An Overview of Rotavirus

Rotavirus, a highly contagious virus, was the most common cause of infectious gastroenteritis (stomach flu) among infants and children before vaccinations were introduced in 2006. Adults can also be infected with rotavirus, although they usually have milder symptoms.

The infection often resolves on its own within a week, but the associated nausea and vomiting can cause dehydration. While you or your child are recovering from rotavirus infection, it is important to stay hydrated and to prevent the spread of infection with strategies such as handwashing.

The symptoms of rotavirus infection are similar for children and adults. Usually, adults tend to have milder versions of the illness. Generally, the infection lasts for approximately three to eight days, but it can take up to two weeks to regain your appetite and weight.

The effects of rotavirus infection can include:

• Stomach pain, cramping, and discomfort
• Low-grade fever, and, rarely, a high fever of 103 degrees or above
• Vomiting
• Diarrhea
• Fatigue
• Loss of appetite
• Irritability
• Chills or feeling hot
• Constantly feeling thirsty

Very young children may become fussy, sleepy, and lose their appetite without knowing how to express their discomfort. Older children will often complain of stomach upset.

You or your child may become very hungry or crave certain foods (like saltines) shortly after vomiting, but may be unable to hold food down without experiencing recurrent vomiting or diarrhea.

Some adults exposed to the virus do not develop any symptoms at all, but can still spread it to other people.

Typically, a rotavirus infection lasts for only a few days. If it becomes prolonged, complications can occur, including:

• Dehydration, potentially requiring treatment with IV fluids
• Blood in the stools, which can appear red or black
• Weight loss
• Lethargy
• Low blood pressure
• Rapid pulse
• Dizziness
• Low amounts of urine or dark yellow urine

While it is a rare complication, rotavirus-induced gastroenteritis can cause death.

Anyone can catch rotavirus, at any age. You can become infected with the virus by exposure to food or objects that are contaminated with it. It is spread by the oral-fecal route, which means that a person who carries the virus can spread it by touching objects or preparing food if their hands have not been properly washed after using the toilet or vomiting.

The virus attacks the lining of the small intestine. Through a physiological process of osmosis, fluids and electrolytes flow into the digestive system, resulting in abdominal cramps, vomiting, and diarrhea.

Most children are exposed to the virus and develop rotavirus-induced stomach flu before the age of five. The illness results in long-lasting immunity in healthy children, and that is one of the reasons why adults typically do not always become sick when exposed to the virus.

Adults also do not usually experience severe effects of the infection. Adults weigh more than very young children, so the impact of the infection—loss of fluids, for example—is not as substantial to a healthy adult's overall health as it is for a very young child. And adults tend to eat food in moderation when they have gastroenteritis, which decreases the symptoms and helps maintain proper nutrition.

Elderly adults and those with a compromised immune system due to illness or chemotherapy can lose their immunity to the virus and are more susceptible to becoming very ill as a result of gastroenteritis.

In a healthy child or adult, gastroenteritis is diagnosed based on the clinical symptoms. If the effects of the infection are severe or persistent, your doctor may order tests to rule out complications or other medical conditions.

Typically, it is not necessary to identify the virus when you have mild gastroenteritis. However, the virus can be identified if it is not improving as expected or if there is a concern that you could have a different infection.

A stool sample can be used to determine which virus or bacteria is causing your infection. Your doctor would instruct you about how to collect a sample, and it would be sent for a laboratory culture to see if an infectious organism grows.

If there is a concern that you or your child could be dehydrated or at risk of severe dehydration, your medical team may order blood tests that can identify whether you have an electrolyte or fluid deficiency. These problems, which are more common when young babes have a rotavirus infection, can occur due to diarrhea, vomiting, and lack of drinking and/or eating.

If you or your child have severe abdominal pain or persistent symptoms, your medical team may want to rule out other conditions, such as appendicitis or bowel obstruction. Diagnostic tests such as abdominal ultrasound, computerized tomography (CT), endoscopy or colonoscopy may be needed.

If you have rotavirus, you can generally manage your illness at home with a few simple strategies.

• Hydration: The most important thing you can do is to focus on keeping yourself hydrated. It is essential that you drink water. If you prefer the taste, you can consider oral rehydration fluids or electrolyte-containing sports drinks, especially if you experience vomiting or diarrhea. Learn how to recognize dehydration.
• Nutrition: If you feel that your stomach can manage it, try to eat something. Start out with crackers or toast, since these are generally the best-tolerated foods. Avoid food that upsets your stomach, such as fatty, deep-fried, or spicy options.
• Rest: While you are sick, try to get some rest to prevent yourself from feeling run down. If you work, it is wise to call in sick so that you can give yourself a chance to recover.
• Medication: Over-the-counter diarrhea medications may prevent stomach discomfort and reduce your diarrhea, but keep in mind that they often have little effect.

Most people can manage rotavirus on their own, but in some cases, professional medical care is necessary.

Call your doctor or get urgent medical attention if you or your child experience any of the following:

• A fever over 100 degrees
• A fever lasting for longer than three or four days
• You feel like you cannot keep down any water or food
• Blood in your stool or dark-colored stools
• Vomiting blood
• Lethargy (extreme tiredness)
• Confusion
• Very little or no urine
• A weak or rapid heartbeat
• Very dry mouth
• Cool sensation in your arms and legs
• Difficulty breathing
• Difficulty walking or standing

While rotavirus is prevalent in the environment, there are a few strategies you can use to avoid getting and spreading it. It is a good idea to follow these precautions even when you do not have rotavirus or any other infection.

Rotavirus has a three to four day incubation period, during which you could be contagious without knowing it. Most other types of gastroenteritis also have an incubation period that may last between one day and several weeks.

Strategies for preventing rotavirus include:

• Hand washing: Diligent hand washing is the best way to prevent spread. The chances of contamination are everywhere, and rotavirus can survive on your hands for hours and on hard, dry surfaces for days. Learn how to wash your hands to prevent an infection.
• Staying home from school or work: It is best for infected children and adults to stay away from childcare facilities, schools, work, and other places where they may spread the virus to others in the environment.
• Special precautions: Because rotavirus is transmitted through stool, you should pay special attention to hand washing when changing diapers or cleaning toilets (consider wearing gloves).
• Infants: If you know that someone is sick, do not allow your young child to be exposed.
• Immunocompromised adults: If you take care of a relative or friend who is immunocompromised, be sure to take precautions and to prevent your loved one from contact with people who have even mild infections.
• Vaccination: Rotavirus vaccine is recommended for most infants and it is effective in reducing the risk of severe disease in children and preventing infection. The RotaTeq (RV5) and the Rotarix (RV1) vaccine are given orally (by mouth) as drops. Your child can have either of these vaccines before the age of six months.

While rotavirus is considered a childhood disease, adults can get it more than once. There are several strains of the virus and you would not necessarily develop natural immunity to one strain after being infected with another.

The more concerning issue is that a healthy child or adult can spread the infection to a person who is not as resilient. If possible, stay away from other people until you are better, especially those who are immunocompromised. Be mindful of shared objects and wash your hands before using them.