rotavirus

Rotavirus: description

Rotavirus is the leading cause of severe diarrhea in infants and children worldwide. The rotavirus is highly contagious and easily transmitted. It can spread so rapidly, especially in the winter months, that it leads to a veritable rotavirus epidemic.

The term rotavirus is used synonymously. It refers to both the disease and the eponymous pathogens. The name rotavirus is based on the optical similarity of the viruses with a wheel (lat. Rota = Rad).

So far seven subgroups of rotaviruses are known. Physicians call these subgroups serotypes and divide them into serotypes A to G. Serogroup A is the most important in the world and responsible for most of the illnesses.

According to the Robert Koch Institute (RKI), approximately 453,000 children under the age of five die annually from rotavirus infection worldwide, and an estimated 2.4 million children are hospitalized annually for rotavirus. Children are more likely to be affected at the age of six months to two years because they have not yet developed antibodies to the rotavirus. At the age of two, 90 percent of all children have undergone rotavirus infection.

But even older children and people over 60 years are not safe from infection. However, infection with rotavirus in adults is less common. Young adults in particular are more likely to develop Noroviruses, which also cause severe vomiting, than rotaviruses. Symptoms such as diarrhea and vomiting are usually much more pronounced in affected adults than in children with rotaviruses.

Infection usually takes place via a schmerinfektion, that is, via feces or contaminated objects as well as food or drinking water in the mouth.

An infection with rotavirus has been notifiable in Germany since 2001. According to RKI, more than 52,000 cases of illness occurred in 2010, and more than 42,000 cases were reported in 2011. The actual number of patients is probably even higher, since not all infections are detected and reported.

Rotavirus: symptoms

Until symptoms of rotavirus infection become apparent, approximately three days pass after infection (rotavirus incubation period). During this time, the virus multiplies and spreads in the body. Some days after infection and up to eight days after infection, those affected can excrete the rotavirus via the stool (small children also longer).

As a rule, rotaviruses initially show mild diarrhea, which can be watery. This diarrhea gets worse within a few hours. Often nausea and vomiting, as well as severe stomach pains are added. Especially children, more rarely when rotaviruses affect adults, often have high fever.

The combination of diarrhea (in extreme cases, vomiting diarrhea) and fever is very dangerous. Through the diarrhea, the body loses a lot of fluid and also important minerals such as electrolytes. In most cases, sufferers have no appetite during the illness and can not keep anything with them. The fever also deprives the body of water. In particular, if the rotavirus affects baby or toddler, the fluid intake must be closely monitored. In Germany, approximately 2,000 babies and toddlers per year are receiving in-hospital treatment for rotavirus, about 50 of them in the intensive care unit. As a cause of death rotaviruses are very rare in Germany.

The symptoms last for about four to seven days, then slowly subside. In about half of those affected, influenza-like symptoms such as coughing, pain in the limbs or respiratory problems also appear during this time. In children, all symptoms are usually more pronounced than in adults. Under certain circumstances, the high fluid loss from fever and diarrhea can be life threatening.

Rotavirus: causes and risk factors

The rotavirus belongs to the family Reoviridea. It is very resistant to the environment and can, for example, survive on surfaces for an astonishingly long time. With disinfectants the rotavirus is difficult to kill. The most common transmission route is fecal-oral infection. Rotaviruses are particularly vulnerable to baby and toddler because they simply put toys or other objects in their mouths. As a source of infection but also come contaminated food or water.

Rotaviruses are one of the most common causes of death for children in developing countries. Travelers, particularly in African and South American regions, should carefully study the specific provisions and recommendations for drinking water and fresh foods for their destination before traveling.

For small children and those with a weakened immune system, rotavirus infection is more dangerous than for otherwise healthy adult individuals. In small children, the immune system is not yet well trained. Even a single rotavirus infection does not protect against re-infection. Since there are many different subgroups of the virus, the rotavirus can infect adults and children many times.

Rotavirus: infection

An infection with the rotavirus can be done as long as the virus is eliminated with the stool. This is usually the case from the first symptoms up to eight days later. This can last longer, especially for small children.

Rotavirus: investigations and diagnosis

If you have the suspicion of having rotaviruses, the family doctor is the first contact person for adults and the pediatrician for children. Most of these can already make a first diagnosis based on the symptoms. First, the medical history is recorded (anamnesis). Here you have the opportunity to describe all symptoms and behavioral changes of your child. Afterwards, the doctor can ask questions like:

• Since when exactly are the symptoms already?
• How exactly does the diarrhea (for example, is it bloody)?
• What did you / your child eat the last days?
• Have you heard of similar cases in your environment (for example, children’s school or kindergarten)?

After the anamnesis, a physical examination takes place. Among other things, the abdomen is scanned to exclude other causes of gastrointestinal discomfort. A differentiation to other viral infections is also absolutely necessary, as a disease with rotaviruses in adults and in children is notifiable.

Rotaviruses can be detected under the microscope in the affected person’s stool. Alternatively, the rotavirus can be diagnosed using an electron microscope or molecular biology techniques. These methods can provide the doctor with additional data and explain the origin of the pathogens. However, they are more complex and are therefore rarely used.

Rotavirus: treatment

The treatment of rotavirus is purely symptomatic. Direct control of viruses with drugs (antivirals) is not possible. Of particular importance is that sufferers drink enough to compensate for high fluid loss again. The dehydration can be life-threatening especially in children, as the body with it also important mineral salts are withdrawn. About half of all children with rotavirus infection are therefore hospitalized. For drinking especially mineral water, tea and diluted fruit juices. On fatty drinks such as milk or in adults on alcohol should be avoided. Babies who are still breast-fed should continue to receive breast milk after consulting the doctor.

Antibiotics can not be used with rotaviruses. They help only with a bacterial infection, but not with a viral disease. Also, agents that help against diarrhea and thus inhibit the intestinal motility should not be taken. To reduce the fever, antipyretic drugs can be given. In adults, these are primarily acetylsalicylic acid (ASA) and Novalgin. In children, these drugs must not be administered. Ibuprofen and acetaminophen are prescribed here.

Pay attention to special hygiene measures during the illness. There are special disinfectants that can be used against rotaviruses. During the acute phase of the illness, you should regularly clean up everything that you, as the person affected or your child, are using. In the case of children, above all, clean toys, dishes and the changing mat as well as all used objects. Wash your hands regularly and be careful not to unnecessarily have much contact with other people to prevent rotavirus transmission.

Since 2006, two different rotavirus vaccines have been approved in Germany. A rotavirus vaccine is recommended for all children. An effect of the vaccine is already evident in a decline in the number of cases.

Rotavirus: disease course and prognosis

Mortality due to rotaviruses is low in Germany – about 0.1 percent of infections. Nearly half of all children under the age of five need to be treated in the hospital. Adults who have been infected with rotavirus are treated in about 20 percent of cases in the hospital. In Germany, the number of new infections has also fallen sharply due to the vaccinations. Still, many parents still consider vaccination against rotavirus unnecessary. This often leads to local epidemics – especially in public institutions such as schools, kindergartens or even hospitals.

In countries where there is no such high standard of medical care as in Germany, infection with rotavirus is much more dangerous in both adults and children. According to the RKI, more than 100 million children develop rotavirus every year in countries such as Africa, Asia and Latin America. An estimated 350,000 to 600,000 children under the age of five die from an infection with the rotavirus.