Rotavirus Gastroenteritis

Background

• Rotavirus is the leading cause of severe childhood gastroenteritis worldwide.
• Highly contagious, with high stool viral burden, prolonged asymptomatic shedding and low infectious dose required to cause disease.
• Fecal-oral transmission is the main means of spread.
• In temperate climates, highest incidence occurs during the winter months and early spring. In tropical climates viral circulation occurs year round.
• Children aged 4 months to 2 years are most affected, though the disease also occurs in adults.
• Incidence of disease has declined substantially in the United States since the introduction of a vaccine in 2006.

Evaluation

• Common symptoms include low-grade fever, vomiting within 1-2 days, and watery diarrhea, typically resolving in 3-7 days.
• Diarrhea may be severe, lasting up to 14 days, this is more often in children, and can lead to dehydration and in some cases shock. Severity often correlates with age of first infection, with most severe infections occurring between 3-35 months of age.
• Gastroenteritis caused by rotavirus cannot be clinically distinguished from that caused by other pathogens.
• A definitive diagnosis is usually not needed as it does not alter management.
• When needed, stool rotavirus antigen testing has high sensitivity and specificity and is the most commonly used option.

Management

• Supportive care is the mainstay of treatment, with emphasis on rehydration.
• No specific antiviral therapy is presently available.
• Use of antiemetics, such as ondansetron, may reduce need for IV rehydration.
• To avoid spread:
  • Children should be excluded from school or day care for 24 hours from last diarrheal episode.
  • Contact precautions are indicated for the duration of the illness while hospitalized.
• An oral live attenuated vaccine is available and recommended for all infants starting at age 6 weeks, unless contraindicated.
• Vaccination may be associated with a small risk of intussusception (1.5 cases per 100,000 doses).