eMedicine Specialties > Gastroenterology > Intestine

Gastroenteritis, Viral: Follow-up

Author: Michael Vincent F Tablang, MD, Resident Physician, Department of Internal Medicine, University of Connecticut Health Center
Coauthor(s): Michael J Grupka, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine; George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: Nov 12, 2008

Follow-up

Deterrence/Prevention

  • 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.8  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.9
    • The phase 3 trial of Rotarix reported the following results:10
      • 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.9
    • Recommendations from the American Academy of Pediatrics and the CDC for the use of Rotarix are pending.11
  • 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.

Patient Education

 


More on Gastroenteritis, Viral

Overview: Gastroenteritis, Viral
Differential Diagnoses & Workup: Gastroenteritis, Viral
Treatment & Medication: Gastroenteritis, Viral
Follow-up: Gastroenteritis, Viral
References
[ CLOSE WINDOW ]

References

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

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

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

  4. 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. Apr 1 2006;42(7):964-9. [Medline].

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

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

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

  8. US Food and Drug Administration. FDA Approves New Vaccine to Prevent Gastroenteritis Caused by Rotavirus. Available at http://www.fda.gov/bbs/topics/NEWS/2008/NEW01814.html.

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

  10. [Best Evidence] 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. Jan 5 2006;354(1):11-22. [Medline].

  11. American Academy of Pediatrics. Red Book® Online Table – NEWStatus of Licensure and Recommendations for New Vaccines*. Available at http://aapredbook.aappublications.org/news/vaccstatus.shtml.

  12. 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. Mar 1996;97(3):424-35. [Medline].

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

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

  15. 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. Sep 1999;37(9):3055-8. [Medline].

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

  17. 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. Feb 1999;18(2):94-7. [Medline].

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

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

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

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

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

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

  24. 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. Dec 1998;178(6):1571-8. [Medline].

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

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

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

  28. 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. Dec 1995;47(4):392-8. [Medline].

  29. ICTVdb. The Universal Virus Database of the International Committee on Taxonomy of Viruses Web site. Available at: http://ictvdb.bio2.columbia.edu/Ictv/index.htm. Accessed on December 27, 2002.

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

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

  32. 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. May 1999;18(5):420-6. [Medline].

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

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

  35. [Best Evidence] 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. Jan 5 2006;354(1):11-22. [Medline].

  36. 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. May 1997;86(5):460-5. [Medline].

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

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

viral gastroenteritis, rotavirus, rotaviruses, stomach flu, diarrhea, dysentery, watery diarrhea, nausea, intestinal flu, infectious diarrhea, traveler's diarrhea, food poisoning, caliciviruses, astroviruses, adenoviruses, Norovirus, Norwalk-like virus, Norwalk virus, Sapovirus, Sapporo-like virus, sporadic infantile viral gastroenteritis, sporadic adult viral gastroenteritis, Clostridium difficile, Giardia lamblia

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

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.

Coauthor(s)

Michael J Grupka, MD, Fellow, Department of Gastroenterology-Hepatology, University of Connecticut School of Medicine
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, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Medical Editor

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, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, 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 is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
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 and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

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

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.