Medscape is available in 5 Language Editions – Choose your Edition here.


Viral Gastroenteritis Follow-up

  • Author: Michael Vincent F Tablang, MD; Chief Editor: Julian Katz, MD  more...
Updated: Dec 14, 2014


See the list below:

  • Natural infection with rotavirus does not afford complete immunity, and multiple infections in the first few years of life probably are common; however, immune response to these infections reduces the frequency and severity of subsequent rotavirus infection.
  • On February 21, 2006, the CDC Advisory Committee on Immunization Practices (ACIP) recommended RotaTeq, an oral attenuated pentavalent rotavirus vaccine (PRV), for the vaccination of infants. Three doses should be given at 2, 4, and 6 months. The third dose should be given no later than 32 weeks.
    • In the REST trial, a double-blind placebo-controlled trial of over 60,000 infants, RotaTeq demonstrated a 74% reduction in all rotavirus cases. There was a 98% reduction in severe cases and a 96% reduction in hospitalized cases.
    • Of note, there was a 59% reduction in all-cause gastroenteritis admissions, highlighting rotavirus as a larger contributor to the cause of acute gastroenteritis than originally expected.
    • The oral live attenuated vaccine was not tested in immunocompromised patients and not approved for this use.
    • There was no association of RotaTeq with intussusceptions in this trial. The former RotaShield vaccine was pulled from the market for increased intussusceptions. However, this risk was only seen in older infants. The RotaTeq trial did not test older infants. For these reasons, the RotaTeq vaccine is not approved for infants older than 32 weeks, and a "catch-up" vaccination is not recommended.
    • There are some questions as to the efficacy in less developed countries where the vaccine was not tested and nonvaccine serotypes (VP4, VP6, and VP7) are more prevalent.
  • RotaShield is not approved for use, but it is being considered for reintroduction into the marketplace in limited use for early infant vaccination only.
  • In April 2008, the United States Food and Drug Administration (FDA) approved a new vaccine for rotavirus gastroenteritis.[17] Rotarix is a monovalent vaccine derived from the most common human rotavirus strain that has been attenuated by serial passage and is administered in 2 oral doses, 1-2 months apart.[18]
    • The phase 3 trial of Rotarix reported the following results:[19]
      • Rotarix was highly protective against severe rotavirus gastroenteritis (85%) and hospitalization for severe rotavirus gastroenteritis (85%).
      • The vaccine was also protective against gastroenteritis of any cause (40%) and hospitalization for gastroenteritis of any cause (42%).
      • Infants vaccinated with Rotarix had fewer serious adverse events or required hospitalization because of gastrointestinal events.
      • The vaccine proved to be safe with respect to the risk of intussusceptions. The observed risk estimate was below the initial risk increase of 4 per 100,000 that led to the withdrawal of the RotaShield vaccine, and it was also below the subsequent consensus risk estimate of 1 per 100,000 for that vaccine.
    • The Rotarix vaccine strain replicates well in the gut after the first dose and provides cross-protection against most other serotypes. RotaTeq, on the other hand, is not so broadly cross-protective and grows less well in human intestines. In addition, the vaccine strains are infrequently shed in the stool, and 3 doses are required.[18]
    • Recommendations from the American Academy of Pediatrics and the CDC for the use of Rotarix are pending.[20]
  • Research on a vaccine for calicivirus infection is proceeding rapidly. Baculovirus-produced antigens spontaneously form virus-like particles without RNA that are immunogenic and possibly protective. Genomes also can be inserted into edible foodstuffs (eg, potatoes, bananas).
  • Proper hygiene is still the first preventative step in viral gastroenteritis. Hand washing to prevent fecal-oral transmission is very important. It also includes properly handling food and using clean water supplies.
  • On a community level, proper sanitation, clean water supplies, and surveillance programs for outbreaks are important steps in prevention.
Contributor Information and Disclosures

Michael Vincent F Tablang, MD Resident Physician, Department of Internal Medicine, University of Connecticut Health Center

Michael Vincent F Tablang, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.


George Y Wu, MD, PhD Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine

George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, Association of American Physicians

Disclosure: Received consulting fee from Springer for consulting; Received consulting fee from Gilead for review panel membership; Received honoraria from Vertex for speaking and teaching; Received honoraria from Bristol-Myers Squibb for speaking and teaching; Received royalty from Springer for review panel membership; Received honoraria from Merck for speaking and teaching.

Michael J Grupka, MD Physician, Atlanta Center for Gastroenterology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Noel Williams, MD, FRCPC FACP, MACG, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

John Gunn Lee, MD Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine

John Gunn Lee, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

  1. Ramani S, Kang G. Viruses causing childhood diarrhoea in the developing world. Curr Opin Infect Dis. 2009 Oct. 22(5):477-82. [Medline].

  2. Scarcella C, Carasi S, Cadoria F, et al. An outbreak of viral gastroenteritis linked to municipal water supply, Lombardy, Italy, June 2009. Euro Surveill. 2009 Jul 23. 14(29):epub ahead of print. [Medline].

  3. Lorrot M, Vasseur M. How do the rotavirus NSP4 and bacterial enterotoxins lead differently to diarrhea?. Virol J. 2007 Mar 21. 4:31. [Medline].

  4. Estes MK, Prasad BV, Atmar RL. Noroviruses everywhere: has something changed?. Curr Opin Infect Dis. 2006 Oct. 19(5):467-74. [Medline].

  5. Desai R, Yen C, Wikswo M, Gregoricus NA, Provo JE, Parashar UD, et al. Transmission of norovirus among NBA players and staff, winter 2010-2011. Clin Infect Dis. 2011 Dec. 53(11):1115-7. [Medline].

  6. CDC research shows outbreaks linked to imported foods increasing. Available at Accessed: March 14, 2012.

  7. Tate JE, Panozzo CA, Payne DC, et al. Decline and change in seasonality of US rotavirus activity after the introduction of rotavirus vaccine. Pediatrics. 2009 Aug. 124(2):465-71. [Medline].

  8. Smith MJ, Clark HF, Lawley D, et al. The clinical and molecular epidemiology of community- and healthcare-acquired rotavirus gastroenteritis. Pediatr Infect Dis J. 2008 Jan. 27(1):54-8. [Medline].

  9. Centers for Disease Control and Prevention (CDC). Deaths from gastroenteritis double. Available at

  10. Notes from the field: outbreaks of rotavirus gastroenteritis among elderly adults in two retirement communities--Illinois, 2011. MMWR Morb Mortal Wkly Rep. 2011 Oct 28. 60(42):1456. [Medline].

  11. Turcios RM, Widdowson MA, Sulka AC, et al. Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998-2000. Clin Infect Dis. 2006 Apr 1. 42(7):964-9. [Medline].

  12. Chhabra P, Payne DC, Szilagyi PG, et al. Etiology of viral gastroenteritis in children 111111111J Infect Dis</i>. 2013 Sep 1. 208(5):790-800. [Medline].

  13. Lee N, Chan MC, Wong B, et al. Fecal viral concentration and diarrhea in norovirus gastroenteritis. Emerg Infect Dis. 2007 Sep. 13(9):1399-401. [Medline].

  14. Lee RM, Lessler J, Lee RA, et al. Incubation periods of viral gastroenteritis: a systematic review. BMC Infect Dis. 2013 Sep 25. 13:446. [Medline]. [Full Text].

  15. Vandenplas Y, Salvatore S, Vieira M, et al. Probiotics in infectious diarrhoea in children: are they indicated?. Eur J Pediatr. 2007 Dec. 166(12):1211-8. [Medline].

  16. Sartor RB. Therapeutic manipulation of the enteric microflora in inflammatory bowel diseases: antibiotics, probiotics, and prebiotics. Gastroenterology. 2004 May. 126(6):1620-33. [Medline].

  17. US Food and Drug Administration. FDA Approves New Vaccine to Prevent Gastroenteritis Caused by Rotavirus. Available at

  18. Glass RI, Parashar UD. The promise of new rotavirus vaccines. N Engl J Med. 2006 Jan 5. 354(1):75-7. [Medline].

  19. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006 Jan 5. 354(1):11-22. [Medline].

  20. American Academy of Pediatrics. Red Book® Online Table - NEWStatus of Licensure and Recommendations for New Vaccines*. Available at

  21. American Academy of Pediatrics. Practice parameter: the management of acute gastroenteritis in young children. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis. Pediatrics. 1996 Mar. 97(3):424-35. [Medline].

  22. Ball JM, Graham DY, Opekun AR, et al. Recombinant Norwalk virus-like particles given orally to volunteers: phase I study. Gastroenterology. 1999 Jul. 117(1):40-8. [Medline].

  23. Belhorn T. Rotavirus diarrhea. Curr Probl Pediatr. 1999 Aug. 29(7):198-207. [Medline].

  24. Bon F, Fascia P, Dauvergne M, et al. Prevalence of group A rotavirus, human calicivirus, astrovirus, and adenovirus type 40 and 41 infections among children with acute gastroenteritis in Dijon, France. J Clin Microbiol. 1999 Sep. 37(9):3055-8. [Medline].

  25. Burkhart DM. Management of acute gastroenteritis in children. Am Fam Physician. 1999 Dec. 60(9):2555-63, 2565-6. [Medline].

  26. Caeiro JP, Mathewson JJ, Smith MA, et al. Etiology of outpatient pediatric nondysenteric diarrhea: a multicenter study in the United States. Pediatr Infect Dis J. 1999 Feb. 18(2):94-7. [Medline].

  27. Centers for Disease Control and Prevention. Advisory Committee Recommends New Vaccine to Prevent Rotavirus. [Full Text].

  28. Centers for Disease Control and Prevention. Outbreak of Gastroenteritis Associated with Noroviruses on Cruise Ships --- United States, 2002. MMWR Morb Mortal Wkly Rep. 2002 Dec 13. 51(49):1112-1115. [Full Text].

  29. Centers for Disease Control and Prevention. Withdrawal of rotavirus vaccine recommendation. JAMA. 1999 Dec 8. 282(22):2113-4. [Medline].

  30. Clark B, McKendrick M. A review of viral gastroenteritis. Curr Opin Infect Dis. 2004 Oct. 17(5):461-9. [Medline].

  31. DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1997 Nov. 92(11):1962-75. [Medline].

  32. Estes MK, Morris AP. A viral enterotoxin. A new mechanism of virus-induced pathogenesis. Adv Exp Med Biol. 1999. 473:73-82. [Medline].

  33. Fankhauser RL, Noel JS, Monroe SS, et al. Molecular epidemiology of "Norwalk-like viruses" in outbreaks of gastroenteritis in the United States. J Infect Dis. 1998 Dec. 178(6):1571-8. [Medline].

  34. Flem E, Vainio K, Dollner H, et al. Rotavirus gastroenteritis in Norway: Analysis of prospective surveillance and hospital registry data. Scand J Infect Dis. 2009. 41(10):753-9. [Medline].

  35. Ford T. Emerging issues in water and health research. J Water Health. 2006. 4 Suppl 1:59-65. [Medline].

  36. Gaggero A, O'Ryan M, Noel JS, et al. Prevalence of astrovirus infection among Chilean children with acute gastroenteritis. J Clin Microbiol. 1998 Dec. 36(12):3691-3. [Medline].

  37. Glass RI, Parashar UD. The promise of new rotavirus vaccines. N Engl J Med. 2006 Jan 5. 354(1):75-7. [Medline].

  38. Green J, Gallimore CI, Norcott JP, et al. Broadly reactive reverse transcriptase polymerase chain reaction for the diagnosis of SRSV-associated gastroenteritis. J Med Virol. 1995 Dec. 47(4):392-8. [Medline].

  39. ICTVdb. The Universal Virus Database of the International Committee on Taxonomy of Viruses Web site. Available at: Accessed on December 27, 2002.

  40. Johnsen CK, Midgley S, Bottiger B. Genetic diversity of sapovirus infections in Danish children 2005-2007. J Clin Virol. 2009 Nov. 46(3):265-9. [Medline].

  41. Maldonado Y, Cantwell M, Old M, et al. Population-based prevalence of symptomatic and asymptomatic astrovirus infection in rural Mayan infants. J Infect Dis. 1998 Aug. 178(2):334-9. [Medline].

  42. Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis. 1999 Sep-Oct. 5(5):607-25. [Medline]. [Full Text].

  43. Pang XL, Joensuu J, Vesikari T. Human calicivirus-associated sporadic gastroenteritis in Finnish children less than two years of age followed prospectively during a rotavirus vaccine trial. Pediatr Infect Dis J. 1999 May. 18(5):420-6. [Medline].

  44. Pang XL, Koskenniemi E, Joensuu J, et al. Effect of rhesus rotavirus vaccine on enteric adenovirus--associated diarrhea in children. J Pediatr Gastroenterol Nutr. 1999 Sep. 29(3):366-9. [Medline].

  45. Pang XL, Vesikari T. Human astrovirus-associated gastroenteritis in children under 2 years of age followed prospectively during a rotavirus vaccine trial. Acta Paediatr. 1999 May. 88(5):532-6. [Medline].

  46. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006 Jan 5. 354(1):11-22. [Medline].

  47. Saps M, Pensabene L, Turco R, et al. Rotavirus gastroenteritis: precursor of functional gastrointestinal disorders?. J Pediatr Gastroenterol Nutr. 2009 Nov. 49(5):580-3. [Medline].

  48. Shornikova AV, Isolauri E, Burkanova L, et al. A trial in the Karelian Republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhoea. Acta Paediatr. 1997 May. 86(5):460-5. [Medline].

  49. Vesikari T, Matson DO, Dennehy P, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006 Jan 5. 354(1):23-33. [Medline]. [Full Text].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.