Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide.
- According to the latest bulletin of WHO, July 2012 – 1.13 lakh deaths occur due to RVD annually in India : 50% by 1st year & 75% by 2nd year of life.
- The clinical presentation of rotavirus illness ranges from mild, watery diarrhea of limited duration to severe diarrhea with vomiting and fever that can result in dehydration with shock, electrolyte imbalance, and death.
- Incubation period is 1–3 days, the illness often begins abruptly, and vomiting often precedes the onset of diarrhea. Up to one-third of patients have a temperature of >102°F (>39°C). Severe, dehydrating rotavirus infection occurs primarily among unvaccinated children aged 03 months–35 months.
Estimated distribution of deaths caused by rotavirus diarrhea among children aged younger than 5 years.
Mechanism of diarrhoea :
The virus infects the mature villus epithelial cells of the small intestine, and infection often leads to fever, vomiting, and diarrhea in children resulting in dehydration and electrolyte disturbances in the youngest children.
Rotaviruses are shed in high concentrations in the stools of infected children.
It’s highly Contagious : Person to person , faeco-oral route and respiratory droplets.
Resistant to Inactivation : Most soaps and disinfectants are ineffective.
Highly communicable, with a small infectious dose of < 100 virus particles and retains infectivity for several weeks.
Complications : Dehydration
- The most common complication associated with rotavirus infection is dehydration. The symptoms of mild and moderate dehydration, not specific to rotavirus, are restlessness, irritability, decreased skin turgor, sunken fontanelle (in infants), sunken eyes, and thirst.
- Malnutrition and diarrhea form a destructive cycle in children and as the most common diarrheal pathogen in infants, rotavirus plays an important role in this cycle. Malnutrition increases the susceptibility of children to future gastrointestinal infections, and diarrhea disrupts the gut’s ability to absorb nutrients, leading to an exasperation of malnutrition.
- Dehydration is responsible for >90% of deaths from infectious diarrhoea. Treatment for rotavirus gastroenteritis, as with the majority of infectious watery diarrhea, is supportive; children should receive appropriate hydration and nutritional support. Since the 1970s, the World Health Organization (WHO) has recommended the use of oral rehydration solution (ORS) for the treatment of dehydration; the worldwide extensive use of this solution saved millions of lives.
- In cases of severe dehydration in which the child is obtunded or unable to drink, intravenous or intraosseous fluids should be used for initial management, with the institution of ORS as soon as possible.
- Antibiotics in general do not have a role in the treatment of rotavirus gastroenteritis.
- Several over-the-counter and prescription antimotility like loperamide are available but due to uncertain side-effect profiles, most experts do not recommend the use of these agents, particularly for pediatric patients.
- The fact that the rates of illness are similar across developed and developing country settings , indicates that hygiene and sanitation improvements, which have been credited with reducing incidence of most causes of infectious diarrhea in developed countries, are unlikely to prevent rotavirus disease significantly.Therefore, prevention and precautionary steps in the form of vaccines is essential for the control of the rotavirus disease.
GOALS FOR ROTAVIRUS VACCINE
- The objectives of the vaccine program include the prevention of moderate to severe disease but not necessarily of mild disease associated with rotavirus. An effective rotavirus vaccine will clearly decrease the number of children admitted to the hospital with severe dehydration.