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CE:8 page 2/8/08 2:25 PM Page 23 CASE STUDY Rotavirus WHAT IS ROTAVIRUS INFECTION? Rotavirus infection is a viral infection of the bowel that causes fever, diarrhea, and vomiting. It is the leading cause of severe gastroenteritis in infants and young children. It can often occur in epidemics affecting mainly children under 2 years of age. HOW IS IT SPREAD? Spread occurs when hands, objects (such as toys), food, or water contaminated by tiny amounts of feces from infected people are put into the mouth of an uninfected person. It is also possible that the virus can be transmitted by coughing and sneezing. WHO IS AT RISK? Those most at risk of infection are people in close contact with sick children, for example living in the same house (parents or siblings), or attending the same day care or school. Spread is also known to occur in hospital settings. The illness can cause severe dehydration, particularly in children under 6 months of age. Some children may need admission to hospital and intravenous fluids. WHAT ARE THE SYMPTOMS? The main symptoms are fever, vomiting, and watery diarrhea which may lead to dehydration and rapid weight loss. The time between becoming infected and developing symptoms is usually between 24 to 72 hours. The symptoms start suddenly and last for four to six days. WHAT IS THE INFECTIOUS PERIOD? A person with rotavirus is infectious while unwell and sometimes for several days afterwards. Most people are no longer infectious after the eighth day. WHAT IS THE TREATMENT? There is no medication that specifically treats rotavirus infection. Management focuses on preventing and treating dehydration caused by vomiting or diarrhea. Anyone with vomiting or diarrhea should drink extra fluids to avoid dehydration. Rehydration therapy with oral glucose/electrolyte solution is particularly effective. If children refuse this solution, diluted fruit juice or soft drinks may be given (one part juice/soft drink to three parts water). Babies should continue to be offered their normal milk feeds plus extra fluids in between feeds. Children with diarrhea who vomit or who refuse extra fluids should see a doctor. Medicines to prevent vomiting or diarrhea should not be given, especially to children, except when prescribed by a doctor. JANUARY | FEBRUARY 2008 HOW CAN ROTAVIRUS INFECTION BE PREVENTED? Rotavirus Vaccine. Rotavirus vaccine is 70 percent effective in preventing any rotavirus gastroenteritis and 85 to 100 percent effective in preventing severe rotavirus gastroenteritis. Centers for Disease Control. The Rotarix® rotavirus vaccine is given by mouth and should be given at the same time as the other vaccines that are due at 2 and 4 months of age. Giving each dose of rotavirus vaccine on time is very important as late or catch-up doses are not to be given. This is because the vaccine has not been tested in older babies and it is not registered for use outside the specific age groups. The first dose of rotavirus vaccine must be given by 14 weeks of age, and the second dose by 24 weeks of age. There is another rotavirus vaccine available. This vaccine, RotaTeq®, requires three doses of vaccine and has slightly different age restrictions for administration. Fewer than 5 percent of children who have the vaccine experience any side effects, which include loss of appetite, diarrhea, fever, and flatulence. Large studies, each involving over 60,000 babies, have found that neither of these two rotavirus vaccines are associated with any severe side effects. Rotavirus vaccine is a live attenuated vaccine. It is not yet known whether the virus from the vaccine can pass from a vaccinated baby to another person. However, it is thought that even if the virus from the vaccine can be transmitted to another person, the risk of side effects from this vaccine virus in someone with lowered immunity would be less than the risk of severe gastroenteritis from rotavirus infection in that person. Therefore babies who live in the same house as someone with lowered immunity should receive rotavirus vaccine. Information about vaccination is available from your doctor, health center, or Centers for Disease Control. Other Preventive Measures. Although the exact mode of transmission is unclear, overall good hygiene is felt to be the best way to prevent rotavirus infection spreading. Hands should be washed thoroughly with warm soapy water: • after going to the toilet • before preparing or handling food • after every diaper change • after changing soiled linen Other measures include: • never change diapers on tables or counters where food is prepared or eaten • clean change areas with warm soapy water and disinfectant after every change • clean books, toys, equipment, furnishings, floors, and toilets regularly (including toilet door handles) • People with diarrhea should not prepare or handle food that will be eaten by others. • Anyone with diarrhea should not attend childcare/ school/work until the diarrhea has ceased. • Anyone with diarrhea should not swim, wade, or paddle in public pools. W W W. C A L N U R S E S . O R G REGISTERED NURSE 23

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