Rotavirus

Overview

Rotavirus is a very contagious virus that causes diarrhea. Before the development of a vaccine, most children 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 receiving fluids through a vein (intravenously) in the hospital.

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

Symptoms

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

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

When to see a doctor

Call your child's doctor if your child:

• Has diarrhea for more than 24 hours
• Vomits frequently
• Has black or tarry stool or stool containing blood or pus
• Has a temperature of 102 F (38.9 C) or higher
• Seems tired, irritable or in pain
• Has signs or symptoms of dehydration, including dry mouth, crying without tears, little or no urination, unusual sleepiness, or unresponsiveness

If you're an adult, call your doctor if you:

• Can't keep liquids down for 24 hours
• Have diarrhea for more than two days
• Have blood in your vomit or bowel movements
• Have a temperature higher than 103 F (39.4 C)
• Have signs or symptoms of dehydration, including excessive thirst, dry mouth, little or no urination, severe weakness, dizziness on standing, or lightheadedness

Causes

Rotavirus is present in an infected person's stool two days before symptoms appear and for up to 10 days after symptoms lessen. 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 that haven't been disinfected for weeks or months.

It's possible to be infected with rotavirus 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. And commonly used alcohol-based hand sanitizers have little effect on rotavirus.

The World Health Organization recommends that all countries give infants a rotavirus vaccine. There are two vaccines available:

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

The vaccines are considered safe and effective, and studies show that they prevent thousands of children from developing rotavirus every year. However, rarely, they can cause a part of the intestine to fold back on itself (intussusception), resulting in possibly life-threatening intestinal blockage.

Children who have had intussusception are more likely to have it again after receiving the rotavirus vaccine. The U.S. Food and Drug Administration recommends that the 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.

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

Many illnesses cause diarrhea. So although rotavirus is often diagnosed based on symptoms and a physical exam, a stool sample analysis might be used 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 the 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.

Self care

If your baby is sick, offer small amounts of liquid. If you're breastfeeding, 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 breads 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 diseases specialist.

What you can do

Preparing a list of questions will help you make the most of your time with your doctor. Some questions you might want to ask your doctor or your child's doctor include:

• What's the likely cause of these symptoms? Are there other possible causes?
• Is there a need for tests?
• What's the best treatment approach? Are there any alternatives?
• Is there a need to take any medicine?
• How can I ease the symptoms?

What to expect from your doctor

Some questions the doctor may ask include:

• When did symptoms begin?
• Have the symptoms been continuous, or do they come and go?
• How severe are the symptoms?
• Does anything seem to improve the symptoms?
• What, if anything, appears to worsen symptoms?

What you can do in the meantime

Drink plenty of fluids. Resume eating a healthy diet, restricting sugars and fats, as soon as possible. If your child is sick, follow the same approach.

If you're breastfeeding or using formula, continue to feed your child as usual. Ask your child's doctor if giving your child an oral rehydration fluid is appropriate.