Rotavirus

What are rotaviruses?

Rotaviruses are very small, non-enveloped virus particles and belong to the Reoviridae family. They are the most common cause of viral intestinal infection in children and have humans as a reservoir.

In western industrialized countries, infants and children between the ages of 6 months and 2 years are particularly affected because they have a high susceptibility to infection due to their lack of immunity. Repeated infections during childhood build up a specific immunity to rotaviruses, because by the age of 3, 90% of all children have had at least one rotavirus infection. Rotavirus is a major contributor to infant mortality in developing countries, which is why the WHO recommends including rotavirus vaccination in all national vaccination programs.

Because immunity to rotavirus is short-lived and there are many different serotypes, recurrent illness is possible, and adults can also be infected with rotavirus, although almost all adults have antibodies to rotavirus. In adults, however, the course is usually milder than in children. Above all , parents of sick children, people over 60 years of age and people in retirement homes have an increased risk of developing rotavirus-related diarrhea. Rotaviruses also play a major role in traveler’s diarrhea.

Diarrheal diseases caused by rotaviruses occur more frequently in winter and in the spring months (February to April), since the pathogens can multiply particularly well in the warm and dry climate of heated apartments. Rotavirus infection is notifiable.

How is rotavirus transmitted?

Rotavirus infection occurs fecal-orally through smear infection or contaminated water and food . The viruses are very easily transmissible – 10 virus particles are enough to infect a child and just 1g of stool of an acutely infected person contains several million viruses. After an infection, there is usually an incubation period of 1 to 3 days before the first symptoms become noticeable. The contagiousness is mainly during the acute stage of the disease and while the virus is being shed in the stool. This period is usually no longer than 8 days.

There is a particular risk of infection in communal toilets , for example in kindergartens and schools.

The virus multiplies in the surface cells of the small intestine . There it leads to the death and rejection of the upper cell layers, which can lead to temporary lactose intolerance . This lactose intolerance returns after a few weeks or months, but cow’s milk or dairy products should be avoided during this time. In addition to shedding the top layers of cells, the small intestine secretes increased fluid and mucus, which further contributes to diarrhea.

Symptoms of rotavirus infection

Symptoms of rotavirus infection vary widely. Adults in particular often do not develop any symptoms. Other people complain of mild diarrhea , others develop a serious illness and have to be treated as an inpatient in a hospital.

A rotavirus infection is primarily noticeable through watery diarrhea and vomiting . In addition, mucus can be observed in the stool . Based on the symptoms, rotavirus gastroenteritis cannot be distinguished from other infectious diarrheal diseases, even if it is usually more severe in small children and infants than other diarrheal diseases. The symptoms usually last 2 to 6 days.

Other possible complaints are:

• Fever
• stomach pain
• Unspecific symptoms of the upper respiratory tract, eg cough , sore throat
• Temporary lactose intolerance
• Dehydration: Dehydration is a dreaded consequence of rotavirus gastroenteritis which, if left untreated, can be fatal and should be treated in hospital.

diagnosis

The diagnosis of rotavirus gastroenteritis is usually made by the symptoms alone and a thorough physical examination. In addition, a stool sample can be taken and the virus can be detected in the stool using the “Enzyme Immune Test” (EIA). This is possible from the 3rd to 4th day of the illness.

When should I go to the doctor?

You should take your child to a pediatrician if:

• An infant has diarrhea for more than 6 hours
• An older child has diarrhea for more than 2 days ,
• Frequent vomiting occurs
• fever >40°C occurs,
• You observe black stool (tarry stool), stool with blood or pus admixtures ,
• The child shows signs of dehydration .

Pregnant women and people with a weakened immune system should consult a doctor early if they have symptoms of severe diarrhea, but at the latest if they develop a fever. Otherwise healthy adults should seek medical attention if:

• you ca n’t keep liquids down for more than 24 hours ,
• you have diarrhea for more than 2 days ,
• you can see blood in the stool or vomit ,
• you develop a fever >39.4°C ,
• you feel dizzy or very weak
• you are showing signs of dehydration .

Signs of dehydration are:

• Dry chapped mouth
• sunken eyes
• Neck veins not visible
• Inelastic skin (standing skin folds)
• Pronounced listlessness
• Little urine, dark urine

You can do this even if you have a rotavirus infection

The most important therapy for a rotavirus infection is the substitution of the missing liquid and mineral salts . For this you can, for example , buy an electrolyte solution from the pharmacy . You should give your child a teaspoon or two of this every few minutes. The solution often helps to relieve vomiting as well. Even still mineral water with a high content of sodium, magnesium, potassium and calcium, with little sulphate can be used as a substitute. The so-called “Fanconi solution”helps especially with children to compensate for the loss of water and mineral salts. To do this, dissolve 3 tbsp (grape) sugar and half a tsp salt in 300 mL orange juice. This mixture is then filled up with 1 L of diluted black tea. You can give the finished Fanconi solution to your child in small portions to drink warm, you can of course drink it yourself if you have diarrhea.

Nowadays it is no longer recommended to follow a strict diarrhea diet. Children with gastrointestinal problems also usually have little appetite and you should not force them to eat, as this can worsen the nausea . The lack of appetite will come back on its own. Nevertheless, you should avoid preparing meals that are difficult to digest for your child. Beneficial for diarrhea are:

• White bread
• pasta
• Zwieback
• potatoes
• bananas.
  If your child is still breastfed , you should simply continue breastfeeding and possibly feed it more often to compensate for the increased fluid consumption.

If your child suffers from abdominal pain , a gentle massage of the abdomen can help to relieve abdominal cramps and the pain associated with them. A hot water bottle can also have a soothing effect.

Adults can also suffer from rotavirus gastroenteritis. In addition to the measures described above, you should take care to avoid substances that further irritate your digestive tract. These include, for example:

• Heavily spiced food
• Caffeine
• Alcohol
• Nicotine

The easiest way to treat rotavirus infection is to avoid it in the first place. Good hygiene is the be-all and end- all here. The most important hygiene measures are:

• Clean toilet
• Washing hands after using the toilet and before eating
• Never drink from the cup of the sick person, eat their leftovers or use their cutlery
• Only use separate towels and washcloths in the bathroom

therapy

Rotavirus gastroenteritis can only be treated symptomatically. The mainstay of treatment is to replace the water and mineral salts lost from diarrhea and vomiting . This can usually be done at home using electrolyte solutions or other substitution measures. If intravenous substitution becomes necessary, hospitalization is indicated. There is also no indication for antibiotic therapy or for taking medication that inhibits intestinal movement (eg loperamide).

Vaccination against rotavirus

Rotavirus accounts for more than 50% of infants hospitalized for severe diarrheal disease. In order to avoid these serious rotavirus diseases and the resulting hospital stays, routine rotavirus vaccination for infants under the age of 6 months has been recommended by the Robert Koch Institute since 2013.

The vaccination takes place as an oral vaccination with a live vaccine . Depending on the age of the child, 2 (Rotarix) or 3 (RotaTeq) doses are given. The vaccination has been proven to be highly effective and effective and is generally well tolerated. Protection for 2-3 seasons is assumed after primary immunization.

A known complication of rotavirus vaccination is a slightly increased risk of bowel invaginations (bowel invaginations) . Since the risk of this complication increases with age, it is recommended to start the vaccination series as early as possible. The likelihood of developing intestinal intussusception is increased mainly in the first 7 days after the first vaccination. In order to develop an intestinal invagination, other risk factors are usually necessary in addition to a rotavirus vaccination, but you should still be aware of possible symptoms:

• Severe abdominal pain
• Persistent vomiting
• Bloody stools.
  It is also recommended to avoid mixing vaccine and breast milk whenever possible. You should not give up breastfeeding because of the vaccination, but it would be good, as far as your child’s breastfeeding rhythm allows, not to breastfeed for one hour before and after the vaccination.

This is how Med-Healths can help with a possible rotavirus infection

If your child suffers from severe diarrhea, you may be unsure whether you should consult a registered pediatrician. What are the possible causes of diarrhea? What treatment options and what alternatives are there? How can I relieve the symptoms? Should I go to the pharmacy to buy an electrolyte solution? You can speak directly to pediatricians through Med-Healths . Of course, they cannot physically examine your child, but they can give you an initial rough assessment of the severity of the illness and a recommendation on how to proceed.