What Preventive Measures Can Be Taken To Avoid Rotavirus Infection?

Overview^1,2,3

Rotaviruses are ribonucleic acid (RNA) viruses that are contained within a protein capsule. It is highly contagious and the leading cause for babies and children with severe gastroenteritis (diarrhoea and vomiting). By the age of five, children typically experience at least one rotavirus infection, regardless of their socioeconomic background. While there is no specific medication to treat Rotavirus, healthcare professionals may recommend medicine to treat the symptoms. Most cases are manageable at home, however, some cases can be more serious and can cause dehydration. Thus, patients may need intravenous rehydration treatment at the hospital. Understanding the virus and its prevention methods is vital for reducing infection rates. 

Understanding rotavirus

Rotavirus is highly infectious and can cause an outbreak in preschool and primary school settings, as well as in hospitals. Rotavirus outbreaks are more likely to occur during the winter season. 

Who is at risk³ 

Rotavirus predominantly occurs amongst babies and young children, however, older children and adults can also get infected by this virus, particularly those with weakened immune systems. Symptoms in adults are usually milder.

What are the symptoms^1,2,3,4

1. Early symptoms usually start 2 days after being exposed to the virus, and include: acute onset of mild fever and vomiting
2. Later followed by watery diarrhoea about 3-8 days
3. Abdominal pain/stomach cramps
4. Feeling sick
5. Complications could include: 
   • Febrile seizures/seizures due to electrolyte imbalance; however, there is no report of sequelae. 
   • Severe dehydration that lead to shock and death if not properly corrected. 
   • Symptoms of dehydration include: less urine, dry mouth and throat, dizzy when standing up, less or even no tears when crying, unusual sleepiness/fussiness. 

Transmission^2,6,8

1. The incubation period is about 1-2 days, and usually lasts between 3-9 days
2. The most common method of transmission is the faecal-oral route by poor hand-hygiene practice
3. Close personal contact, such as changing a baby's nappy
4. It may also spread through the air by coughing and sneezing as well as via contaminated sources, such as food, water and toys. It can survive for weeks in clean drinking water
5. Rotavirus is commonly spread in families, hospitals, and childcare centres

Global prevalence and statistics^1,2

1. Rotavirus is responsible for about 25 million clinic visits yearly, 2 million hospital admissions, and roughly 180,000–450,000 deaths of children under 5 years of age all over the globe
2. There is no formal surveillance of rotavirus infections or circulating strains available in the EU/EEA
3. In the UK, Rotavirus infection is seasonal, occurring mostly between January to March. However, low-grade transmission occurs all year round
4. Most children had their first Rotavirus infection between 1 month to 4 years. Once they had been infected, they usually acquired immunity, however, it might be short-lived. Rotavirus infection can happen throughout life, but only very few lead to severe disease that requires medical attention or hospitalisation
5. In England and Wales, every year, an estimated 130,000 children will visit their GP, and approximately 12,700 children with rotavirus gastroenteritis will be hospitalised
6. Rotavirus is most likely to infect newborns, but usually illness is usually mild or asymptomatic. This may be due to protection by circulating maternal antibodies
7. Although severe gastroenteritis Rotavirus can happen in any child, a limited number of risk factors for the development of severe disease have been noted, including low-birth-weight infants (<2,500 g), and another child <24 months of age in the household. Also severe immunodeficiency conditions
8. Rotavirus infection may also be acquired in hospitals. In the USA, a third of Rotavirus infections among hospitalised patients were found to have been acquired in the hospital. Numerous other papers have also recorded the importance of rotavirus infection in hospital-acquired gastroenteritis.
9. Although in the UK, the deaths from Rotavirus are rare, it is difficult to quantify the numbers accurately. There are an estimated three to four deaths associated with rotavirus each year in England and Wales
10. Infections in adults are rarely reported, but they can occur among individuals who care for or are in contact with children suffering from rotavirus gastroenteritis. Adults who get rotavirus disease tend to have milder symptoms

Key preventive measures

Vaccination^5,6,7,9 

Two doses of vaccination will be given as part of the NHS vaccination schedule. The first dose will be given at 8 weeks old and the second dose at 12 weeks old. In the UK, Rotarix® (a live attenuated vaccine), is the vaccine that is offered as part of the national childhood immunisation programme, and it is given orally.

If your baby missed their first dose, they can catch up to 15 weeks old, and if they missed the second dose, they can have it up to 24 weeks old. Most babies are eligible to have the vaccine, however, there are some conditions that prevent them from getting vaccinated, such as anaphylaxis, SCID, intussusception, fructose intolerance, glucose galactose malabsorption or sucrase-isomaltase insufficiency, etc. When in doubt, you should seek appropriate advice from your Doctor whether your babies can have the vaccine or not.

After vaccination, between 1-10 babies can experience mild diarrhoea, 

If your baby has a high temperature, diarrhoea or vomiting, postpone the vaccination until they're feeling better. The Rotavirus vaccine is the best way to protect your child from Rotavirus disease and is highly effective at preventing infection in babies. However, it does not protect from diarrhoea and vomiting from other viruses, such as Norovirus.

Hygiene and sanitation practices¹⁰

1. Meticulous hand hygiene by all caring for affected children - thoroughly wash your hands before and after caring for your baby. Make sure your child also washes their hands, especially after using the toilet. Handling and disposing of dirty nappies carefully. Wear gloves and a surgical mask while disposing of or handling vomitus and faeces, also wash hands thoroughly afterwards. Avoid work or attending school, and consult a healthcare professional if you are experiencing fever, vomiting, or diarrhoea. Exclude infected individuals and asymptomatic carriers from handling food and caring for children, the elderly, and immunocompromised individuals.

Make sure to wash your hands frequently, especially before handling food or eating. Following these 5 food safety principles while handling food will help prevent rotavirus infections.. 

• Only drink boiled water from the mains or bottled drinks from sources that are trusted
• Avoid drinks with ice from uncertain sources
• Only purchase fresh food from hygienic and reliable sources
• You may eat the skin of fruits after thoroughly washing them. However, to reduce the risk of getting ill, especially when travelling abroad, it is advisable to peel the fruits before eating and avoid consuming the peels
• Ensure to cook food thoroughly, particularly shellfish, before eating.
• Those who are in a high-risk group (pregnant women, people with weakened immune systems, infants, young children and the elderly) should avoid eating foods that are meant to be consumed raw, such as shellfish (especially oysters), or any dishes containing uncooked ingredients, like prepared or pre-packaged salads

Maintain good environmental hygiene

• Ensure all rooms are well ventilated
• Clean with disinfectant all touched surfaces and common areas, such as furniture, toys, doorknobs, and other common shared items
• Clean up vomit and faeces promptly and thoroughly disinfect the contaminated areas
• Ensure the proper functioning of sanitary facilities and drainage systems
• Toilets that are used by infected persons and the soiled areas must be cleaned and disinfected

Role of healthcare providers¹¹

• Promote vaccinations and educate patients and their families about Rotavirus disease
• Advocate the importance of hygiene
• Work together with local/public health authorities to keep track and prevent
• Support and give guidance for families on recognising the symptoms and when to seek help
• Ensure infection control policies in the healthcare setting
• Keep up to date with the latest information regarding Rotavirus infection

Summary

Many measures can be taken to prevent rotavirus infection. Vaccination is crucial and considered as the most effective strategy to reduce incidence rates. Good hygiene practices, such as regular handwashing, proper handling of dirty nappies, and managing faeces and vomitus, are essential. Maintaining clean sanitary facilities and adhering to food and water safety measures are also important. By implementing these strategies, healthcare providers and caregivers can significantly reduce the risk of rotavirus infections, especially in infants and young children.