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Rotavirus

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Dr. Santosh Palve
Gastroenterologist

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Diarrhoea is very common among newborns and children below two years of age. Most types of diarrhoeas that a baby suffers from are viral and settle on their own. It is the body’s way of eliminating specific offending agents from the system.

There can be various infections or viruses that can lead to diarrhoea in babies. The most debilitating one among them is the rotavirus.[1] This potent virus causes stomach infection that leads to diarrhoea and erodes the health of the child.[2]

‘Diarrhoea caused due to rotavirus affects mostly young children below two years of age. Infection due to this virus is severe and also causes death in large numbers,’ informs Dr Rohit Agarwal, past president of the Indian Association of Pediatrics, attached to Chandrajoyti Children’s Hospital, Mumbai.

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There are 2.75 lakh cases of diarrhoea recorded in babies worldwide annually, of which 1.25 lakh are due to rotavirus. ‘About 40 per cent of deaths occur globally due to the rotavirus infection and in India, this virus alone is responsible for 11 per cent infantile deaths due to diarrheal attack,’ says Dr Rohit about the alarming statistics.

Types

Rotaviruses are RNA (Ribonucleic Acid) viruses without an envelope and are classified based on the type of surface proteins present on the outer layer of the virus:


  • G Type: 90% of virus types worldwide are the G type rotavirus ranging from G1, G2, G3, G4 and G9. They have the G protein which is also referred to as VP7 glycoprotein.

  • P-Type: They have the P protein, also referred to as VP4 protease cleaved protein. P[4], P[6], and P[8] are the most common P-type rotavirus.[3]

Symptoms

Symptoms of the disease usually appear two days after exposure. The virus usually affects the bowel pattern in children. The common symptoms of this viral attack are:


  • Frequent watery stools

  • High-grade fever

  • Vomiting associated with diarrhoea

  • Dehydration


Remember, dehydration together with a rotavirus infection isn’t a good indication.

This could also increase the probability of death due to viral infection.[1]

Look for signs like these which point to mild dehydration:

  • Slightly sunken eyes

  • Dry or sticky tongue and mouth

  • Cool, dry skin of arms and legs

  • Lethargy (Child is less focused and less responsive to words or touch)

  • Pale or blotchy colour of the skin

  • Sleepiness

  • Irritability

  • Less frequent urination or fewer wet diapers

  • A sunken feeling of the baby fontanelle (a soft gap between the bones of the skull in an infant)

  • Extreme thirst

  • Fewer or no tears when crying

  • Weight loss

  • Less elasticity in the skin.[1,4,5,6]


Symptoms of severe dehydration include:

  • Parched (extremely dry) tongue and mouth

  • Very little or no urination in a diaper (Dry diaper)

  • Irritability and lethargy

  • Deeply sunken eyes

  • Unable to drink fluid

  • Breathing deeply

  • Cold arms and legs.[1,4,5,6]

Causes And Risk Factors 

Causes 

‘Rotavirus is an airborne disease and it can affect almost all the sects of the society at large,’ says Dr Agarwal. Infants and children below three years of age are mostly affected by this virus. Some of the causes are as follows:


  • This infection is highly contagious. So, children staying at a crèche or baby care centre are more susceptible to getting one if any other child is affected.[7]

  • If an adult gets infected with this virus, the severity is often less than that in children.

  • Adults who get the virus include those who are older, care for children with rotavirus or have a compromised immune system due to other conditions.[2]

  • The virus usually spreads by the faecal-oral route, which means it is transmitted from the stools to the child’s mouth. The virus is primarily found in the stools of the infected person and can spread from there. It can remain in the faecal matter for up to 10 days after the symptoms stop.[2]

  • This happens if the child’s hands are not washed properly after passing stools, or he touches an area contaminated with the virus and then puts his fingers in the mouth. Rotavirus can remain on hard surfaces for days together and on the surface of hands for hours. [5]

  • Parents and caregivers can spread the virus too if they do not wash their hands properly after changing the diapers of infected infants.

  • It can spread by sneezing or coughing, but this route is not very common.[5]

  • One might get infected with different strains of the virus. So, if a child suffers from a rotavirus infection frequently, he may be getting infected with different strains of the virus over a period of time.[1]


‘One thing with viral infections is that each time one gets infected one gain some immunity from it. The same happens with rotavirus too, but the mortality rates due to a rotavirus infection as compared to other viral infections are very high. Hence it is necessary to seek precaution from the rotavirus infection before it’s too late,’ informs Dr Agarwal. Also, read how to decode your baby’s motions.

Remember, complete immunity from rotavirus infection while getting infected for the first time is not possible; however, repeated attacks can make each episode less severe. However, they can weaken your child’s health.

Risk Factors

The risk factors for getting the infection are as follows:

  • Most children get ill with the virus between the age of three months and three years.

  • Children under three years of age are most prone to severe diarrhoea and dehydration.[6]

  • It is more commonly seen in the cooler winter months.

  • Any child who is close to an infected person may be at risk.


Also, the virus affects children who are malnourished and have lower immunity. In countries like Africa and India, its prevalence is more as compared to other parts of the world,’ says Dr Agarwal.

Prevention 

It is challenging to keep a child completely away from being exposed to the rotavirus due to its prevalence and its ability to spread rapidly.[1] One must take the following measures:


  • Proper hygiene and timely care, along with proper disposal of infected infant’s diapers and use of appropriate disinfectants to clean doorknobs, tables, etc., can help one limit the severity of the viral attack.[6]

  • Here are the hand-washing tips from the CDC (Centers for Disease Control and Prevention):


- Use warm water

- Use soap. Lather for 10-15 seconds and get the soap on the wrists, under your nails and in between your fingers.

- Rinse hands properly and dry them with a clean napkin.[1]

  • However, vaccination can be the safest way to prevent a bout of rotavirus infection.[1]


‘The vaccination can prevent the infection attack to an extent of 98 per cent in children and is the best way to garner prevention for the same,’ says Dr Agarwal.

Diagnosis 

The signs and symptoms mentioned above can make your paediatrician wary about your child’s condition. A stool test can confirm the presence of the viral strains in it.[2]

Advanced techniques include nucleic acid detection PCR (Polymerase Chain Reaction) assays or antigen-detection immunoassays on stool specimens to detect rotavirus RNA or antigens and make a diagnosis rapidly.[8]

Treatment

The treatment will depend on:


  • Child’s symptoms

  • The general health of the child

  • The seriousness of the condition

  • Age of the child.[6]


Since rotavirus is a viral infection, it cannot be treated with antibiotics and tends to resolve on its own. Careful monitoring is required as there is a chance of dehydration. Check should be kept on:

  • The number of times your child has urinated[1]

  • Young babies should urinate every six hours, and older children should urinate at least every eight hours.

  • The use of antibacterial medication is not recommended[1]

  • Older children can be given an anti-diarrhoeal agent after asking the doctor.[7]

  • To reduce the loss of fluids due to diarrhoea, constant fluids should be administered. Fruit juices and sports drinks containing sugar should be avoided as they can worsen diarrhoea.

  • A balanced diet should be followed if the child can eat.[6]

  • Oral rehydrating solutions containing salts are the most prevalent therapy.

  • Clear fluids should be given to children with severe vomiting.

  • · Medication for diarrhoea and vomiting should not be given without medical advice.[6-7]


For Severe Cases of Dehydration due to diarrhoea:

  • Hospitalisation: It may be necessary to administer IV (intravenous) fluids.

  • IV Fluids: They might reduce dehydration.

  • Blood Tests: Blood levels of sugar and electrolytes are measured.[6]


Despite the mortality due to rotavirus infection, it is still preventable with vaccinations.[7] ‘Because the virus is so prevalent, it is difficult to prevent its attack without being vaccinated. The efficacies of the vaccination can vary from country to country, but it is still preventable with a simple oral vaccination. There is more research happening in the country to make a cheaper and more effective form of the vaccination to make it available for all sects of the society,’ says Dr Agarwal.

Prognosis And Complications 

Prognosis

The disease resolves in three to nine days. Proper rehydration can reduce the complications due to dehydration. Rarely, death may occur because of dehydration due to severe diarrhoea.[2-7]

Complications

The child can stay affected by rotavirus for up to nine days till the virus leaves his system.[7]

However, rotavirus infection along with dehydration can lead to death in rare cases.[2] Also, a bout of rotavirus infection can rob the essential fluids in the system leading to dehydration.

Hence, proper fluid intake is necessary to limit its consequences.[2] At times, a child might have to be hospitalised to receive fluids intravenously to combat the attack of the virus in his system.[6]

References: 

1. Standford Children’s Health. Available at:

https://www.stanfordchildrens.org/en/topic/default?id=what-is-rotavirus-1-2802. Accessed on: June 16, 2021.

2. Cleveland Clinic Rotavirus. Available at: https://my.clevelandclinic.org/health/diseases/8275-rotavirus. Accessed on: June 16, 2021.

3. World Health Organisation information sheet observed rate of vaccine reactions Rotavirus vaccine. Available at: https://www.who.int/vaccine_safety/initiative/tools/Rotavirus_vaccine_rates_information_sheet_0618.pdf?ua=1. Accessed on: June 16, 2021.

4. Boston’s Children’s Hospital Rotavirus Causes and Symptoms. Available at: https://www.childrenshospital.org/conditions-and-treatments/conditions/r/rotavirus-infections/symptoms-and-causes. Accessed on: June 16, 2021

5. National Foundation of Infectious Disease Frequently Asked Questions About Rotavirus. Available at: https://www.nfid.org/infectious-diseases/frequently-asked-questions-about-rotavirus/. Accessed on: June 16, 2021.

6. Rotavirus Infection in Children - Health Encyclopedia - University of Rochester Medical Center. Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02540. Accessed on: June 16, 2021.

7. Healthy Children.org Rotavirus. Available at: https://www.healthychildren.org/English/health-issues/vaccine-preventable-diseases/Pages/Rotavirus.aspx. Accessed on June 16, 2021.

8. Rotavirus Clinical Information (CDC). Available at: https://www.cdc.gov/rotavirus/clinical.html. Accessed on: Jun 16 , 2021

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