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Rotavirus Treatment & Management

  • Author: David D Nguyen, MD, FACEP; Chief Editor: Kirsten A Bechtel, MD  more...
Updated: Sep 13, 2015

Prehospital Care

Prehospital care of affected infants should be directed toward ensuring a secure airway, breathing, identification of circulatory compromise, and maintenance of adequate circulation. Field personnel may not be able to achieve access in the child with a contracted circulatory volume.

Infants who appear significantly dehydrated ideally should have 20 mL/kg isotonic sodium chloride solution or Ringer lactate solution administered en route to the hospital.

Patients who are less severely affected need only monitored transport.

The destination ED should be an ED approved for pediatrics (EDAP) or a pediatric critical care center (PCCC).


Emergency Department Care

After ensuring proper airway and breathing and assessing circulation, identification and treatment of dehydrated infants is the main objective. In many cases, appropriate rehydration may be accomplished using established oral rehydration protocols. Lethargic children require a fingerstick glucose level immediately either by EMS or in the ED.

For severely dehydrated children, vascular access (often via an IO line) is required.

Administer 20 mL/kg boluses until volume is restored. A total requirement of 60-80 mL/kg is not uncommon.

If more than 40 mL/kg is necessary, consider electrolytes, BUN, and creatinine levels.

Maintenance of hydration the key issue for children who are not dehydrated. Selection of an appropriate fluid is crucial. Some data show that administration of a bolus of 5% dextrose in 0.9% saline can help lower the level of serum ketones in dehydrated gastroenteritis patients.[20] A reduction in hospitalization rate, however, was not seen in this study comparing patients who received dextrose in 0.9% saline compared with those receiving 0.9% saline.[20]

Infants who receive hyperosmolar fluids (eg, commercial soft drinks, sports drinks, gelatin) and those who are fed high salt-content solutions (eg, commercial soup, boiled milk) are at risk for significant hypernatremia.

Ideal maintenance beverages for dehydrated infants with viral enteritis are commercial infant solutions such as Pedialyte and Rice-Lyte. These beverages contain a small amount (usually 2-3%) of glucose and the correct balance of sodium and potassium.

Rehydrating infants with these beverages may be particularly difficult within the first 2 days of the illness because vomiting frequently occurs.

If the infant is vomiting, administer small, frequent feedings.

Once vomiting has resolved, the baby may be given a standard soy-based infant formula. This formula provides adequate energy intake for intestinal healing.

Supplemental feedings of oral maintenance solutions may be administered if fluid losses are excessive.

Avoid sports drinks and other hyperosmolar beverages for the reasons previously stated. Similarly, excessive free-water intake may predispose the infant to hyponatremia.

Antiemetics may be considered for children older than 6 months to control emesis.

Contributor Information and Disclosures

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, Texas Medical Association, Harris County Medical Society

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, MD, MMM is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American Association for Physician Leadership, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Sally S Henin, MD, FACEP Medical Director, Forensic Nursing Services, Memorial Hermann Health System

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Kirsten A Bechtel, MD Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine; Co-Director, Injury Free Coalition for Kids, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Additional Contributors

Garry Wilkes, MBBS, FACEM Director of Clinical Training (Simulation), Fiona Stanley Hospital; Clinical Associate Professor, University of Western Australia; Adjunct Associate Professor, Edith Cowan University, Western Australia

Disclosure: Nothing to disclose.

  1. Laidman J. Rotavirus Vaccine Greatly Reduced Healthcare Use. Medscape Medical News. Available at Accessed: June 12, 2014.

  2. Leshem E, Moritz RE, Curns AT, Zhou F, Tate JE, Lopman BA, et al. Rotavirus Vaccines and Health Care Utilization for Diarrhea in the United States (2007-2011). Pediatrics. 2014 Jun 9. [Medline].

  3. Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009 Feb 6. 58:1-25. [Medline]. [Full Text].

  4. US Food and Drug Administration. FDA safety communication: FDA releases final study results of a Mini-Sentinel Postlicensure Observational Study of rotavirus vaccines and intussusception [press release]. June 13, 2013. Available at Accessed: September 3, 2013.

  5. Turcios RM, Curns AT, Holman RC, et al. Temporal and geographic trends of rotavirus activity in the United States, 1997-2004. Pediatr Infect Dis J. 2006 May. 25(5):451-4. [Medline].

  6. Gilger MA, Matson DO, Conner ME, Rosenblatt HM, Finegold MJ, Estes MK. Extraintestinal rotavirus infections in children with immunodeficiency. J Pediatr. 1992 Jun. 120(6):912-7. [Medline].

  7. FDA Approves New Vaccine to Prevent Gastroenteritis Caused by Rotavirus. US Food and Drug Administration. April 3, 2008. Available at

  8. Yee EL, Staat MA, Azimi P, Bernstein DI, Ward RL, Schubert C, et al. Burden of rotavirus disease among children visiting pediatric emergency departments in Cincinnati, Ohio, and Oakland, California, in 1999-2000. Pediatrics. 2008 Nov. 122(5):971-7. [Medline].

  9. Linhares AC, Bresee JS. Rotavirus vaccines and vaccination in Latin America. Rev Panam Salud Publica. 2000 Nov. 8(5):305-31. [Medline].

  10. Christie CD, Duncan ND, Thame KA, Onorato MT, Smith HD, Malcolm LG, et al. Pentavalent rotavirus vaccine in developing countries: safety and health care resource utilization. Pediatrics. 2010 Dec. 126(6):e1499-506. [Medline].

  11. Rotavirus surveillance--worldwide, 2001-2008. MMWR Morb Mortal Wkly Rep. 2008 Nov 21. 57(46):1255-7. [Medline]. [Full Text].

  12. Danchin MH, Bines JE. Defeating rotavirus? The global recommendation for rotavirus vaccination. N Engl J Med. 2009 Nov 12. 361(20):1919-21. [Medline].

  13. Fischer TK, Viboud C, Parashar U, et al. Hospitalizations and deaths from diarrhea and rotavirus among children 111111111J Infect Dis</i>. 2007 Apr 15. 195(8):1117-25. [Medline].

  14. MacReady N. Rotavirus vaccine benefits extend beyond immediate targets. Medscape Medical News. August 27, 2013. Available at Accessed: September 3, 2013.

  15. Gastañaduy PA, Curns AT, Parashar UD, Lopman BA. Gastroenteritis hospitalizations in older children and adults in the United States before and after implementation of infant rotavirus vaccination. JAMA. 2013 Aug 28. 310(8):851-3. [Medline].

  16. Newman RD, Grupp-Phelan J, Shay DK, Davis RL. Perinatal risk factors for infant hospitalization with viral gastroenteritis. Pediatrics. 1999 Jan. 103(1):E3. [Medline].

  17. Anderson EJ, Weber SG. Rotavirus infection in adults. Lancet Infect Dis. 2004 Feb. 4(2):91-9. [Medline].

  18. Dennehy PH, Cortese MM, Begue RE, et al. A case-control study to determine risk factors for hospitalization for rotavirus gastroenteritis in U.S. children. Pediatr Infect Dis J. 2006 Dec. 25(12):1123-31. [Medline].

  19. Rotavirus vaccines. WHO position paper – January 2013. Wkly Epidemiol Rec. 2013 Feb 1. 88(5):49-64. [Medline].

  20. Levy JA, Bachur RG, Monuteaux MC, Waltzman M. Intravenous Dextrose for Children With Gastroenteritis and Dehydration: A Double-Blind Randomized Controlled Trial. Ann Emerg Med. 2012 Sep 5. [Medline].

  21. Cezard JP, Bellaiche M, Viala J, Hugot JP. [Medication in infectious acute diarrhea in children]. Arch Pediatr. 2007 Oct. 14 Suppl 3:S169-75. [Medline].

  22. Martinot A, Pruvost I, Aurel M, Hue V, Dubos F. [Improvement in the management of acute diarrhoea in France?]. Arch Pediatr. 2007 Oct. 14 Suppl 3:S181-5. [Medline].

  23. Fleisher GR. Infectious disease emergencies. Fleisher GR, Ludwig S, Silverman BK, eds. Synopsis of Pediatric Emergency Medicine. 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2002. 298-325.

  24. Roslund G, Hepps TS, McQuillen KK. The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial. Ann Emerg Med. 2008 Jul. 52(1):22-29.e6. [Medline].

  25. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. September 7, 2011;

  26. Turck D. [Prevention and treatment of acute diarrhea in infants]. Arch Pediatr. 2007 Nov. 14(11):1375-8. [Medline].

  27. Prevention of rotavirus disease: updated guidelines for use of rotavirus vaccine. Pediatrics. 2009 May. 123(5):1412-20. [Medline].

  28. 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].

  29. Cortes JE, Curns AT, Tate JE, Cortese MM, Patel MM, Zhou F, et al. Rotavirus vaccine and health care utilization for diarrhea in US children. N Engl J Med. 2011 Sept 22. 365:1108-1117.

  30. Dennehy PH, Bertrand HR, Silas PE, Damaso S, Friedland LR, Abu-Elyazeed R. Coadministration of RIX4414 oral human rotavirus vaccine does not impact the immune response to antigens contained in routine infant vaccines in the United States. Pediatrics. 2008 Nov. 122(5):e1062-6. [Medline].

  31. Global Advisory Committee on Vaccine Safety, December 2011. Wkly Epidemiol Rec. 2012 Feb 10. 87(6):53-9. [Medline].

  32. Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2012 Feb 15. 2:CD008521. [Medline].

  33. Wang FT, Mast TC, Glass RJ, Loughlin J, Seeger JD. Effectiveness of an Incomplete RotaTeq® (RV5) Vaccination Regimen in Preventing Rotavirus Gastroenteritis in the United States. Pediatr Infect Dis J. 2012 Sep 25. [Medline].

  34. Payne DC, Boom JA, Staat MA, Edwards KM, Szilagyi PG, Klein EJ, et al. Effectiveness of pentavalent and monovalent rotavirus vaccines in concurrent use among US children 1111Clin Infect Dis</i>. 2013 Mar 13. [Medline].

  35. Mast TC, Wang FT, Su S, Seeger JD. Evidence of herd immunity and sustained impact of rotavirus vaccination on the reduction of rotavirus-related medical encounters among infants from 2006 through 2011 in the United States. Pediatr Infect Dis J. 2015 Jun. 34 (6):615-20. [Medline].

  36. Pollard SL, Malpica-Llanos T, Friberg IK, Fischer-Walker C, Ashraf S, Walker N. Estimating the herd immunity effect of rotavirus vaccine. Vaccine. 2015 Jul 31. 33 (32):3795-800. [Medline].

  37. Givon-Lavi N, Greenberg D, Dagan R. Comparison between two severity scoring scales commonly used in the evaluation of rotavirus gastroenteritis in children. Vaccine. 2008 Oct 29. 26(46):5798-801. [Medline].

  38. Sarker SA, Jäkel M, Sultana S, Alam NH, Bardhan PK, Chisti MJ, et al. Anti-Rotavirus Protein Reduces Stool Output in Infants With Diarrhea: A Randomized Placebo-Controlled Trial. Gastroenterology. 2013 Jul 2. [Medline].

  39. La Frazia S, Ciucci A, Arnoldi F, Coira M, Gianferretti P, Angelini M, et al. Thiazolides, a new class of antiviral agents effective against rotavirus infection, target viral morphogenesis inhibiting viroplasm formation. J Virol. 2013 Aug 7. [Medline].

  40. Information on RotaTeq and Intussusception. US Food and Drug Administration. February 13, 2007. Available at

  41. Patel MM, López-Collada VR, Bulhões MM, De Oliveira LH, Bautista Márquez A, Flannery B, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med. 2011 Jun 16. 364(24):2283-92. [Medline].

  42. Buttery JP, Danchin MH, Lee KJ, Carlin JB, McIntyre PB, Elliott EJ, et al. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine. 2011 Apr 5. 29(16):3061-6. [Medline].

  43. Haber P, Patel M, Izurieta HS, Baggs J, Gargiullo P, Weintraub E, et al. Postlicensure monitoring of intussusception after RotaTeq vaccination in the United States, February 1, 2006, to September 25, 2007. Pediatrics. 2008 Jun. 121(6):1206-12. [Medline].

  44. Belongia EA, Irving SA, Shui IM, Kulldorff M, Lewis E, Yin R, et al. Real-time surveillance to assess risk of intussusception and other adverse events after pentavalent, bovine-derived rotavirus vaccine. Pediatr Infect Dis J. 2010 Jan. 29(1):1-5. [Medline].

  45. Zickafoose JS, Benneyworth BD, Riebschleger MP, Espinosa CM, Davis MM. Hospitalizations for Intussusception Before and After the Reintroduction of Rotavirus Vaccine in the United States. Arch Pediatr Adolesc Med. 2012 Jan 2. [Medline].

  46. Desai R, Parashar UD, Lopman B, Helena de Oliveira L, Clark AD, Sanderson CF, et al. Potential intussusception risk versus health benefits from rotavirus vaccination in latin america. Clin Infect Dis. 2012 May. 54(10):1397-405. [Medline].

  47. Information Pertaining to Labeling Revision for RotaTeq. US Food and Drug Administration. June 15, 2007. Available at

  48. Greenberg HB. Rotavirus vaccination and intussusception--act two. N Engl J Med. 2011 Jun 16. 364(24):2354-5. [Medline].

  49. Tate JE, Cortese MM, Payne DC, Curns AT, Yen C, Esposito DH, et al. Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data. Pediatr Infect Dis J. 2011 Jan. 30(1 Suppl):S56-60. [Medline].

  50. Clark HF, Lawley D, Matthijnssens J, DiNubile MJ, Hodinka RL. Sustained decline in cases of rotavirus gastroenteritis presenting to the Children's Hospital of Philadelphia in the new rotavirus vaccine era. Pediatr Infect Dis J. 2010 Aug. 29(8):699-702. [Medline].

  51. Wang FT, Mast TC, Glass RJ, Loughlin J, Seeger JD. Effectiveness of the pentavalent rotavirus vaccine in preventing gastroenteritis in the United States. Pediatrics. 2010 Feb. 125(2):e208-13. [Medline].

  52. Boom JA, Tate JE, Sahni LC, Rench MA, Hull JJ, Gentsch JR, et al. Effectiveness of pentavalent rotavirus vaccine in a large urban population in the United States. Pediatrics. 2010 Feb. 125(2):e199-207. [Medline].

  53. Yen C, Tate JE, Wenk JD, Harris JM 2nd, Parashar UD. Diarrhea-associated hospitalizations among US children over 2 rotavirus seasons after vaccine introduction. Pediatrics. 2011 Jan. 127(1):e9-e15. [Medline].

  54. Tate JE, Mutuc JD, Panozzo CA, Payne DC, Cortese MM, Cortes JE, et al. Sustained decline in rotavirus detections in the United States following the introduction of rotavirus vaccine in 2006. Pediatr Infect Dis J. 2011 Jan. 30(1 Suppl):S30-4. [Medline].

  55. Gastanaduy PA, Sanchez-Uribe E, Esparza-Aguilar M, et al. Effect of Rotavirus Vaccine on Diarrhea Mortality in Different Socioeconomic Regions of Mexico. Pediatrics. 2013 Mar 4. [Medline].

  56. Tate JE, Haynes A, Payne DC, et al. Trends in National Rotavirus Activity before and After Introduction of Rotavirus Vaccine into the National Immunization Program in the United States, 2000-2012. Pediatr Infect Dis J. 2013 Feb 19. [Medline].

  57. Leshem E, Tate JE, Steiner CA, Curns AT, Lopman BA, Parashar UD. Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine. JAMA. 2015 Jun 9. 313 (22):2282-4. [Medline].

  58. Aliabadi N, Tate JE, Haynes AK, Parashar UD, Centers for Disease Control and Prevention (CDC). Sustained decrease in laboratory detection of rotavirus after implementation of routine vaccination—United States, 2000-2014. MMWR Morb Mortal Wkly Rep. 2015 Apr 10. 64 (13):337-42. [Medline].

  59. Karafillakis E, Hassounah S, Atchison C. Effectiveness and impact of rotavirus vaccines in Europe, 2006-2014. Vaccine. 2015 Apr 27. 33 (18):2097-107. [Medline].

  60. Anderson EJ, Rupp A, Shulman ST, Wang D, Zheng X, Noskin GA. Impact of rotavirus vaccination on hospital-acquired rotavirus gastroenteritis in children. Pediatrics. 2011 Feb. 127(2):e264-70. [Medline].

  61. Flores AR, Szilagyi PG, Auinger P, Fisher SG. Estimated burden of rotavirus-associated diarrhea in ambulatory settings in the United States. Pediatrics. 2010 Feb. 125(2):e191-8. [Medline].

  62. Urueña A, Pippo T, Betelu MS, Virgilio F, Hernández L, Giglio N, et al. Cost-effectiveness analysis of rotavirus vaccination in Argentina. Vaccine. 2015 May 7. 33 Suppl 1:A126-34. [Medline].

  63. Javanbakht M, Moradi-Lakeh M, Yaghoubi M, Esteghamati A, Mansour Ghanaie R, Mahmoudi S, et al. Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran. Vaccine. 2015 May 7. 33 Suppl 1:A192-200. [Medline].

  64. Ahmeti A, Preza I, Simaku A, Nelaj E, Clark AD, Felix Garcia AG, et al. Cost-effectiveness of rotavirus vaccination in Albania. Vaccine. 2015 May 7. 33 Suppl 1:A201-8. [Medline].

  65. Rheingans RD, Antil L, Dreibelbis R, Podewils LJ, Bresee JS, Parashar UD. Economic costs of rotavirus gastroenteritis and cost-effectiveness of vaccination in developing countries. J Infect Dis. 2009 Nov 1. 200 Suppl 1:S16-27. [Medline].

  66. Kim SY, Goldie SJ, Salomon JA. Cost-effectiveness of Rotavirus vaccination in Vietnam. BMC Public Health. 2009 Jan 21. 9:29. [Medline].

  67. Rossignol JF, Abu-Zekry M, Hussein A, Santoro MG. Effect of nitazoxanide for treatment of severe rotavirus diarrhoea: randomised double-blind placebo-controlled trial. Lancet. 2006 Jul 8. 368(9530):124-9. [Medline].

  68. Rogers M, Weinstock DM, Eagan J, Kiehn T, Armstrong D, Sepkowitz KA. Rotavirus outbreak on a pediatric oncology floor: possible association with toys. Am J Infect Control. 2000 Oct. 28(5):378-80. [Medline].

  69. Tamimi AH, Carlino S, Edmonds S, Gerba CP. Impact of an alcohol-based hand sanitizer intervention on the spread of viruses in homes. Food Environ Virol. 2014 Jun. 6 (2):140-4. [Medline].

  70. Tamimi AH, Edmonds-Wilson SL, Gerba CP. Use of a Hand Sanitizing Wipe for Reducing Risk of Viral Illness in the Home. Food Environ Virol. 2015 Jun 11. [Medline].

  71. Bass DM. Rotavirus and other agents of viral gastroenteritis. Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 2004. 1081-3.

  72. Bines JE. Rotavirus vaccines and intussusception risk. Curr Opin Gastroenterol. 2005 Jan. 21(1):20-5. [Medline].

  73. Hamilton JR. Viral enteritis. Pediatr Clin North Am. 1988 Feb. 35(1):89-101. [Medline].

  74. Hand L. Rotavirus Vaccine May Also Prevent Related Infant Seizures. Medscape [serial online]. Available at Accessed: November 25, 2013.

  75. Kombo LA, Gerber MA, Pickering LK, Atreya CD, Breiman RF. Intussusception, infection, and immunization: summary of a workshop on rotavirus. Pediatrics. 2001 Aug. 108(2):E37. [Medline].

  76. Payne DC, Baggs J, Zerr DM, Klein NP, Yih K, Glanz J, et al. Protective Association Between Rotavirus Vaccination and Childhood Seizures in the Year Following Vaccination in US Children. Clin Infect Dis. 2013 Nov 20. [Medline].

  77. Peter G, Myers MG. Intussusception, rotavirus, and oral vaccines: summary of a workshop. Pediatrics. 2002 Dec. 110(6):e67. [Medline].

  78. Pickering LK, Cleary TG. Infections of the gastrointestinal tract. Gershon AA, Hotez PF, Katz SL, eds. Krugman's Infectious Diseases of Children. 2004. 220-1.

  79. Ramig RF. Pathogenesis of intestinal and systemic rotavirus infection. J Virol. 2004 Oct. 78(19):10213-20. [Medline].

  80. Santosham M, Foster S, Reid R, et al. Role of soy-based, lactose-free formula during treatment of acute diarrhea. Pediatrics. 1985 Aug. 76(2):292-8. [Medline].

  81. 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].

  82. Widdowson MA, Bresee JS, Gentsch JR, Glass RI. Rotavirus disease and its prevention. Curr Opin Gastroenterol. 2005 Jan. 21(1):26-31. [Medline].

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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