ROTAVIRAL

diarrheas
Dr.T.V.Rao MD
Importance of Rotaviruses

 Rotaviruses are major cause of diarrheal

illness in Human infants in the world
 Adults too can get infected
 Young animals, calves, piglets can also
infected
Rota virus –Seasonal
Impact
 Rotavirus infections spread easily.
Outbreaks usually occur in the winter and
early spring, between about November
and April. Rotavirus infections often
spread in settings where many children
are together, such as daycare centres.
Global Impact of Rotavirus
Infections
Characters of Rotavirus
 A rotavirus has a characteristic wheel-like
appearance when viewed by electron
microscopy (the name rotavirus is derived from
the Latin rota, meaning "wheel"). Rotaviruses
are non enveloped, double-shelled viruses.
The genome is composed of 11 segments of
double-stranded RNA, which code for six
structural and five nonstructural proteins. The
virus is stable in the environment
Rotavirus resembles a wheel
( Rota = Wheel )
Classification of
Rotaviruses

 Rota viruses are classified as Five

species ( A- E )
 Two other species are tentatively
identified
( F and G )
Structure of Rotaviruses
 Antigenic classification
mainly dependent on
structural protein VP6
 Group A is important
human pathogen
 Outer capsid protein VP4
and VP7 carry epitopes
important in neutralizing
antibodies
Structural configuration of
Rotavirus
Pathogenicty
 The virus infect the villi of the small intestine (Gastric
and colonic mucosa are not infected)
 They multiply in the cytoplasam of the enterocytes and
damage their transport mechanisms.
 The Rota viral encoded particle NSP4 is a viral
enterotoxin and induces secretions by triggering a
signal transduction pathway
 Damaged cell may show into lumen of the intestinal
and release large quantities of virus which appear in
the stool.
 Viral excretion usually lasts for 2 – 12 days in
otherwise healthy patients
Why Diarrhea in Rota viral
Infections

 Diarrhea caused by
Rotaviruses may be
due to impaired
sodium and glucose
absorption as
damaged cell on villi
are replaced by non
absorbing immature
crypt cell
Immunity in Rota viral
Infections
 By age 3 years, 90% of
the children have serum
antibodies to one or
more types
 Young children suffer
upto to five reinfections
by 2 years of age
 Secretary IgA or
Interferon are important
in protection against
Rota viral infections.
Impact of Rota viral
Infections
 Rotavirus is the most common cause of severe
diarrhea among children, resulting in the hospitalization
of approximately 55,000 children each year in the
United States and the death of over 600,000 children
annually worldwide. The incubation period for rotavirus
disease is approximately 2 days. The disease is
characterized by vomiting and watery diarrhea for 3 - 8
days, and fever and abdominal pain occur frequently.
Immunity after infection is incomplete, but repeat
infections tend to be less severe than the original
infection.
Rota viral infection
damages Intestines
 Pathogens, e.g., rotavirus, may strip the tips of
the villi from large patches of the intestinal wall
thus decreasing the surface area and
decreasing by more than 50% the specific
absorptive capacities of the intestine. The
result is malabsorption which can cause
malnutrition - most especially in a child already
nutritionally compromised by repeated previous
attacks of diarrhea.
Clinical Findings

 Rotavirus cause major events of diarrheal diseases in

children and infants worldwide
 Incubation period is 1 – 3 days.
 Present with
Watery diarrhea
Fever
Abdominal pain
Vomitting leading to dehydration
Loss of electrolytes and fluids
May be fatal unless treated
Patients with milder disease recovers promptly in 3 –
8 days
Dehydration is leading cause
in Morbidity and Mortality
Rotavirus have great impact
on Infants and Children
Rota viral infection in
Immunosuppresed and
others
 In children with immunodeficienes , Rotavirus
cause sever and prolonged disease.
 Adults seroconvert but not manfiest with
diarrhea
 However in closed wards sever disease can
occur.
 In India and China large outbreaks of severe
gastroenteritis have occured
Laboratory Diagnosis
 Microscopy ( EM )

Demonstration of
Virus in stool helps in
early disease
Electron Microscopy
has made the
identification simpler
Other Methods in
Diagnosis
 Virus can be
demonstrated by IEM
 Latex agglutination
tests
 ELISA can detect
antibodies and
establishing raise
in titers
Genotyping

 Genotyping is most
sensitive method for
detection of
Rotavirus nucleic
acid from stool
specimens
Treatment
 Treatment of Gastroenteritis is supportive
 Correction of Loss of water and electrolytes
 Failure for prompt correction of dehydration leads to
Acidosis
Shock
Death
Correction Electrolyte remain the goal treatment in Rota
viral infections.
Lesser deaths if effective replacement therapy is initiated
UNICEF/WHO O.R.S

 Sodium Chloride 3.5 grams

 Sodium Bicarbonate 2.5 grams
 Potassium Chloride 1.5 grams
 Glucose 20 grams
 To be dissolved in one liter of clean
drinking water
Fluid Replacement

 Management consists of replacement of

fluids ( ORS ) and restoration of
Electrolyte balance
 Oral rehydration Therapy is highly
effective in reducing morbidity and
mortality
 Severe dehydration needs parental
administration of fluids.
Basic measures in Rota
viral prevention

 Keep your hands

clean. Wash hands
often with soap and
warm water after
using the toilet,
diapering and before
preparing or eating
food.
Epidemiology
 Rotaviral infections continue to be most
important cause of Gastroenteritis in
young children
 Estimates range 3 billion – 5 billion
infections
 Children > 5 years age highly susceptible
to infections
 Results in 1 million deaths
Impact on Hospitals

 Upto 50 % of cases of Acute

Gastroenteritis of the Hospitalized
children throught the world are caused by
Rotavirus
 Winter season highly predisposing
 Nosocomial infections need attention
Prevention and Control
 In view of fecal oral route of transmission
waste water management, safe water
supplies sanitation are significant control
measurers.

 Vaccine – In 2006 an Oral Bovine based

Rota viral vaccine was licensed in USA
Educational material
on Rota viral Diarrhea
for Graduate Medical
Students
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com