Rotavirus Gastroenteritis (RGE)

What is rotavirus?

Rotavirus is a leading cause of severe gastroenteritis in infants and young children. Virtually all children will be infected with rotavirus by the age of 5.1,2

Rotavirus is transmitted by the fecal-oral route. After an estimated incubation period of about 2 days, the illness starts suddenly, usually with fever and vomiting, followed by watery diarrhea that lasts between 3 to 7 days.1,3

Rotavirus can cause a range in severity of symptoms, from asymptomatic infection to severe dehydrating diarrhea, vomiting, fever, and electrolyte imbalance. In very rare instances, rotavirus infection can cause death.2,3

What are the symptoms of rotavirus gastroenteritis?

Rotavirus causes a spectrum of illness ranging from asymptomatic infection to severe dehydration resulting from vomiting and diarrhea.2

Asymptomatic
Infection

Severe
Dehydration

The Symptoms of Rotavirus Gastroenteritis Range From Asymptomatic Infection to Severe Dehydration The Symptoms of Rotavirus Gastroenteritis Range From Asymptomatic Infection to Severe Dehydration

Symptoms typically include watery diarrhea that can persist for 3 to 7 days, vomiting, fever, and abdominal pain. In some cases, diarrhea can be severe, leading to dehydration, electrolyte imbalance, and metabolic acidosis. Up to 1 in 3 children experience a fever greater than 102°F (39°C).2,4

Symptoms of dehydration in young children and infants:

  • No wet diapers for ≥3 hours
  • Dry mouth and tongue
  • Decrease or absence of tears
  • Unusual lethargy or irritability
  • Sunken eyes or cheeks
  • Sunken soft spot on the top of the skull5,6

Infants and young children are most susceptible to getting rotavirus infection, although it can affect older children and adults. Adults affected by rotavirus usually have milder symptoms.7

It can be difficult to predict which children will have severe disease. However, the most severe disease typically occurs among infants and children 4 to 23 months of age.1,6

What are the risk factors for rotavirus infection?

Children aged 3 to 35 months are most likely to get rotavirus gastroenteritis, especially those in daycare or other childcare settings.2,4

Older adults and adults looking after young children are also more at risk of contracting rotavirus illness.4

In the US, the risk of getting rotavirus infection is highest during the winter and spring months.4

How is rotavirus transmitted?

Rotavirus is transmitted by the fecal-oral route, both through close person-to-person contact and fomites (inanimate objects).1

Hand soaps and other cleaning products may not effectively kill the virus. It is easily spread and can survive on toys and household surfaces for weeks, and on hands for several hours.2,8

What is the incubation period for rotavirus?

Rotavirus has an estimated incubation period of 1 to 2 days, after which the disease can begin abruptly. Fever and vomiting often precede diarrhea.1

Which serotypes commonly cause rotavirus gastroenteritis?

Rotavirus strains are described by their G and P proteins, which define the serotype of the virus. The genotype is expressed in brackets after the serotype designation (eg, G1P1A[8]). Often the strain is presented as G-serotype and P-genotype (eg, G1P[8]).2,9

Rotavirus gastroenteritis (RGE) is caused by multiple strains (eg, G1P[8], G2P[4], G3P[8], G4P[8], G9P[8], G12P[8]).9,10

Two P genotypes—P[4] and P[8]—are responsible for most human rotavirus illness.9 Rotavirus strain distribution can vary by region and year.9,10

What makes the rotavirus G2 serotype different?

G2 is genetically distinct from other common rotavirus serotypes.11

The 5 most common rotavirus strains belong to 2 distinct, minimally related genogroups.11,12

Wa Genogroup
  • G1P[8]
  • G3P[8]
  • G4P[8]
  • G9P[8]
DS-1
Genogroup
  • G2P[4]

G2 strains generally do not share either G or P surface proteins with other common rotavirus G serotypes.13

Can someone be reinfected with rotavirus?

Yes, children can be reinfected with rotavirus several times during their lives. Second infections are most likely to be caused by another G serotype.14

Are subsequent infections with rotavirus as severe as the first infection?

Subsequent infections are generally less severe than the first infection.14

How prevalent is rotavirus?

Rotavirus is a leading cause of severe gastroenteritis in infants and young children. Virtually all children will be infected with rotavirus by the age of 5.1,2

Severe dehydrating diarrhea caused by rotavirus is most common among children aged 4 to 23 months of age.1

Rotavirus infection in the US in the pre-vaccine era

In children <5 years and prior to 2006, rotavirus was annually responsible for2:

In Children Younger Than 5 Years Old, Rotavirus Infection was Responsible for Over 400,000 Physician Visits Annually Before 2006 >400,000 physician visits
In Children Younger Than 5 Years Old, RGE Infection was Responsible for Over 200,000 Emergency Department Visits Annually Before 2006 >200,000 emergency department visits
Rotavirus Gastroenteritis was Responsible for 55,000 to 70,000 Hospitalizations in Children Younger Than 5 Years Old Annually Before 2006 55,000 to 70,000 hospitalizations
20 Rotavirus Infection was Responsible for 20 to 60 Deaths of Children Younger Than 5 Years Old Annually Before 2006 60
20 to 60 deaths

CDC Disease Information

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reference1

Reference

  1. Centers for Disease Control and Prevention (CDC). Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2009;58(RR-2):1–25.
reference2

Reference

  1. Centers for Disease Control and Prevention (CDC). Rotavirus. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington, DC: Public Health Foundation; 2015:311–324. http://www.cdc.gov/vaccines/pubs/pinkbook/index.html. Accessed June 27, 2018.
reference3

Reference

  1. Payne DC, Parashar UD. Chapter 13: Rotavirus. In: Roush SW, Baldy LM, eds. Manual for the Surveillance of Vaccine-Preventable Diseases. Atlanta, GA: Centers for Disease Control and Prevention (CDC) and Department of Health and Human Services; 2017:1–17. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt13-rotavirus.html. Updated May 18, 2018. Accessed October 1, 2019.
reference4

Reference

  1. Mayo Clinic. Rotavirus Symptoms & Causes. https://www.mayoclinic.org/diseases-conditions/rotavirus/symptoms-causes/syc-20351300?p=1. Updated March 12, 2019. Accessed October 1, 2019.
reference5

Reference

  1. Mayo Clinic. Dehydration Symptoms & Causes. https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086?p=1. Updated September 19, 2019. Accessed October 1, 2019.
reference6

Reference

  1. National Foundation for Infectious Diseases (NFID). Frequently asked questions about rotavirus. http://www.nfid.org/idinfo/rotavirus/faqs.html. Accessed October 1, 2019.
reference7

Reference

  1. Centers for Disease Control and Prevention (CDC). Rotavirus symptoms. https://www.cdc.gov/rotavirus/about/symptoms.html. Last updated: April 23, 2018. Accessed October 1, 2019.
reference8

Reference

  1. Ansari SA, Sattar SA, Springthorpe VS, et al. Rotavirus survival on human hands and transfer of infectious virus to animate and nonporous inanimate surfaces. J Clin Microbiol. 1988;26(8):1513–1518.
reference9

Reference

  1. Dormitzer PR. Rotaviruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Vol 2. 9th ed. Philadelphia, PA: Elsevier; 2019:1983-1996.
reference10

Reference

  1. Dóró R, László B, Martella V, et al. Review of global rotavirus strain prevalence data from six years post vaccine licensure surveillance: is there evidence of strain selection from vaccine pressure? Infect Genet Evol. 2014;28:446–461.
reference11

Reference

  1. Gentsch JR, Laird AR, Bielfelt B, et al. Serotype diversity and reassortment between human and animal rotavirus strains: implications for rotavirus vaccine programs. J Infect Dis. 2005;192(suppl 1): S146–S159.
reference12

Reference

  1. Matthijnssens J, Van Ranst M. Genotype constellation and evolution of group A rotaviruses infecting humans. Curr Opin Virol. 2012;2(4):426–433.
reference13

Reference

  1. Dennis AF, McDonald SM, Payne DC, et al. Molecular epidemiology of contemporary G2P[4] human rotaviruses cocirculating in a single U.S. community: footprints of a globally transitioning genotype. J Virol. 2014;88(7):3789–3801.
reference14

Reference

  1. Velázquez FR, Matson DO, Calva JJ, et al. Rotavirus infection in infants as protection against subsequent infections. N Engl J Med. 1996;335(14):1022–1028.
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