Rotaviral Diarrhoea

Editor-in-Chief

North East Medical Journal

Introduction: While different organisms can cause diarrhoea, the most common cause of severe and fetal diarrhoea among infants and young children is Rotavirus, a genus of double-stranded RNA virus in the family Reoviridae. By the age of five, nearly every child in the world has been infected with rotavirus at least once. However, with each infection, immunity develops, and subsequent infections are less severe; adults are rarely affected. There are five species of rotavirus, referred to as A, B, C, D and E. Humans are primarily infected by species A, B and C. most commonly by species A, which causes more than 90% of infections in human. All five species cause disease in other animals. Within rotavirus A there are different strains, called serotypes.¹

Epidemiology: Rotavirus A, is endemic worldwide. Each year rotavirus causes millions of cases of diarrhoea in developing countries, almost 2 million resulting in hospitalization and an estimated 453,000 resulting in the death of a child younger than five. This is about 40 per cent of all hospital admissions related to diarrhea in children under five worldwide. In the United States alone before initiation of the rotavirus vaccination programme over 2.7 million cases of rotavirus gastroenteritis occurred annually, 60,000 children were hospitalized and around 37 died from the results of the infection. The major role of rotavirus in causing diarrhoea is not widely recognised within the public health community, particularly in developing countries. It is the leading single cause of severe diarrhoea among infants and children, being responsible for about 20% of cases, and accounts for 50% of the cases requiring hospitalization among them. Rotavirus causes 37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than five. Boys are twice as likely as girls to be admitted to hospital. Rotavirus infections occur primarily during cool, dry season. The number attributable to food contamination is unknown. Outbreaks of rotavirus A diarrhoea are common among hospitalized infants, young children attending day care centres, and elderly people in nursing homes. Rotavirus is also known to be a cause of nosocomial diarrhoea outbreak.² An outbreak caused by contaminated municipal water occurred in Colorado in 1981. During 2005, the largest recorded epidemic of diarrhoea occurred in Nicaragua. This unusually large and severe outbreak was associated with mutations in the rotavirus A genome, possibly helping the virus escape the prevalent immunity in the population. A similar large outbreak occurred in Brazil in 1977.¹ In, Asia, Rotavirus kills more than 170 each day and causes a significant proportion of diarrhoeal disease hospitalizations. Rotavirus causes nearly half of all diarrhoeal disease hospitalizations in children under five in Asia. In South-East Asia and the Western Pacific, 42% and 47% of diarrhoea hospitalizations are due to rotavirus, respectively.³