Rotavirus infection


Rotavirus infection

Description, Causes and Risk Factors:

A group of RNA viruses (family Reoviridae) wheel-like in appearance that form a genus, Rotavirus, which includes the human gastroenteritis viruses (a major cause of infant diarrhea throughout the World). Separated into groups A through F, rotaviruses can infect a number of vertebrates. They are fastidious, and in vitro culture is difficult.

Rotavirus is a major killer of children, causing approximately 450,000 deaths per year Worldwide.

Rotavirus is a virus, commonly present across the World. It is a major cause of vomiting and diarrhea in babies resulting in severe dehydration (loss of body salts and water). Rotavirus diarrhea is different from other types of diarrhea because it can cause much more severe dehydration. The baby may suffer from fever, vomiting and severe diarrhea. Rotavirus diarrhea may happen up to 20 times a day & continue up to 9 days. All this leads to severe dehydration which often requires hospitalization.

Rotavirus spreads very easily and is mainly transmitted through infected hands, toys, objects, surfaces and also through person-to-person contact. It may also spread by air (by sneezing, coughing).

The studies on epidemiological profile of rotavirus infection have revealed that 20-50 percent of hospitalizations for diarrhea among children in 0-5 years age group are associated with this infection. The morbidity and mortality are much in children infected with rotavirus than previously estimated, and is responsible for two million deaths per year in developing countries.

Rotavirus genogroups are based on the structure of specific genes:

G types (G1-G14) refer to the VP7 protein (gene 9) and P types P1A[8]-P1B[4] refer to VP4 protein (gene 4) and are differentiated by Reverse transcriptase polymerase chain reaction (RT-PCR). Rotaviruses can therefore be typed and strains circulating in the community can be monitored. The strains change in frequency of circulation over time, and occasionally new re-assortment strains are introduced to a community. At least 42 P-G combinations have been recognized in human infections. Some of the vaccine strains like G9, G8, G5 and P2A are not covered by available Rotavirus vaccines that have undergone clinical trials. This study is part of an ongoing research project in a tertiary care hospital.

The components of the immune response that protect children from Rotavirus infection and disease are not completely understood. Both serum and mucosal antibodies are probably important. Antibodies to both the VP4 and VP7 proteins neutralize virus infectivity. However, in vaccine studies, correlation between these antibodies and protection has been poor. The first infection with rotavirus elicits a serum neutralizing antibody response to the serotype of the infecting virus. Subsequent infections elicit a broader, cross-reactive response. Studies have suggested that antibody is important in the resolution of infection and in protection against subsequent infection, whereas cell-mediated immunity is most important in the resolution of rotavirus infections. Because a reliable immune correlate of protection has not been found, each new vaccine candidate must be tested in large field trials for efficacy.

Naturally acquired rotavirus infections provide the greatest protection against re-infection causing severe disease. After a first natural infection, infants and young children are protected against subsequent symptomatic disease regardless of whether the first infection was symptomatic. After a first infection, 40% of children are protected against any subsequent infection with rotavirus, 75% are protected against any rotavirus diarrhea, and 88% are protected against severe rotavirus diarrhea. Second, third, and fourth infections confer progressively greater protection. No child with 2 previous infections has subsequently developed severe rotavirus diarrhea.

Symptoms:

The incubation period for rotavirus disease is approximately 2 days. The disease is characterized by vomiting and watery diarrhea for 3 to 8 days, and fever and abdominal pain occur frequently. Dehydration is more common in rotavirus infection and is the most common cause of death related to rotavirus infection.Immunity after infection is incomplete, but repeat infections tend to be less severe than the original infection.

Diagnosis:

Diagnosis may be made by rapid antigen detection of rotavirus in stool specimens. There are several licensed test kits on the market which are sensitive, specific and detect all serotypes of rotavirus. Strains may be further characterized by enzyme immunoassay or reverse transcriptase polymerase chain reaction (RT-PCR), but such testing is not commonly done.

Treatment:

For persons with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days. Treatment is nonspecific and consists of oral re-hydration therapy to prevent dehydration. About 1 out of 70 children with rotavirus gastroenteritis will require hospitalization for intravenous fluids.

Currently there are two rotavirus vaccines available. One of them is a monovalent rotavirus G1P8 vaccine while the other one is a pentavalent rotavirus vaccine covering G1, G2, G3, G4 and P8.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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