Rotavirus

What is rotavirus?

Rotavirus is a viral infection that can cause gastroenteritis. Gastroenteritis is an infection of the gut (intestines) which causes symptoms of being sick (vomiting) and diarrhoea. It usually also causes a fever.

How is rotavirus spread?

Rotavirus is present in the gut (intestines) of an infected person and can pass out in their diarrhoea. It is easily spread from an infected person to another by close contact. This is often because the virus is on the infected person's hands after they have been to the toilet. For smaller children who wear nappies, it may be spread by the hands of the person changing the infected child's nappy. Surfaces or objects touched by the infected person can also allow the virus to spread. The virus can be passed on if the infected person prepares food. Outbreaks of rotavirus that affect many people can occur - for example, in nurseries or schools.

It usually takes about 48 hours after first contact with rotavirus before symptoms develop. This period is known as the 'incubation period' for the virus. The person is still contagious until about ten days after their diarrhoea settles.

How common is rotavirus?

Rotavirus is the most common virus causing gastroenteritis in children in the UK (and worldwide). Almost every child in the UK has a rotavirus infection before they are 5 years old. Rotavirus infection is most common in children between the ages of 6 months and 2 years.

Around 18,000 children are thought to be admitted to hospital each year in England and Wales because of rotavirus infection. Most children with rotavirus infection do not need admission to hospital: only about 1 child in 10 who has rotavirus infection In the UK needs to be admitted to hospital.

Adults can become infected with rotavirus but the infection is usually very mild. Rotavirus infection is more common in infants and younger children than in teenagers. In the UK, rotavirus infection is seasonal. The virus is more common during the winter season from November to April.

Rotavirus symptoms

The first symptoms are usually a high temperature (fever) and being sick (vomiting). Watery diarrhoea then follows. The diarrhoea can range from mild to severe. The diarrhoea may clear up in about three days but, in some cases, it can last for up to nine days. Your child may also have some uncomfortable stomach cramps. These may ease off after each time they pass some diarrhoea.

With vomiting and diarrhoea, there is a risk of your child becoming lacking in fluid in their body (dehydrated). You should consult a doctor quickly if you suspect that your child is becoming dehydrated. Mild dehydration is common and is usually easily and quickly treated by drinking lots of water, milk or juice. Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to work normally.

Symptoms of dehydration

• Symptoms of dehydration in children include passing little urine, a dry mouth, a dry tongue and lips, fewer tears when crying, sunken eyes, weakness, being irritable or having no energy.
• Symptoms of severe dehydration in children include drowsiness, pale or mottled skin, cold hands or feet, very few wet nappies, and fast (but often shallow) breathing. This is a medical emergency and immediate medical attention is needed.

Dehydration is more likely to occur in:

• Children under the age of 1 year (especially those under 6 months old). This is because babies don't need to lose much fluid to become dehydrated.
• Children under the age of 1 year who were a low birth weight and who have not 'caught up' with their weight.
• Any child with severe diarrhoea and vomiting - especially if they have passed six or more very loose stools (faeces) or vomited three or more times in the previous 24 hours.

How is rotavirus diagnosed?

Rotavirus is usually diagnosed after a sample of your child's stool (faeces) is sent to the laboratory for testing. However for most children who have a bout of gastroenteritis, it is not necessary to send a stool sample to be tested. This is because the treatment is the same even if you know the cause: drink plenty of water, milk or juice.

How long does rotavirus last?

In the western world most children recover within a week of symptoms starting.

When should I seek medical advice?

Most children who have gastroenteritis in the UK (including gastroenteritis caused by rotavirus infection) have mild symptoms which will get better in a few days. The important thing is to ensure that they have plenty to drink. In many cases, you do not need to seek medical advice. However, you should seek medical advice in the following situations (or if there are any other symptoms that you are concerned about):

• If your child is under the age of 6 months.
• If your child has an underlying medical condition (for example, heart or kidney problems, diabetes, history of premature birth).
• If your child has a high temperature (fever).
• If you suspect a lack of fluid in the body (dehydration) is developing (see earlier).
• If your child appears drowsy or confused.
• If your child is being sick a lot and unable to keep fluids down.
• If there is blood in their diarrhoea or vomit.
• If your child has severe tummy pain.
• If your child has a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment or HIV infection.
• Infections caught abroad.
• If your child has severe symptoms, or if you feel that their condition is getting worse.
• If your child's symptoms are not settling - for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 5-7 days.

How do you treat rotavirus?

There is no special medication to treat rotavirus. The aim is to make sure that your child has plenty of fluids and does not become dehydrated. Children can usually be cared for at home. Occasionally, admission to hospital is needed if symptoms are severe or to treat any dehydration.

Fluids to prevent dehydration

You should encourage your child to drink plenty. The aim is to prevent dehydration. The fluid lost in what they bring up (their vomit) and/or their diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids.

Babies under 6 months old are at increased risk of dehydration. You should seek medical advice if they develop diarrhoea and vomiting. Breast or bottle feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds. If you are breastfeeding, make sure you stay well hydrated too.

Rehydration drinks may be advised by a healthcare professional for children at increased risk of dehydration (see above for whom this may be). They are made from sachets available from pharmacies and on prescription. You should be given instructions about how much to give. Rehydration drinks provide a perfect balance of water, salts, and sugar. The small amount of sugar and salt helps water to be absorbed better from the gut (intestines) into the body. Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available but they have to be made carefully as too much salt can be dangerous to a child. Rehydration drinks are cheap and readily available in the UK, and are the best treatment for your child.

If your child vomits, wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.

Fluids to treat dehydration

If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. Read the instructions carefully for advice about how to make up the drinks and about how much to give. This can depend on the age and the weight of your child. At home, you could give diluted apple juice in a mix of half apple juice and half water. If you are breastfeeding, you should continue with this during this time. Otherwise, don't give your child any other drinks unless the doctor or nurse has said that this is OK. It is important that your child is rehydrated before they have any solid food.

Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a nasogastric tube. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with fluids given directly into a vein (intravenous fluids).

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, encourage your child to have their normal diet. You do not need to leave out any types of food. This used to be advised but is now known to be wrong. So:

• Breastfed babies should continue to be breast-fed if they will take it. This will usually be in addition to extra rehydration drinks (described above).
• Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above).
• Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important, and food can wait until the appetite returns.

Medication is not usually needed

You should not give medicines to stop diarrhoea to children under 12 years old. They are unsafe to give to children and can have possible serious complications. However, you can give paracetamol to ease any distress associated with a high temperature or headache.

Are there any complications?

Complications of rotavirus infection are not very common. If they do occur, they can include the following:

Dehydration and salt (electrolyte) imbalance in the body

This is the most likely complication. It occurs if the water and salts that have been lost are not replaced by drinking enough fluids. If your child drinks well, it is unlikely to occur, or is only likely to be mild and will soon recover as your child drinks.

Lactose intolerance

This can sometimes occur for a period of time after rotavirus infection. It is known as 'secondary' or 'acquired' lactose intolerance. Your child's gut (intestine) lining can be damaged by the episode of gastroenteritis. This leads to a lack of an enzyme called lactase that is needed to help the body digest the milk sugar lactose. Lactose intolerance leads to bloating, tummy pain, wind and watery stools (faeces) after drinking milk. The condition gets better when the infection is over and the intestinal lining heals.

Preventing spread of infection to others

If your baby has rotavirus infection, be especially careful to wash your hands after changing nappies and before preparing, serving, or eating food. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry your hands properly after washing. For older children, whilst they have rotavirus, the following are recommended:

• Regularly clean the toilets used with disinfectant. Clean the flush handle, toilet seat, sink taps, bathroom surfaces and door handles at least daily with hot water and detergent. Disposable cleaning cloths should be used (or a cloth just for toilet use).
• If a potty has to be used, wear gloves when you handle it. Dispose of the contents into a toilet, wash the potty with hot water and detergent, and then leave it to dry.
• Make sure your child washes their hands after going to the toilet. Ideally, they should use liquid soap in warm running water, but any soap is better than none. Dry properly after washing.
• If clothing or bedding is soiled, first remove any diarrhoea into the toilet. Then wash in a separate wash at as high a temperature as possible.
• Don't let your child share towels and flannels.
• Don't let your child help to prepare food for others.
• Your child should stay off school or nursery for at least 48 hours after the last episode of diarrhoea or being sick. They should also avoid contact with other children where possible during this time.

Can rotavirus be prevented?

The advice given in the previous section is mainly aimed at preventing the spread of rotavirus infection from your child to other people. Good hygiene is essential to prevent the spread of many infections to others. Handwashing is the most important thing that you and your child can do. In particular, always wash your hands, and teach children to wash theirs:

• After going to the toilet (and after changing nappies or helping an older child to go to the toilet).
• Before preparing or touching food or drinks.
• Before eating.

If you smoke, you should also wash your hands before smoking. Washing hands regularly and properly is known to make a big difference to the chance of developing rotavirus and other gut infections.

Rotavirus vaccine

There is an effective vaccine against rotavirus. The vaccine has been used in many countries and has been shown to be safe and effective.

In the UK from July 2013 babies have received drops (by mouth) to help prevent rotavirus. These drops are given at 2 and 3 months of age. The vaccines are given at the same time as their other routine vaccinations.

How effective are the rotavirus vaccines?

The first vaccines against rotavirus were made in the 1990s and had to be withdrawn after they were found to cause too many side-effects. But scientists designed new vaccines and the main ones were licensed in 2006.

They have been tested carefully and have been found to be really effective: they can reduce the symptoms of rotavirus or even stop it happening, in around 3/4 of children who get vaccinated.

In the developing world, the benefits of the vaccines can be huge - potentially reducing the number of deaths from rotavirus by 75% (current estimates suggest about 130,000 children under 5 years of age die worldwide each year from rotavirus).

How safe are the rotavirus vaccines?

• Large studies have found that side-effects to the rotavirus vaccines are very rare.
• In general they are very safe vaccines.
• Any side-effects that have been thought to be caused by the rotavirus vaccines are also found, at the same rate, in children given placebo (fake) medicines.
• The benefits of the vaccine far outweigh any possible side-effects, particularly in the developing world.