings.
- Low birth weight, prematurity and bottle-feeding have been associated with increased risk of admission to hospital because of rotavirus infection.
- The incubation period is approximately 48 hours. Common clinical features include watery diarrhoea and vomiting.
- Fever, anorexia and abdominal pain are also frequently reported.
- Diarrhoea can be severe and dehydration is a common presenting complaint. See also the separate article Dehydration in Children.
- Apart from dehydration, the other main clinical sign is hyperactive bowel sounds.
- Adults, if affected, usually have a few days of nausea, anorexia and cramping pain. Diarrhoea is usually much less severe in adults than in children.
In the absence of dehydration, investigations are often not required because the management is the same as for any cause of gastroenteritis. However, stool samples will need to be sent to the laboratory when there is an outbreak of infection, such as in a children's nursery.
- Stool sample: rotavirus can be identified by several means - eg, enzyme immunoassay (the most common), latex agglutination, electron microscopy or culture.
- Renal function and electrolyte levels should be measured if there is significant dehydration.
- Blood glucose levels should be measured in very young infants and in any child with associated lethargy.
Investigations may also be required if there is any suspicion of a non-infective cause of diarrhoea. See also the separate article Childhood Diarrhoea.
- Other causes of infective gastroenteritis.
- Other sites of infection - eg, urinary tract infection, otitis media, meningitis, pneumonia.
- Other causes of diarrhoea - eg, toddler's diarrhoea, constipation with overflow, intussusception, coeliac disease.
- The most important complication of rotavirus infection is dehydration and the potential complications of dehydration - eg, seizures, acute kidney injury and venous thrombosis.
- Loss of lactase from the gut (causing lactose intolerance) may occur. See also the separate article Lactose Intolerance.
- Most children recover within a week of the onset of symptoms. However, re-infection is common.
- In developed countries, the prognosis for rotavirus infection is excellent as long as adequate hydration is maintained.
- Rotavirus is associated with significant mortality in developing countries, with more than 500,000 children dying each year as a result of severe dehydration associated with rotavirus disease.
- Worldwide in 2008, diarrhoea due to rotavirus infection caused 37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan.
- Good hygiene is the most important way of preventing the spread of rotavirus.See also the separate article Gastroenteritis in Children.
- Rotavirus vaccination (see below).
Rotavirus vaccination is effective in reducing the incidence and severity of rotavirus gastroenteritis.
- In high- and middle-income countries, rotavirus vaccines have achieved 85-100% protection against severe disease. In low-income countries in Africa and Asia, protection is less (50-75%).
- Despite this reduced efficacy in low-income countries, the high burden of diarrhoeal disease in these regions means that proportionately more severe cases are prevented by vaccination than elsewhere.
- A significant decline in acute gastroenteritis-related deaths among Latin American children was observed after the introduction of rotavirus vaccination:
- Vaccination achieved a decrease in the number of cases of rotavirus acute gastroenteritis and of severe rotavirus diseases.
- Vaccination was also associated with a dramatic reduction in hospitalisations and outpatient visits for all-cause acute gastroenteritis.
- Safety studies showed that adverse events, such as intussusception, occur only rarely (rates <1 in 50,000).
UK vaccination programme
A new UK vaccination programme began in July 2013.Children aged under 4 months are vaccinated against rotavirus. The oral vaccine is expected to halve the number of cases of vomiting and diarrhoea caused by rotavirus and lead to 70% fewer hospital stays. The vaccine is given to infants in two separate doses (at 2 and 3 months old) and is given at the same time as other routine vaccines.
Rotarix® vaccine is used in the UK. Rotarix® is indicated for the active immunisation of infants aged 6 to 24 weeks for the prevention of gastroenteritis due to rotavirus infection.
- Hypersensitivity to the active substance or any non-active substance within the vaccine; hypersensitivity after previous administration of rotavirus vaccines.
- History of intussusception or any uncorrected congenital malformation of the gastrointestinal tract that would predispose to intussusception.
- Severe combined immunodeficiency disorder (SCID).
- Administration of Rotarix® should be postponed in subjects suffering from acute severe febrile illness. The presence of a minor infection is not a contra-indication for immunisation.
- Administration of Rotarix® should be postponed in subjects suffering from diarrhoea or vomiting.
December 2017 - Dr Hayley Willacy recently read that Public Health England has now updated chapter 6 of the Green Book to specify that children born to mothers who were on immunosuppressive biological therapy during pregnancy, will not be eligible to receive rotavirus vaccine. If there is any doubt as to whether an infant may be immunosuppressed due to the mother’s therapy, including exposure through breastfeeding, specialist advice should be sought.
Further reading and references
Diarrhoea and vomiting in children under 5; NICE Clinical Guideline (April 2009)
Infectious Diarrhoea - The Role of Microbiological Examination of Faeces - Quick Reference Guide for Primary Care; British Infection Association and Health Protection Agency (October 2009)
Gastroenteritis; NICE CKS, September 2009 (UK access only)
Parashar UD, Nelson EA, Kang G; Diagnosis, management, and prevention of rotavirus gastroenteritis in children. BMJ. 2013 Dec 30347:f7204. doi: 10.1136/bmj.f7204.
Rotavirus; Public Health England
Grimwood K, Lambert SB, Milne RJ; Rotavirus infections and vaccines: burden of illness and potential impact of vaccination. Paediatr Drugs. 2010 Aug 112(4):235-56. doi: 10.2165/11537200-000000000-00000.
Patel MM, Glass R, Desai R, et al; Fulfilling the promise of rotavirus vaccines: how far have we come since licensure? Lancet Infect Dis. 2012 Jul12(7):561-70.
Gray J; Rotavirus vaccines: safety, efficacy and public health impact. J Intern Med. 2011 Sep270(3):206-14. doi: 10.1111/j.1365-2796.2011.02409.x. Epub 2011 Jul 3.
Tate JE, Burton AH, Boschi-Pinto C, et al; 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2012 Feb12(2):136-41. doi: 10.1016/S1473-3099(11)70253-5. Epub 2011 Oct 24.
Soares-Weiser K, Maclehose H, Bergman H, et al; Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2012 Feb 152:CD008521.
Lepage P, Vergison A; Impact of rotavirus vaccines on rotavirus disease. Expert Rev Anti Infect Ther. 2012 May10(5):547-61. doi: 10.1586/eri.12.39.
Millions more protected against disease through improved vaccination programme; Dept of Health, April 2013
Manufacturer's PIL, Rotarix®; GlaxoSmithKline UK, The electronic Medicines Compendium. Dated November 2012