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Rotavirus

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Related Terms
  • Adult diarrhea rotavirus, ADRV, CAL, dehydration, diarrhea, dysentery, electrolyte imbalance, fecal incontinence, gastroenteritis, incontinence, infant diarrhea, Reoviridae (family), RIX4414, Rotarix®, RotaTeq®, rotaviral gastroenteritis, rotavirus A, rotavirus B, rotavirus C, rotavirus D, rotavirus E, rotavirus vaccine, RV5, RVGE, sedoreovirinae, serotypes, severe wild-type rotavirus gastroenteritis (RGE).

Background
  • In infants and young children, rotavirus is one of the most common causes of severe diarrhea. Stomach flu (misnamed because it is not caused by the influenza virus) is caused by several viruses, one of which is rotavirus. There are five types of rotavirus. The most common is rotavirus A. Although rotavirus infections are extremely common, immunity to the specific strain develops following the initial infection. Therefore, subsequent infections result in less severe symptoms.
  • Rotavirus is transmitted by the fecal-oral route, meaning that it is present on unwashed or insufficiently washed hands and is accidentally ingested. Once in the body, it infects cells lining the small intestine and causes symptoms of gastroenteritis (inflammation of the stomach and intestines), such as vomiting and diarrhea.
  • Rotavirus accounts for up to 50% of hospitalizations for severe diarrhea in infants and children. Approximately half a million children under the age of five years die from rotavirus each year, with more than two million becoming severely ill. Since 2009, the World Health Organization has recommended the inclusion of rotavirus vaccination in national immunization programs. Prior to the initiation of the rotavirus vaccination program in the United States, it is estimated that rotavirus caused 2.7 million cases of severe gastroenteritis, 60,000 hospitalizations, and 37 deaths yearly. Rotavirus infections generally peak during the winter months, starting in the late fall and ending in the early spring. Of current interest to scientists are the effects of diet, malnutrition, and breast milk on the efficacy of vaccines.

Signs and symptoms
  • Gastroenteritis associated with the first rotavirus infection is characterized by vomiting, watery diarrhea, abdominal pain, and a low-grade fever. Bowel movements may occur as often as 20 times daily and may last up to nine days. Vomiting may also be severe.
  • Dehydration is common in rotavirus infections, due to watery diarrhea. Signs of dehydration may include tiredness, weakness, an inability to drink, deep breathing, lack of tears, or cold hands and feet. Symptoms generally occur about two days after the initial infection. Subsequent rotavirus infections may be asymptomatic (lacking symptoms).

Diagnosis
  • Upon admission to the hospital for severe gastroenteritis symptoms, children are generally tested for rotavirus A. The testing involves looking for the virus in the child's stool with an immunoassay, a test that measures the presence or concentration of a specific substance, in this case, proteins on the virus.

Complications
  • Complications of the virus infection are rare with access to good health care and appropriate treatment.
  • If complications do occur, they may include severe diarrhea, resulting in hospitalization and potentially death, due to severe dehydration. Also, rare complications include problems in the central nervous system (CNS). In this case, rotavirus may be detected in the CNS fluid. Encephalitis (irritation and swelling of the brain) and meningitis (bacterial infection of the brain and spinal cord) are possible.
  • Other potentially rare complications include viremia (rotavirus in the blood) and hypovolemia (decreased blood volume), which may lead to circulatory collapse (failure of blood vessels).
  • Possible complications of any severe illness from diarrhea include metabolic acidosis (too much acid in body fluids), impaired consciousness, convulsions (seizures), circulatory shock (inadequate flow of blood to body tissues), and prerenal azotemia (abnormal levels of certain chemical waste in the blood).
  • Available rotavirus vaccines contain a virus, or parts of a virus, called porcine circovirus (PCV). At this time, evidence to suggest these vaccines cause illness or other adverse effects in humans is lacking.

Treatment
  • Treatment of an acute rotavirus infection is nonspecific and involves management of symptoms. The main role of treatment is to maintain hydration.
  • Oral electrolyte rehydration solutions involve drinking extra water containing small amounts of salt and sugar. If the dehydration is serious enough, fluid is either injected directly into a vein (through an intravenous drip) or is given directly into the stomach using a nasogastric tube (a tube going through the nose). Blood sugar and electrolytes are then monitored.

Integrative therapies
  • Good scientific evidence:
  • Lactobacillus GG: There is good evidence from available well-designed research in children to support the use of Lactobacillus GG (LGG) in the treatment of acute diarrhea from rotavirus infection. Further research on dose and duration is required.
  • LGG is likely safe when taken by mouth by adults at recommended doses for up to one year. LGG is possibly safe when used during pregnancy, six months before delivery, and during breastfeeding for up to six months. Use cautiously in pregnant mothers and infants at risk for developing atopic dermatitis (eczema). Avoid in patients with injury to the lining of the intestine. Avoid in patients with below-normal immune function. Avoid with known allergy or sensitivity to dairy products, if LGG is taken as part of a dairy product.
  • Unclear or conflicting scientific evidence:
  • Bovine colostrum: Bovine colostrum high in antibodies to rotavirus serotypes has been shown to reduce total stool output, stool frequency, and the need for oral rehydration solution. More research is needed in this area.
  • Use bovine colostrum with caution. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Use cautiously with immune system disorders and atherosclerosis (hardening of the arteries) or if on medications, such as antidiarrheal agents (e.g., Imodium®), insulin, and CNS agents (amphetamines, caffeine). Avoid with caner and in those at risk of cancer. Avoid if pregnant or breastfeeding. Avoid if allergic or hypersensitive to dairy products.
  • Historical or theoretical uses that lack sufficient evidence:
  • Açaí: Açaí is a berry grown on the açaí palm tree (Euterpe oleracea), which is native to tropical areas of Central and South America. There is a lack of research on the effectiveness of this agent for rotavirus infections.
  • Use cautiously with high blood pressure, swelling, ulcers, or bleeding in the intestines. Use cautiously if taking cyclooxygenase inhibitors. Avoid if pregnant or breastfeeding. Avoid if allergic or sensitive to açaí.
  • Bitter orange: Bitter orange (Citrus aurantium) is a flowering, fruit-bearing evergreen tree native to tropical Asia. There is a lack of research on the effectiveness of this agent for rotavirus infections.
  • Use bitter orange preparations that are applied to the skin cautiously with fair skin. Use cautiously with headache and hyperthyroidism (too much thyroid hormone). Avoid with preexisting cardiovascular (heart) disease, narrow-angle glaucoma, and intestinal colic. Avoid if taking antiadrenergic agents, beta-blockers, or QT interval-prolonging drugs or with long QT interval syndrome. Avoid if taking antidepressants, stimulants, or honey. Avoid if pregnant or breastfeeding. Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family.
  • Stevia: Stevia is an extract of Stevia rebaudiana.There is a lack of research on the effectiveness of this agent for rotavirus infections.
  • Use cautiously with hypotension (high blood pressure), hypocalcemia (calcium deficiency), and hypoglycemia (low blood sugar). Use cautiously if taking hypotensive (blood pressure-lowering) drugs, hypoglycemic (blood sugar-altering) drugs, or insulin. Avoid with impaired kidney function or other kidney diseases. Avoid if pregnant or breastfeeding. Avoid if allergic or hypersensitive to plants in the Asteraceae/Compositae (daisy) family, including ragweed, chrysanthemums, and marigolds.

Prevention
  • Handwashing and cleanliness help decrease the spread of germs in general and are recommended in the prevention of rotavirus exposure. However, the virus is very common, making it likely for one to contract it eventually. In fact, it is thought that almost every child has been infected before the age of five.
  • The following are approved sanitation methods that may help decrease the spread of rotavirus: washing surfaces with chlorine-based disinfectants (diluted bleach or 70% alcohol) or soap and water, and disposing of dirty diapers in a sanitary manner.
  • Rotavirus infection can be prevented using vaccines against rotavirus A. Rotarix® and RotaTeq® are two oral vaccines containing attenuated live virus (meaning that the virus is alive but has very low virulence). Rotarix® is given orally in a two-dose series to young infants (less than 24 weeks of age). It appears to protect against rotavirus gastroenteritis caused by certain strains.
  • Since 2009, the World Health Organization has recommended the inclusion of rotavirus vaccination in national immunization programs.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Centers for Disease Control and Prevention (CDC). .
  2. Beards GM, Campbell AD, Cottrell NR, et al. Enzyme-linked immunosorbent assays based on polyclonal and monoclonal antibodies for rotavirus detection. J Clin Microbiol. 1984 Feb;19(2):248-54.
  3. Fischer TK, Viboud C, Parashar U, et al. Hospitalizations and deaths from diarrhea and rotavirus among children <5 years of age in the United States, 1993-2003. J Infect Dis. 2007 Apr 15;195(8):1117-25.
  4. Koletzko S, Osterrieder S. Acute infectious diarrhea in children. Dtsch Arztebl Int. 2009 Aug;106(33):539-47.
  5. Kuehn BM. FDA: Benefits of rotavirus vaccination outweigh potential contamination risk. JAMA. 2010 Jul 7;304(1):30-1.
  6. Mast TC, Khawaja S, Espinoza F, et al. Case-control Study of the Effectiveness of Vaccination With Pentavalent Rotavirus Vaccine in Nicaragua. Pediatr Infect Dis J. 2011 Jul 15.
  7. Matson DO. The pentavalent rotavirus vaccine, RotaTeq. Semin Pediatr Infect Dis. 2006 Oct;17(4):195-9.
  8. McClenahan SD, Krause PR, Uhlenhaut C. Molecular and infectivity studies of porcine circovirus in vaccines. Vaccine. 2011 Jun 24;29(29-30):4745-53.
  9. Munos MK, Walker CL, Black RE. The effect of rotavirus vaccine on diarrhoea mortality. Int J Epidemiol. 2010 Apr;39 Suppl 1:i56-62.
  10. National Institutes of Health (NIH) Medline Plus. .
  11. Natural Standard: The Authority on Integrative Medicine. .
  12. O'Ryan M. Rotarix (RIX4414): an oral human rotavirus vaccine. Expert Rev Vaccines. 2007 Feb;6(1):11-9.
  13. Patel M, Shane AL, Parashar UD, et al. Oral rotavirus vaccines: how well will they work where they are needed most? J Infect Dis. 2009 Nov 1;200 Suppl 1:S39-48.
  14. Patel MM, Tate JE, Selvarangan R, et al. Routine laboratory testing data for surveillance of rotavirus hospitalizations to evaluate the impact of vaccination. Pediatr Infect Dis J. 2007 Oct;26(10):914-9.
  15. U.S. Food and Drug Administration. .
  16. World Health Organisation (WHO). .

Causes
  • Rotavirus is transmitted by the fecal-oral route, meaning that it is present on unwashed or insufficiently washed hands and is accidentally ingested. Once in the body, the virus infects cells lining the small intestine and causes gastroenteritis symptoms, such as diarrhea.
  • Some scientists have suggested that airborne transmission of rotavirus is possible but rare.
  • Rotavirus stays transmissible in the environment (on counters, for example) for long periods of time.

Risk factors
  • Rotavirus infection is considered very common. In fact, it is thought that almost every child has been infected before the age of five. Symptoms are most severe in individuals with compromised, weakened, or underdeveloped immune systems or in those with an initial infection. Therefore, symptoms are most severe in young children (six months to two years old) and the elderly. Also, symptoms may occur if an individual was originally infected with a different serotype of the virus. Asymptomatic adults may still transmit rotavirus.

Types of the disease
  • There are five species of rotavirus (rotaviruses A through E). Rotavirus A is the most common type of rotavirus infection in humans. It is the species of rotavirus that is common in hospitalized infants, daycare centers, and nursing homes.
  • Rotaviruses B and C are less common than rotavirus A. Rotavirus B is commonly called adult diarrhea rotavirus, or ADRV. It has caused major epidemics of diarrhea, occurring as a result of sewage contamination of drinking water, in mainland China. Rotavirus C-associated diarrhea is rare, but outbreaks have occurred.
  • Different serotypes (strains) of each rotavirus species also exist. Serotypes are differentiated by compounds (proteins) found on the surface of the virus.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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