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Clinical Information

Español: Acerca del rotavirus

Clinical Features

Rotavirus is the most common cause of severe diarrhea among children. Prior the introduction of rotavirus vaccines in the United Sates in 2006, rotavirus resulted in the hospitalization of approximately 55,000 U.S. children each year. Globally, rotavirus is estimated to cause 527,000 deaths in children annually. The incubation period for rotavirus disease is approximately 2 days. The disease is characterized by vomiting and watery diarrhea for 3 to 8 days, and fever and abdominal pain occur frequently. Immunity after infection is incomplete, but repeat infections tend to be less severe than the original infection.

Vaccinated and unvaccinated children may develop rotavirus disease more than once because there are many different types of rotavirus and because neither vaccine nor natural infection provide full immunity (protection) from future infections. However, second infection tends to be less severe than the first rotavirus infection.

The Virus

Rotavirus has a characteristic wheel-like appearance when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel"). Rotaviruses are nonenveloped, double-shelled viruses. The genome is composed of 11 segments of double-stranded RNA, which code for six structural and five nonstructural proteins. The virus is stable in the environment. See photos.

Epidemiologic Features

The primary mode of transmission is via fecal-oral route. Because the virus is stable in the environment, transmission can occur through ingestion of contaminated water or food and contact with contaminated surfaces or objects. In the United States and other countries with a temperate climate, the disease has a winter seasonal pattern, with annual epidemics occurring from December through June. The highest rates of illness occur among infants and young children, and most children in the United States are infected by 5 years of age. Adults can also be infected, though disease tends to be mild.

Diagnosis

Diagnosis may be made by rapid antigen detection of rotavirus in stool specimens. Strains may be further characterized by enzyme immunoassay or reverse transcriptase polymerase chain reaction, but such testing is not commonly done.

Treatment

For persons with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days. Treatment is nonspecific and consists of oral rehydration therapy to prevent dehydration. About 1 out of 70 children with rotavirus gastroenteritis will require hospitalization for intravenous fluids.

Prevention

The rotavirus vaccine is very effective in preventing rotavirus gastroenteritis. The CDC recommends routine vaccination of infants with either of 2 available vaccines. RotaTeq® (RV5), licensed in 2006, is given in 3 doses at ages 2 months, 4 months, and 6 months; Rotarix® (RV1), licensed in 2008, is given in 2 doses at ages 2 months and 4 months. These vaccines also differ in how they are made and the number of doses, but both are given orally and both provide protection against the disease. For more information, see Prevention of Rotavirus Gastroenteritis among Infants and Children: Recommendations of the Advisory Committee on Immunization Practices (ACIP).

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