17 Rotavirus

17.2 Clinical features

Rotavirus infects almost all children during infancy or early childhood. Transmission occurs through the faecal–oral route both through close personal contact and through fomites. Aerosol transmission has been hypothesised but remains unproven.1

The incubation period is one to three days, after which illness can begin abruptly, with fever and vomiting often preceding the onset of diarrhoea.1, 3 Up to one-third of children will develop a fever of >39oC.4, 5 The illness lasts from three to eight days. Children with rotavirus are infectious immediately before, and up to one to two weeks after, the onset of symptoms. Large quantities of rotavirus are shed in the stool, and few virions are required to cause infection in a susceptible host.6

Rotavirus infection in the first three months of life is frequently mild or asymptomatic. This is possibly due to passive protection from maternally acquired antibodies, being breastfed and the intestinal cell structure of newborn infants.1, 7

Severe dehydrating gastroenteritis caused by rotavirus occurs predominantly in infants and children aged 3 months to 2 years.2 The clinical spectrum ranges from asymptomatic infection to an acute severe illness with frequent and large-volume diarrhoea and vomiting, leading to dehydration, electrolyte disturbance and their sequelae. The illness spectrum from rotavirus is more severe than from other common causes of diarrhoea in children.1