Rotavirus

Epidemiology

Rotavirus is an RNA virus of the Reoviridae family. Rotavirus is a leading cause of acute gastroenteritis in infants and young children, typically affecting those under 5 years of age. Prior to the introduction of the oral rotavirus vaccine (Rotarix®) into the UK immunisation schedule in 2013, rotavirus accounted for around 130,000 GP consultations and 12,700 hospital admissions annually in children under 5.

Rotavirus is the most common cause of gastroenteritis in infants and very young children and the most common cause of severe gastroenteritis in children.

Rotavirus infections in the UK typically peak in winter and early spring (February–April). Following vaccination implementation, disease incidence has fallen dramatically.

Transmission

Transmission of rotavirus is by person-to-person spread, either directly by faecal to oral route or by environmental contamination.

Pathogenesis

Infected enterocytes are sloughed off, leading to villous atrophy and loss of absorptive capacity. This results in malabsorption of carbohydrates and fats, and an osmotic diarrhoea due to unabsorbed solutes in the intestinal lumen.

Additionally, rotavirus NSP4 protein acts as an enterotoxin, promoting chloride secretion and contributing to secretory diarrhoea.

The combined osmotic and secretory diarrhoea leads to profuse watery stools, vomiting, and dehydration, which can be severe in infants and young children.

Diagnosis

Laboratory confirmation of diagnosis is not typically required for mild, self-limiting cases. In clinical or outbreak settings, diagnosis is usually confirmed using stool-based antigen detection or PCR (a type of nucleic acid amplification test (NAAT)) methods to diagnose infection. NAATs are the preferred diagnostic tool due to high sensitivity and specificity.

Management

Supportive care:

• The mainstay of treatment
• Oral rehydration therapy (ORT) is first-line.
• Intravenous fluids may be necessary in cases of severe dehydration.
• Antibiotics are NOT indicated.

Vaccination:

• Rota virus vaccine significantly reduces rotavirus-related admissions.
• Rotarix®, an oral live attenuated vaccine, given at 8 and 12 weeks of age.

Infection control:

• Hand hygiene and environmental cleaning are key in preventing spread, particularly in healthcare and childcare settings.
• Children with symptoms should be kept out of nurseries or schools until 48 hours after symptoms resolve.