Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. According to WHO estimates in 2013 about 215 000 children aged under 5 years die each year from vaccine-preventable rotavirus infections; the vast majority of these children live in low-income countries.

Overview

Rotavirus is a very contagious virus that causes diarrhea. It’s the most common cause of diarrhea in infants and children worldwide, resulting in over 215,000 deaths annually. Before the development of a vaccine, most children in the United States had been infected with the virus at least once by age 5.

Although rotavirus infections are unpleasant, you can usually treat this infection at home with extra fluids to prevent dehydration. Occasionally, severe dehydration requires intravenous fluids in the hospital. Dehydration is a serious complication of rotavirus and a major cause of childhood deaths in developing countries.

Good hygiene, such as washing your hands regularly, is important. But vaccination is the best way to prevent rotavirus infection.

Symptoms

Rotavirus infection usually starts within two days of exposure to the virus. Initial symptoms are a fever and vomiting, followed by three to eight days of watery diarrhea. The infection can cause abdominal pain as well.

In adults who are otherwise healthy, a rotavirus infection may cause only mild signs and symptoms or none at all.

Causes

Rotavirus is present in an infected person’s stool several days before symptoms appear and for up to 10 days after symptoms subside. The virus spreads easily through hand-to-mouth contact throughout this time — even if the infected person doesn’t have symptoms.

If you have rotavirus and you don’t wash your hands after using the toilet — or your child has rotavirus and you don’t wash your hands after changing your child’s diaper or helping your child use the toilet — the virus can spread to anything you touch, including food, toys, and utensils. If another person touches your unwashed hands or a contaminated object and then touches his or her mouth, an infection may follow. The virus can remain infectious on surfaces for weeks or longer if the area isn’t disinfected.

Because there are many types of rotavirus, it’s possible to be infected more than once, even if you’ve been vaccinated. However, repeat infections are typically less severe.

Risk factors

Rotavirus infections are common in children ages 3 to 35 months — particularly those who spend time in child care settings. Older adults and adults caring for young children have an increased risk of infection as well.

In the United States, the risk of rotavirus is highest in winter and spring.

Complications

Severe diarrhea can lead to dehydration, particularly in young children. Left untreated, dehydration can become a life-threatening condition regardless of its cause.

Prevention

To reduce the spread of rotavirus, wash your hands thoroughly and often — especially after you use the toilet, change your child’s diaper or help your child use the toilet. But even strict hand-washing doesn’t offer any guarantees.

There are two vaccines available to prevent rotavirus infection:

1. RotaTeq. This vaccine is given by mouth in three doses, often at ages 2 months, 4 months and 6 months. The vaccine is not approved for use in older children or adults.
2. Rotarix. This vaccine is a liquid given in two doses to infants at ages 2 months and 4 months.

Sometimes a part of the intestine can fold back onto itself (intussusception). This can cause a life-threatening intestinal blockage. Intussusception is a very rare but life-threatening side effect of the rotavirus vaccine. Children who have had intussusception before are more likely to have it again after receiving the rotavirus vaccine. For this reason, the Food and Drug Administration (FDA) recommends that the rotavirus vaccine not be given to children who have a history of intussusception.

For children who don’t have a history of intussusception, there is a very small risk that it can develop after the rotavirus vaccine is given. Even so, the benefits of the vaccine far outweigh the risks. Since the rotavirus vaccines became available, studies have shown that they prevent thousands of children from becoming sick and being hospitalized each year.

If your child has stomach pain, vomiting, diarrhea, blood in his or her stool, or a change in bowel movements after getting the rotavirus vaccine, contact your doctor immediately.

Diagnosis

Rotavirus is often diagnosed based on symptoms and a physical exam. A stool sample may be analyzed in a lab to confirm the diagnosis.

Treatment

There’s no specific treatment for a rotavirus infection. Antibiotics and antivirals won’t help a rotavirus infection. Usually, the infection resolves within three to seven days.

Preventing dehydration is the biggest concern. To prevent dehydration while the virus runs its course, drink plenty of fluids. If your child has severe diarrhea, ask your doctor about offering an oral rehydration fluid such as Pedialyte or Enfalyte — especially if diarrhea lasts longer than a few days.

For children, a rehydration fluid can replace lost minerals more effectively than can water or other liquids. Severe dehydration may require intravenous fluids in the hospital.

Anti-diarrheal medications aren’t recommended for a rotavirus infection.

Lifestyle and home remedies

If your baby is sick, offer small amounts of liquid. If you’re breast-feeding, let your baby nurse.

If your baby drinks formula, offer a small amount of an oral rehydration fluid or regular formula. Don’t dilute your baby’s formula.

If your older child isn’t feeling well, encourage him or her to rest. Offer bland foods that don’t contain added sugar, such as whole-grain bread or crackers, lean meat, yogurt, fruits, and vegetables.

Plenty of liquids are important, too, including an oral rehydration fluid. Avoid soda, apple juice, dairy products other than yogurt, and sugary foods, which can make diarrhea worse.

Avoid anything that may irritate your stomach, including highly seasoned foods, caffeine, alcohol, and nicotine.

Preparing for your appointment

If you or your child needs to see a doctor, you’ll likely see your primary care provider first. If there are questions about the diagnosis, your doctor may refer you to a gastroenterologist or an infectious disease specialist.

What you can do in the meantime

Drink plenty of fluids. Stick with bland foods to reduce stress on your digestive system. If your child is sick, follow the same approach — offer plenty of fluids and bland food.

If you’re breast-feeding or using the formula, continue to feed your child as usual. Ask your child’s doctor if giving your child an oral rehydration fluid is appropriate.