Rotavirus is the most common cause of sporadic, severe, dehydrating diarrhea in young children worldwide (peak incidence, 3 to 15 months). Diagnosis is based on clinical suspicion, but polymerase chain reaction testing as part of a multiplex panel for a variety of causes of acute gastroenteritis can be done. Treatment is supportive with oral fluids, but occasionally IV fluids are needed.
Rotavirus incidence has decreased by about 80% in the United States since the introduction of routine rotavirus immunization. Rotavirus is highly contagious; most infections occur by the fecal-oral route. Adults may be infected after close contact with an infected infant.
In temperate climates, most infections occur in the winter and spring. In the United States before rotavirus vaccination became available, a wave of rotavirus illness would begin in the Southwest in December and end in the Northeast in April or May. Now, the illness occurs less predictably and can occur year round (1).
Incubation period is 1 to 3 days.
(See also Overview of Gastroenteritis.)
Reference
1. Centers for Disease Control and Prevention: Rotavirus in the U.S. Accessed April 27, 2023.
Symptoms and Signs of Rotavirus Gastroenteritis
Rotavirus gastroenteritis in infants and young children may last 5 to 7 days.
Vomiting occurs in 90% of patients, and fever > 39° C (> 102.2° F) occurs in about 30%.
Diarrhea is watery and non-bloody.
In adults the symptoms of rotavirus gastroenteritis are usually mild. In children, the diarrhea is more likely to cause severe dehydration and even death.
Diagnosis of Rotavirus Gastroenteritis
Immune-based assays
Polymerase chain reaction (PCR) testing
Diagnostic testing is not routinely done except to diagnose an outbreak; when done, it involves tests to identify rotavirus in the stool. Enzyme-linked immunosorbent assay (ELISA) and latex agglutination are two commonly used tests.
Nucleic acid testing (PCR) is very sensitive and is often done in a multiplex PCR panel, including a number of causes of gastroenteritis.
Treatment of Rotavirus Gastroenteritis
Oral or IV fluids
Sometimes antidiarrheal agents and/or antiemetics
Supportive care including rehydration with fluids and electrolytes is the mainstay of treatment and is all that is needed for most adults. Oral glucose-electrolyte solutions, broth, or bouillon may prevent dehydration or treat mild dehydration. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially—see Oral Rehydration
Isotonic IV fluids such as Ringer’s lactate and normal saline solution should be given when there is severe dehydration, shock, or altered mental status and ileus or failure of oral rehydration therapy (see also the Infectious Diseases Society of America's [IDSA] 2017 clinical practice guidelines for the diagnosis and management of infectious diarrhea). In severe dehydration, IV rehydration should be continued until pulse, perfusion, and mental status normalize.
Antidiarrheal agents should not be given to children < 18 years of age with acute diarrhea (see the IDSA guidelines). Antidiarrheals can be considered in adult patients with watery diarrhea (as shown by heme-negative stool), especially during an outbreak, suggesting a viral cause is likely. However, antidiarrheals may cause deterioration of patients with Clostridioides difficile or E. coli O157:H7 infection and thus should not be given to any patients in whom the cause of diarrhea has not been identified and in whom these disorders may be suspected (ie, based on recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever).
Prevention of Rotavirus Gastroenteritis
Two live-attenuated oral rotavirus vaccines are available that are safe and effective against the majority of strains responsible for disease. Rotavirus immunization is part of the recommended infant vaccination schedule.
Key Points
Clinical course may last 5 to 7 days.
Oral rehydration is usually adequate, but antiemetics and sometimes IV fluids may be needed.
Antidiarrheal agents are safe for adults with watery diarrhea but should be avoided in children < 18 years of age and in any patient with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Infectious Diseases Society of America: Clinical practice guidelines for the diagnosis and management of infectious diarrhea (2017)
