Department: COMBATING INFECTION
ONE OF SEVERAL viruses known to cause gastroenteritis, rotavirus is the most common cause of severe diarrhea among infants and young children and causes about 600,000 deaths worldwide each year.1 In the United States, rotavirus is responsible for about 272,000 ED visits among children under age 5 annually. Adults are infected by rotavirus, but they're often asymptomatic or less severely affected.2
Rotavirus infects the cells of the small intestinal villi. Because these cells play a role in carbohydrate digestion and the absorption of fluid and electrolytes in the intestines, rotavirus infections lead to malabsorption by impaired hydrolysis of carbohydrates and excessive fluid loss from the intestine. The virus is most active from December through May in the United States and year-round in many developing countries. Because rotavirus is primarily transmitted via the fecal-oral route, the most significant risk factor for rotavirus infection in children is participation in group daycare.2
Signs and symptoms
The incubation period for rotavirus is about 2 days. Common signs and symptoms of rotavirus gastroenteritis include anorexia; vomiting; watery, bloodless diarrhea that lasts for 3 to 8 days; and abdominal cramps. A history of exposure to other children with diarrhea is an important assessment clue.1,2
The most common physical assessment finding is hyperactive bowel sounds. Oliguria is also an important sign of possible rotavirus infection because it indicates dehydration.2
Diagnosis and treatment
Rotavirus is diagnosed by rapid antigen detection of the virus in stool specimens. If severely dehydrated, the patient needs hospitalization for restoration of fluid and electrolyte balance.
Treatment for a patient with less severe gastroenteritis includes oral rehydration and supportive care. Antidiarrheal medications aren't indicated except in cases of excessive or significantly prolonged diarrhea because of possible adverse reactions.2 For those with healthy immune systems, rotavirus gastroenteritis generally lasts only a few days.
Two oral rotavirus vaccines, RotaTeq and Rotarix, have been developed to prevent rotavirus infection. RotaTeq is approved for use in infants age 6 to 32 weeks and given in three oral doses. Administer the first dose at age 6 to 12 weeks, and subsequent doses at 4- to 10-week intervals. The third dose shouldn't be given to infants after age 32 weeks.3
Rotarix is approved for use in infants age 6 to 24 weeks and given orally in two doses. Administer the first dose to infants beginning at age 6 weeks, and the second dose after an interval of at least 4 weeks and before age 24 weeks.4
For safe administration:
- Don't administer Rotarix to infants who have a history of latex hypersensitivity because the oral applicator contains latex.4 RotaTeq may be given instead.
- If an infant spits out the Rotarix vaccine, a single replacement dose may be considered at the same visit.4 If an infant spits out the RotaTeq vaccine, a replacement dose isn't recommended. The infant can continue to receive any remaining doses in the series.3
- Because these are live vaccines, use caution when administering them to immunocompromised patients.4,5
- Don't give either vaccine to an infant with gastroenteritis.5
- Report any patient vaccine reactions to the Vaccine Adverse Event Reporting System.
The most dangerous consequence of a rotavirus infection is dehydration, so teach parents the signs and symptoms, such as irritability, lethargy, sunken eyes and fontanel, and a dry mouth and tongue. Tell them to seek medical care at the first sign of dehydration.
Educate parents about the rotavirus vaccine and review immunization records to determine if your patient is up to date. Because rotavirus is contagious, reinforce the importance of thorough hand hygiene before preparing, serving, or eating food and after toileting and diapering. Recommend regular sanitization of diapering stations and toys.
1. Centers for Disease Control and Prevention. About Rotavirus
2. Nguyen DD, Awad SH, King BR. Rotavirus
3. RotaTeq Prescribing Information
4. Rotarix Prescribing Information
5. Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep