Rotavirus infection in paediatrics

Dr Angela Dramowski (dramowski@sun.ac.za),

Paediatric Infectious Diseases, Stellenbosch University,

Cape Town, South Africa

ICAN Harare 2014

Outline

Epidemiology of RV diarrhoea

Virology

Clinical presentation

Case management

Prevention of RV disease

Diarrhoea kills 2,195 children every day:

more than AIDS, malaria, measles combined

Global deaths from Rotavirus

Rotavirus disease burden and

public health significance

Glass et al, Lancet 2006

Natural history of RV infection

Velazquez et al. NEJM. 1996; 335: 1022–1028.

• All children will get

at least 1 infection

• Natural infection

reduces severity of

subsequent

infections

• Infants become

immune after 1–3

infections.

Nosocomial RV infection

Twenty surveillance studies US and Europe

Pooled nRV incidence = 2.9 / 100 hospitalizations [CI]: 1.6–4.4

Highest incidence < 2 years and epidemic months (8.1/100)

Few studies of nRV in Africa (Botswana, Guinea)

2 x neonatal outbreaks in Cape Town, South Afica

Virology

Reoviridae (ds RNA virus)

icosahedral protein capsid

NON-enveloped virus

Types A –G

VP7 capsid protein-G : neutralization

VP4 protein spike-P: neutralization protein, cell attachment, virulence, haemagglutination

Fecal-oral spread

10 trillion infectious particles/gram of faeces

<100 particles infective dose!

Distribution of rotavirus strains from a

global collection of 2,748 strains

Viral heterogeneity

Pathogenesis

Destruction of enterocytes = malabsorption

Toxic protein : - reduces water reabsorption

reduces activity of brush-border disaccharides

deficiency of lactase enzyme with milk intolerance

Clinical presentation

Incubation period 2 days

Duration of symptoms: 3-7 days

Virus shedding: 5 - 21 days

Mild to severe vomiting

Profuse watery diarrhoea

Low grade fever

Complications: dehydration, electrolyte abnormalities,

febrile seizures (most severe 6 months - 2 years )

Diagnosis

Stool :

Rapid tests

ELISA

PCR

Electron microscopy

Management

Supportive care

Fluid replacement: ORS or IV

Zinc supplement

Breastfeeding/feeding

Vitamin A

15

Rehydration unit, Mogadishu, Somaliawww.voanews.com/content/doctors_without_borders_completes_cholera_campaign/1146248.html

Impact of oral rehydration

Prevention of Rotavirus disease

Reductions in death and hospital admissions, particularly in

developing countries (Cochrane review 2012)

Rotavirus vaccines

Live attenuated vaccine, 2 oral formulations,

2-3 doses before 6 months of age, WHO EPI since 2009

RV vaccine & intussuception

Rotashield vaccine (1998)

Withdrawn by CDC shortly thereafter

Adverse events reports: intussuception

Calculated risk of 1-2 extra cases of

intussusception caused among each

10,000 infants vaccinated with

RotaShield® vaccine.

Rotavirus vaccine access

7 point plan for DD

1. Fluid replacement

2. Zinc

3. Rotavirus + measles EPI

4. Early, exclusive breastfeeding

5. Handwashing with soap

6. Improved water supply/quality

7. Community-wide sanitation

promotion.

"It is a tragedy that diarrhoea, which is little

more than an inconvenience in the developed

world, kills an estimated 1.5 million children

each year.“

UNICEF Executive Director Ann M. Veneman.