ROTAVIRAL ENTERITIS

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Rotaviral enteritis:

(ICD 10: A 08.0)

It is a sporadic, seasonal and often severe gastroenteritis of infants and young children characterized by:

  • Vominting
  • Fever
  • 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.

Diagnosis:

  • Stool specimens or rectal swabs. Diagnosis is usually based on the demonstration of rotavirus antigen in stools.

Infectious agent:

  • Rotavirus belongs to the Reoviridae family.
  • Group A is common.

Occurrence:

  • 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.

Reservoir:

  • Probably humans.

Mode of transmission:

  • Probably faecal-oral route.
  • There is some evidence that rotavirus may be present in contaminated water.

Incubation period:

  • 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?

1. Notification:

  • Notify the nearest District Health Office.

2. Tests:

  • 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.

4. Isolation:

  • 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.

Epidemic measures:

  • Search for vehicles of transmission and source on epidemiologic basis.

Disaster implications:

  • A potential problem with dislocated populations.

International measures:

  • WHO Collaborating Centres.

Contact information:

Vaccine Preventable Disease Unit,

Communicable Disease Section,

Disease Control Division,

Ministry of Health.

Tel: 03-8883 4412/4506,

Fax: 03-8888 6270,

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Local Enquiries: (in Penang)

Pejabat Kesihatan Daerah Timur Laut (PKDTL),

Jalan Perak, 11600-Pulau Pinang.

Tel: 04-2828500/ 04-2818900 (Hotline);

Fax: 04-2829869