Rotavirus 

  • Author: David D Nguyen, MD, FACEP; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jan 17, 2012
 

Background

Rotavirus is one of several viruses known to cause gastroenteritis. The rotavirus genome consists of 11 segments of double-stranded RNA enclosed in a double-shelled capsid. It is classified in the Reoviridae family. Rotavirus is a self-limited infection. Fluid stool losses may be dramatic, and death from dehydration is not uncommon, particularly in developing countries.

Transmission electron micrograph of rotavirus. ImaTransmission electron micrograph of rotavirus. Image courtesy of Centers for Disease Control and Prevention. Transmission electron micrograph of intact rotavirTransmission electron micrograph of intact rotavirus particles, double-shelled. Image courtesy of Centers for Disease Control and Prevention and Dr. Erskine Palmer.

Rotavirus infection most commonly strikes during the winter months (December through May), but it occurs year round in developing countries. In the United States every year, rotavirus first appears in the Southwest and spreads to the Northeast.[1] Almost every child 5 years and younger at some point will be infected with rotavirus in both developed countries and developing countries.

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Pathophysiology

Rotavirus, like other viruses that cause enteritis, primarily infects the cells of the small intestinal villi, especially those cells near the tips of the villi. Because these particular cells have a role in the digestion of carbohydrates and in the intestinal absorption of fluid and electrolytes, rotavirus infections lead to malabsorption by impaired hydrolysis of carbohydrates and excessive fluid loss from the intestine. A secretory component of the diarrhea with increased motility can further exacerbate the illness. This increased motility appears to be secondary to virus-induced functional changes at the villus epithelium.

The pathologic changes to the intestinal lining may not correlate well with the clinical manifestations of the illness. In normal hosts, infections rarely occur in another organ system, although extraintestinal infections have been seen in immunocompromised hosts.[2]

The virus is shed in high titers in the stool starting before the onset of symptoms and persists for up to 10 days after symptom appearance.

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Epidemiology

Frequency

United States

Before the introduction of the rotavirus vaccines, this virus was estimated to cause 2.1-3.2 million diarrheal illnesses each year, with 55,000-70,000 of these requiring hospitalization annually.[3, 4, 5] In the 1990s and early 2000s, 410,000-600,000 office visits and 205,000-272,000 emergency department annual visits were attributed to rotavirus, and this resulted in yearly direct and indirect costs of the illness to be approximately $1 billion.[3, 5]

International

Worldwide incidence of rotavirus is estimated to cause more than 125 million cases of infantile diarrhea annually.[6] Rotavirus is the foremost cause of childhood dehydrating gastroenteritis worldwide.[3, 7] More than 2 million children younger than 5 years of age are hospitalized annually due to rotavirus gastroenteritis, and, of these, approximately 500,000-527,000 children die from this disease.[8, 9]

Mortality/Morbidity

Before the introduction of the newer rotavirus vaccines, rotavirus was estimated to cause 20-60 deaths annually in the United States in children younger than 5 years.[3, 10]

Approximately 500,000-527,000 deaths in children younger than 5 years are seen worldwide due to rotavirus.[8, 9] Virtually all these deaths occur as a result of hypovolemia.

Significant morbidity is rare in the United States, but dehydration and shock can result in ischemic injury to the kidneys or the central nervous system.

Children who become severely dehydrated may develop deep venous thromboses or cerebral venous thromboses.

Race

Race is not a factor in rotavirus infection, but one study did show that there was a reduced risk of hospitalization in infants born from Asian mothers in Washington State.[11] Socioeconomic class also plays an important role as this disease is more prevalent among children with Medicaid insurance.[11]

Sex

Rotavirus affects males and females equally, although males with viral gastroenteritis have been associated with an increased risk of hospitalization compared with females.[11]

Age

Rotavirus can cause illness in adults and children. However, adults are often asymptomatic or less severely affected.

Adults, if affected, usually have a few days of nausea, anorexia, and cramping pain.[12] Diarrhea is a less significant symptom in adults than in children.

Young children aged 4-24 months, particularly those in group daycare settings, are at increased risk for acquiring rotavirus.

Low birth weight and prematurity as well as the paucity of breastfeeding have been associated with hospitalization from rotavirus.[13]

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Contributor Information and Disclosures
Author

David D Nguyen, MD, FACEP  Clinical Assistant Professor of Emergency Medicine, The University of Texas Medical Branch at Galveston, TX

David D Nguyen, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Harris County Medical Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sally Henin Awad, MD, FACEP  Medical Director, Forensic Nursing Program, Memorial Hermann Hospital System

Sally Henin Awad, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Writers Association, American Professional Society on the Abuse of Children, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Brent R King  MD, MMM, Clive Nancy and Pierce Runnells Distinguished Professor of Emergency Medicine; Professor of Pediatrics, University of Texas Health Science Center at Houston; Chair, Department of Emergency Medicine, Chief of Emergency Services, Memorial Hermann Hospital and LBJ Hospital

Brent R King is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American College of Physician Executives, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes  MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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Transmission electron micrograph of rotavirus. Image courtesy of Centers for Disease Control and Prevention.
Transmission electron micrograph of intact rotavirus particles, double-shelled. Image courtesy of Centers for Disease Control and Prevention and Dr. Erskine Palmer.
This electron micrograph reveals a number of RNA rotavirus virions, and a number of unknown, 29nm virion particles. Image courtesy of Centers for Disease Control and Prevention.
 
 
 
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