(ICD 10: A 08.0)
It is a sporadic, seasonal and often severe gastroenteritis of infants and young children characterized by:
- Watery diarrhoea.
- Occasionally associated with severe dehydration and death in young children.
Secondary symptomatic cases among adult family contacts can occur. Rotavirus is a major cause of nosocomial (hospital cause) diarrhoea in newborns and infants. Rotavirus diarrhoea is more severe than acute diarrhoea.
- Stool specimens or rectal swabs. Diagnosis is usually based on the demonstration of rotavirus antigen in stools.
- Rotavirus belongs to the Reoviridae family.
- Group A is common.
- Essentially all children are infected by rotavirus in their first 2 to 3 years of life, with peak incidence of clinical disease in the 6 to 24 month age group. (Advice vaccination for new born second child by 6/12 if elder sibling not vaccinated).
- Outbreaks occur among children in day care settings.
- Rotavirus is more frequently associated with severe diarrhoea.
- Infection of adults is usually subclinical, but outbreaks occur in geriatric units.
- Rotavirus occasionally causes traveller’s diarrhoea in adults.
- Probably humans.
Mode of transmission:
- Probably faecal-oral route.
- There is some evidence that rotavirus may be present in contaminated water.
- 1 to 3 days
Period of communicability:
- During the acute stage of the disease.
- Rotavirus is not usually detectable after about the 8th day of infection.
- Symptoms last for an average of 4 to 6 days.
Susceptibility and resistance:
- Susceptibility is greatest between 6 and 24 months of age.
- By the age of 3, most individuals have acquired rotavirus antibody.
- Diarrhoea in uncommon in infected infants below the age of 3 months.
What to do when there is a case of Rotavirus?
- Notify the nearest District Health Office.
- Stool specimens or rectal swabs by electron microscopy (EM), Enzyme-linked immunosorbent assay (ELISA), Latex agglutination (LA) and other immunologic techniques for which commercial kits are available.
- Evidence of rotavirus infection can be demonstrated by serologic techniques but diagnosis is usually based on the demonstration of rotavirus antigen in stools.
- False positive ELISA reactions are common in newborns; positive tests require confirmation by an alternative test.
3. Preventive measures:
- In august 1998, an oral, live, tetravalent, rhesus based rotavirus vaccine (RRV-TV) was licensed for use in infants. The vaccine should be administered to infants between the ages of 6 weeks and 1 year. The recommended schedule is 3 doses at ages 2, 4 and 6 months. The first dose may be administered at ages 6 weeks to 6 months; subsequent doses should be administered with a minimum interval of 3 weeks between any two doses.
- The effectiveness of other preventive measures is undetermined:
- Hygienic measures applicable to diseases transmitted via the faecal-oral route may not be effective in preventing transmission.
- The virus survives for long periods on hard surfaces, in contaminated water and on hands but is inactivated by chlorine.
- In day care settings, dressing infants with coveralls to cover diapers has been demonstrated to decrease transmission of the infection.
- Prevent exposure of infants and young children to individuals with acute gastroenteritis in family and institutional settings (day care or hospital) by maintaining a high level of sanitary practice.
- Breast feeding may reduce the severity of gastroenteritis but does not affect infection rates.
- Enteric precautions (proper disposal of diapers and soiled articles).
- Frequent handwashing by the caretakers of infants.
5. Concurrent disinfection:
- Sanitary disposal of diapers.
- Place coveralls over diapers to prevent leakage.
6. Quarantine and Immunization of contacts:
7. Investigation of contacts and the source of infection:
- Sources of infection should be sought in certain high risk populations.
8. Specific treatment:
- Oral rehydration salts (ORS) is adequate in most cases.
- Intravenous fluids in cases with vascular collapse or uncontrolled vomiting.
- Antibiotics and anti-motility drugs are contraindicated.
- Search for vehicles of transmission and source on epidemiologic basis.
- A potential problem with dislocated populations.
- WHO Collaborating Centres.
Vaccine Preventable Disease Unit,
Communicable Disease Section,
Disease Control Division,
Ministry of Health.
Tel: 03-8883 4412/4506,
Fax: 03-8888 6270,
Local Enquiries: (in Penang)
Pejabat Kesihatan Daerah Timur Laut (PKDTL),
Jalan Perak, 11600-Pulau Pinang.
Tel: 04-2828500/ 04-2818900 (Hotline);