How Can Travellers Protect Themselves from Rotavirus In Areas with Outbreaks?

Are you eager to travel to an international destination? Did you know pre-travel plans go beyond planning schedules, destinations, and logistics? A pre-travel plan should cover health precautions besides the travel insurance.

Generally, diarrhoea affects 10 to 40 % of travellers during their travel, especially to low/middle-income countries (LMIC).¹ Rotavirus, one of the prevalent pathogens responsible for travellers’ diarrhoea, can be easily prevented with vaccination (primarily for infants) and good hygiene practices.²

Want to learn more? Read this article to help you plan a safe trip and protect yourself and your family from rotavirus in areas with outbreaks.

Rotavirus and the rotavirus vaccine: A quick guide 

What makes rotavirus notorious?

Rotavirus, a highly contagious virus, has been the common cause of viral gastroenteritis, an intestinal infection. Though anyone can get rotavirus gastroenteritis, children younger than five years are more vulnerable to this infection, causing watery diarrhoea and/or vomiting. 

Rotavirus primarily spreads through the faecal-oral route, i.e., tiny particles of the faeces or vomit of the infected to the mouth of a susceptible individual. Also, unclean hands and fomites contribute to rotavirus transmission. Rarely the virus can spread through food and water.²

Rotavirus infection among children is so widespread that they develop antibodies against it by three years of age.³ 

How has the rotavirus vaccine impacted childhood diarrhoea worldwide?

Rotavirus-induced gastroenteritis cases have plummeted and become less severe in high-income countries (HIC) since the introduction of the rotavirus vaccine (oral) in 2006.³

In 2009, the World Health Organisation (WHO) recommended that the rotavirus vaccine be included in the national immunisation programmes globally, particularly for countries in South and Southeast Asia and sub-Saharan Africa.⁴ 

Despite the availability of the vaccine, rotavirus continues to cause life-threatening childhood diarrhoea in many LMICs due to insufficient vaccination coverage and access to immunisation programmes.^2,4 

What are the rotavirus vaccines available internationally?

WHO has considered four rotavirus vaccines highly effective in preventing severe gastroenteritis in infants and children. These are Rotarix™, RotaTeq™, Rotavac™, and RotaSiil™, and all of them are available internationally and prequalified by the WHO.

Table 1: Everything you need to know about rotavirus vaccines

*Physician's discretion is advised

Stay healthy while travelling: A healthcare preparation checklist for international trips

Travelling can be enriching. It offers the opportunity to connect with locals, explore new cultures, traditions, and cuisine, gain a unique insight into the world, and grow from the experiences. 

If you are travelling to an LMIC or plan to, especially with a child or an older family member(s), you must prepare well in advance. Healthcare precautions are important to protect the children and your family and allow them to enjoy their time abroad while staying healthy.

Research your destination

While you research the visa requirements, places to visit and activities, weather, accommodation and travel options, language, currency, and vaccination requirements of your destination, do not forget to read about any ongoing disease outbreaks.

Rotavirus outbreaks: do they still happen despite vaccination?

WHO recommends the rotavirus vaccine as a routine vaccination for infants worldwide.⁵ The organisation highlights the rotavirus vaccine as a comprehensive strategy to control diarrhoeal diseases. However, challenges persist:

Missed vaccinations in eligible infants

Age-eligible infants not vaccinated with the rotavirus vaccine is a challenge common to high-income countries (HICs) and LMICs.^4,6 

Vaccine hesitancy is hindering the success of rotavirus immunisation programmes in HICs and LMICs.⁷

Economic constraints, poor healthcare systems, including a lack of trained professionals, vaccine shortages, and lack of awareness are the significant reasons for missed vaccinations in LMICs.⁸

Vaccine failures

WHO reports that vaccine effectiveness is lower in low-income countries due to problems with vaccine storage.⁴ The success of such vaccines is a gamble on protection.

In addition to the missed or failed vaccination in children, the emergence of new rotavirus strains can result in regional rotavirus outbreaks.^4,6 

Understand the latest rotavirus vaccination coverage (global) among 1-year-olds released by the WHO.

Before travelling, you must check the travel advisory for the country you are visiting. WHO provides the latest updates for travellers. You should check the travel advisories issued by your country.

In the UK, one can check the Foreign, Commonwealth & Development Office (FCDO) travel advice website.

Check if vaccinations are up-to-date

Vaccinations protect individuals from infectious diseases. Vaccination reduces the severity of a disease if it cannot be prevented. 

Before you travel, it is advised that you:⁹

• Check the vaccination requirements of your destination country at least 6 months before your travel
• Consult with your local healthcare provider about the vaccines required and recommended for your travel
• Make sure that your and your child’s routine vaccinations are up-to-date

If your travel is at the last minute, you should still visit your doctor. An acceleration of the routine vaccine schedule can be planned for your travel.⁹

Learn more about the routine vaccines for review before travelling and vaccines for travellers to protect against diseases restricted to a country. 

How can the rotavirus vaccine protect your child during travel?

Even after 15 years of WHO's recommendation to use the rotavirus vaccine in all countries globally, many countries (including HICs) still report areas with rotavirus outbreaks.^6,9 Children who travel must be up-to-date with their rotavirus vaccination to minimise the risk of contracting the virus or severe diarrhoea.⁹ WHO continues to advise that the first dose of the rotavirus vaccine should be administered to an infant as soon as possible after 6 weeks of age, along with routine childhood vaccinations.

Rotavirus vaccination reduces the severity of rotavirus diarrhoea to mild ones without dehydration among children.⁴ It also reduces the transmission of the virus, providing indirect protection to unvaccinated older children and adults.

Prevention is the first line of defence

Only infants below 8 months of age are eligible for the rotavirus vaccine. Following vaccination programmes, rotavirus infection has been more prevalent in older, unvaccinated children.²

Cases of rotavirus outbreaks affecting adult populations have been reported in closed set-ups across the world, such as nursing homes, hospitals, educational settings, and cruise ships. Rotavirus infection in adults can cause a sudden onset of gastroenteritis. Though most adults with rotavirus infections tend to be asymptomatic or have milder symptoms, the older and immunocompromised adults could experience prolonged and severe disease.³

Precautionary measures to protect your family's health

Simple measures such as maintaining good hygiene can help you and your family make great memories. The following precautions can reduce the risk of contracting rotavirus (or any) infections:^2,3,9

• Frequently wash hands with soap and water, especially before eating or smoking and after using the toilets
• Alcohol-based hand sanitisers (60 %) should be used when washing hands with water and soap is not possible
• Although the spread of rotavirus through water and food is rare, take care about what and where you eat and drink
• If you have an infant, breastfeeding (if feasible) is the safest form of nutrition, as it does not require preparation of bottles or clean water (for formulated milk)
• Keep yourself hydrated and have a good rest at the end of the day
• If you see someone get sick (vomiting or diarrhoea), especially on a cruise ship, leave the area and report it to the staff  

Be prepared for the unexpected

In spite of vaccinations and preventive measures, you or your family member could still get infected. Hence, save the emergency numbers in your destination country on your phone. 

A travel medical kit should be prepared before travel and carried with you at all times.⁹ Check the rules with the foreign embassy on taking medicines to different countries.

Learn how to assemble a travel medical kit for you and your child. 

If the symptoms are mild, treat them with oral therapies like:^2,9 

• Low-osmolarity Oral Rehydration Solution (ORS) and zinc-supplementation
• Children (older than 12 years) and adults can consume antidiarrhoeal medications (e.g., loperamide) to relieve symptoms and control diarrhoea

However, if the symptoms do not subside or dehydration is observed, a hospital visit may be advisable. 

FAQs

What is accelerated rotavirus vaccination?

Though the first dose of the rotavirus vaccine is recommended between 6 weeks and 14 weeks, 6 days of age, it is preferred that the first dose of the vaccine be administered when the infant is 2 months old(8 weeks). 

The recommended interval for consecutive doses is 8 weeks, i.e., at the 4^th (second dose) and 6^th months (third dose). The vaccination should be completed before the child is 8 months old.

However, for infants travelling, the first dose of the rotavirus vaccine may be given at 6 weeks of age. The consecutive doses can be administered at a minimum interval of 4 weeks as per ‘General Best Practice Guidelines for Immunisation.’

Are rotavirus outbreaks seasonal?

Traditionally, rotavirus was considered a winter disease in the temperate regions due to high cases of hospitalisations from rotavirus infections between December and April.^2,3 Incidents of infections were high during months with low precipitations and humidity, deeming it seasonal. However, in regions with tropical climates, the rotavirus infections occurred year-round.² 

With the global rotavirus immunisation programmes, the seasonal peaks of rotavirus infections (outbreaks) have reduced and become inconsistent in HICs.^3,10  

Summary

• Rotavirus is the leading cause of viral gastroenteritis in children below the age of 5
• Rotavirus vaccination of infants less than 8 months of age is the most effective option for protection against severe rotavirus disease
• Simple measures, such as maintaining good hand hygiene, can lower the risk of rotavirus infection
• Rotavirus infection in adults is usually mild and can be treated at home