Pathogen / transmission

• RNA virus, identified in 1973

• Faecal-oral transmission

• Ubiquitous and infect almost every child globally by 3-5 years of age

• Most important cause of gastroenteritis in children - approx 40% of admissions

Clinical

• Vomiting & fever, followed by watery diarrhoea

• Clinically indistinguishable from diarrhoea caused by other pathogens, but can be more severe and rotavirus/norovirus more likely during the winter in non-equatorial countries

• Recurrent infections, progressively diminish in severity

Diagnosis

• Usually clinical

• Virus detection in stool: Antigen (ELISA/immunochromatography) /PCR more sensitive and allow genotyping (for epidemiological/vaccine studies)

Management

• Supportive, prevent dehydration, ORS is the cornerstone of treatment

• Zinc for 10-14 days after diarrhoea started (exact mechanism unclear but probably anti-inflammatory/anti-secretory effects)

• Probiotics (some evidence)

• Antivirals: limited evidence e.g. nitazoxanide

• Anti-emetics (e.g. metoclopramide, ondansetron) progressed from 'not recommended' to 'possibly recommended' due to reducing dehydration

Prevention

• Vaccination, licensed for global use in 2006 (reduction in hospitalisations and diarrhoea deaths e.g. <5 years deaths reduced from >500,000 to around >200,000). Live, attenuated, given at 2, 4 +/- 6 months. Good safety record although increased risk of intussusception reported in some seetings

• Improvements in hygiene/sanitation do not substantially reduce the burden of disease

References

• Rotavirus, Nature Primer, 2017