Reoviruses Follow-up

  • Author: Gholamreza Rasouli, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 2, 2011
 

Deterrence/Prevention

  • Reovirus: No specific treatment or prevention measures are recommended for reovirus infections in humans because of the lack of definitive association with disease. Vaccine preparations are available for veterinary use.
  • Colorado tick fever
    • CTF is best prevented by avoiding contact with the wood tick. This may be achieved by wearing suitable clothing to decrease the possibility of an infected tick becoming attached to the body. Instruct patients and family members to inspect the scalp and neck and the sleeve, belt, trouser, and sock line areas carefully for ticks several times each day and to remove any ticks that may be found to prevent them from becoming imbedded in the skin.
    • Repellent can be sprayed on clothing or applied to exposed skin in adults. Remind patients and family members to tuck long pants into socks, to wear shirts tucked in, and to inspect clothing and skin frequently for attached ticks. Identifying ticks on light-colored clothing is easier. Persons with documented CTF should be prohibited from blood donation until the viremia, which often is prolonged, has cleared.
    • Education is the best means by far of preventing the disease. Periodically remind the public of the clinical features of CTF and the ticks that transmit the causative agents. Because of the generally benign nature of the disease, attempts at active immunization do not appear to be indicated, and extensive specific measures to rid any large area of the United States of the wood tick do not appear to be warranted.
  • Rotavirus
    • Rotavirus typically infects children in the first 3 years of life during epidemics that occur in the winter in temperate climates. In developed countries with ready access to medical care and careful attention to oral and intravenous rehydration, fatalities are relatively rare, but rotavirus illness is still an important cause of morbidity. In developing countries, the impact of the disease is much more striking, with estimates that rotavirus may be the leading cause of childhood mortality in many countries.
    • In view of the fecal-oral route of transmission, wastewater treatment and sanitation are significant control measures.
    • Responses to the vaccine are generally assessed by evaluating the rise in serum antibody levels. However, several rotavirus vaccine trials indicate that clinical efficacy rates are higher than seroconversion rates, suggesting that serum antibodies are not sensitive enough indicators of immune responses and that assessment of local immunity may prove more reliable.
    • Studies addressing the role of serum antibody as a predictor of susceptibility to infection and illness have yielded conflicting results because monitoring of serum antibody responses may underestimate mucosal antibody by as much as 200%.
    • Precedents for using animal rotavirus strains as vaccine candidates include (1) the antigenic relatedness between human and animal rotaviruses and (2) evidence for the stimulation of heterologous protective immunity using one strain of rotavirus as an immunogen. For example, calves infected in utero with calf rotavirus developed resistance to challenge with HRV.
    • A rhesus rotavirus-tetravalent vaccine (RRV-TV, Rotashield) was licensed for use in the United States in August 1998. The vaccine consists of a quadrivalent formulation incorporating the VP7 neutralization specificity of each of the 4 clinically important serotypes with the attenuation phenotype of rhesus rotavirus.
    • The rhesus rotavirus–based quadrivalent vaccine was very successful in preventing severe rotavirus diarrhea in 2 trials in the United States and in one in Finland, with protection rates of 80-91%. In developing countries, its efficacy has been less impressive.
    • In Peru and Brazil, the efficacy of RRV-TV afforded only 20% and 35% protection respectively for any rotavirus gastroenteritis and 50-60% protection for severe rotavirus gastroenteritis. A febrile reaction occurred in about 30% of those vaccinated in Finland. Although most reactions were mild and clinically insignificant, the finding is an important part of the total clinical profile of the vaccine. In a United States multicenter trial, only 7% of vaccine recipients and 4% of placebo recipients had fever during the 5 days after the first vaccination. On July 16, 1999, the Centers for Disease Control and Prevention recommended that health care providers suspend use of the licensed RRV-TV (RotaShield, Wyeth Laboratories, Inc, Marietta, Pennsylvania) in response to 15 cases of intussusception.[17]
    • The risk of intussusception following RotaShield immunization is estimated to be 1 in 10,000-32,000.[18] The risk is highest during the 3-14 days following receipt of the first dose of vaccine. Infants older than 3 months at the time of the first dose of vaccine are at increased risk of intussusception. Although debate continues surrounding the exact quantitation of risk of intussusception, it is accepted as a rare adverse event.
    • Several rotavirus vaccines are now marketed in the United States. The orally administered live-virus vaccines exhibit similar safety characteristics. RotaTeq is a pentavalent vaccine that contains 5 live reassortant rotaviruses and is administered as a 3-dose regimen against G1, G2, G3, and G4 serotypes, the 4 most common rotavirus group A serotypes. RotaTeq also contains attachment protein P1A (genotype P[8]). Rotarix protects against rotavirus gastroenteritis caused by G1, G3, G4, and G9 strains and is administered as a 2-dose series in infants aged 6-24 weeks.
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Complications

  • Reovirus
    • Rare cases of reovirus-induced neurologic disease in humans, including encephalitis and meningitis, have been reported. A 10-month-old infant with encephalitis, pneumonitis, myocarditis, and hepatitis was reported in whom reovirus serotype 1 was isolated from stool specimens and postmortem brain tissue. Tillotson and Lerner (1967) reported a 5-year-old girl who had extensive pneumonia and died after 15 days of illness.[4]
    • Joske and associates (1964) noted a 10-month-old girl who died after a respiratory illness of 4 days' duration.[5] Reovirus type 1 was recovered from the stool and brain of this child, and postmortem study revealed interstitial pneumonia, myocarditis, hepatitis, and encephalitis.
  • Colorado tick fever: In a few cases, complications such as encephalitis, aseptic meningitis, and hemorrhage have been reported. Other associated syndromes include pericarditis, epididymoorchitis, rheumatic fever syndrome, and atypical pneumonitis. The association of hepatitis with CTF also has been described.
  • Rotavirus: Rotavirus infections are associated with aseptic meningitis, necrotizing enterocolitis, acute myositis, hepatic abscess, pneumonia, Kawasaki disease[12] , SIDS[19] , and Crohn disease.
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Prognosis

  • Reovirus and CTF infections are usually benign diseases with excellent prognosis.
  • Rotavirus
    • In developed countries with ready access to medical care and careful attention to oral and intravenous rehydration, fatalities are relatively rare, but rotavirus illness is still an important cause of morbidity.
    • In developing countries, the impact of the disease is much more striking, with estimates that it may be the leading cause of childhood mortality in many countries.
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Patient Education

  • Because reovirus and rotavirus infections occur by fecal-oral transmission, wastewater treatment and sanitation are significant control measures.
  • Colorado tick fever: Education is by far the best means of preventing the disease. The public should be periodically reminded of the clinical features of CTF and the ticks that transmit the causative agents. Repellents can be sprayed on clothing or applied to exposed skin. Remind patients and family members to tuck long pants into socks, to wear shirts tucked in, and to inspect clothing and skin frequently for attached ticks. Identifying ticks on light-colored clothing is easier.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center and Children's Health Center. Also, see eMedicine's patient education articles Ticks and Sudden Infant Death Syndrome (SIDS).
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Contributor Information and Disclosures
Author

Gholamreza Rasouli, MD  Fellow, Department of Medicine, Division of Infectious Diseases, Louisiana State University Medical Center at Shreveport

Gholamreza Rasouli, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 Author of chapter; MERCK None Other

Specialty Editor Board

Wesley W Emmons, MD, FACP  Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE

Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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