Rotavirus Gastroenteritis (RGE)

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

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

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

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

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

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

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

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

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

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

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

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

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: