Disease factsheet about rotavirus

Rotaviruses are the single most important cause of severe diarrhoeal illness in infants and young children worldwide. By the age of five years most children irrespective of socioeconomic setting will have been infected at least once. While infected, many children will be in need of medical attention due to extensive fluid loss.

Rotavirus infections is not a notifiable disease at EU level and in  most EU/EEA MSs. Hence, no EU/EEA-wide epidemiological or laboratory surveillance is conducted.

Rotavirus infections are vaccine-preventable following the approval of two oral, live attenuated rotavirus vaccines in 2006 for use in infants ). Some EU/EEA countries have introduced rotavirus vaccines into their national immunization programmes.

Case definition

No EU case definition is available as rotavirus infections are not notifiable at European level. 

The pathogen

• The rotaviruses comprise the genus Rotavirus within the virus family Reoviridae;
• The viral genome contains 11 segments of double-stranded RNA;
• Classification of rotaviruses involves determination of serotype (antigenic characterization) and/or genotype (genetic characterization);
• Most rotaviruses causing diarrhoeal illness in children worldwide belong to serogroup A, but rotaviruses group B and C may also cause disease in humans. Available vaccines provide protection against the most common group A rotaviruses;
• Genetic characterization of rotaviruses uses the specificities of the two outer capsid proteins, VP4 (P-type) and VP7 (G-type).

Clinical features and sequelae

• Fever
• Vomiting
• Diarrhoea
• Extensive nausea and vomiting in some children result in difficulties in providing oral rehydration and severe fluid loss in need of medical attention.
• Complications include febrile seizures/seizures due to electrolyte disturbances but no residual sequelae due to seizures have been reported.
• Severe dehydration may lead to shock and death if not corrected. This is rarely seen in the EU/EEA where access to health care and rehydration is available for all. However, if cases only come to the attention of health care after significant fluid loss a limited number of deaths are reported each year.
• With symptomatic treatment, including rehydration, symptoms are commonly relieved within 3 to 8 days.

Epidemiology

No formal surveillance of rotavirus infections or circulating strains is available in the EU/EEA.

From burden-of-disease studies it is noted that rotaviruses cause seasonal peaks of diarrhoeal disease between December and May in EU/EEA. However, sustained low-grade transmission is identified all year round.

Most children acquire their primary rotavirus infection between 6 and 36 months of age. Subsequent rotavirus infections occur throughout life but only rarely lead to severe disease leading to medical attention or hospitalisation.

Severe RV GE disease may develop in any child. However, a limited number of risk factors for development of severe disease have been identified including low-birth-weight infants (<2,500 g), another child <24 months of age in the household and severe immunodeficiency conditions. 

Circulating rotavirus genotypes vary by season and country and co-circulation of several genotypes are noted each year.

Transmission

• The incubation period is 1-2 days.
• The infective period is 1-3 weeks. Asymptomatic carriers are common.
• Rotaviruses are mainly transmitted from person-to-person through the faecal-oral route, but transmission may also occur through contaminated objects (e.g. door-handles, water-taps, toilet-seats and toys), airborne droplets and contaminated water or food.

Diagnostics

 Excretion of rotaviruses may be confirmed by analysing stool samples using:

• antigen-detecting assays (enzyme immunoassays, immunochromatographic rapid tests),
• genome-detecting assays (PCR)
• electron microscopy

Case management and treatment

Clinical management is directed towards early replacement of fluid losses using oral rehydration at home. However, with more extensive fluid losses there may be a need for nasogastric and/or intravenous rehydration provided in hospital settings. Apart from fluid replacement, no other therapy is required in previously healthy individuals and the condition is self-limiting. No antiviral drugs are available.

Infection control, personal protection and prevention

Children seeking medical attention in emergency departments/out-patient clinics or those hospitalized with rotavirus disease have the potential to be sources of nosocomially acquired infections.

General protective measures for protection against rotavirus infections include meticulous hand hygiene by all caring for affected children. However, improved socioeconomic standard and hygiene in EU/EEA countries over the last 50-100 years have not decreased circulation of rotaviruses. Resistance to physical inactivation (along with the large number of viral particles shed in stool) contribute to the efficient transmission of human rotaviruses. Rotaviruses may persist on dry surfaces for up to two months.

Two live attenuated vaccines for oral use providing prevention against rotavirus disease   ere authorised in the European Union in 2006; The indication for these vaccines is active immunization of infants for prevention of gastroenteritis due to rotavirus infection. Some EU/EEA countries have introduced rotavirus vaccination in their national immunisation programme and this is summarised in the ECDC Vaccine Scheduler.

Disclaimer: The information contained in this factsheet is intended for the purpose of general information and should not substitute individual expert advice or judgement of healthcare professionals.