Rotavirus

Rotavirus is a highly contagious virus that causes diarrhoea and vomiting. These symptoms can lead to severe dehydration.

Treatment for rotavirus mainly involves fluid replacement. A rotavirus vaccine is available to help prevent infection in infants, who are at greatest risk.

General information

Rotavirus is the most common cause of diarrhoea and dehydration in infants and young children worldwide. Older children and adults can also get sick from rotavirus, but if they have a healthy immune system the illness is self-limiting and lasts for only a few days.

Nine out of 10 New Zealand children will develop rotavirus illness by three years of age. Before the rotavirus vaccine became available in New Zealand, an estimated one in 43 children under five years of age were hospitalised because of rotavirus each year.

Those most at risk from rotavirus are:

• Infants and children under two years of age
• Infants with a low birth weight who are still under weight
• Infants and children with other medical conditions, e.g., heart or kidney disease, or diabetes.

Winter and early spring are the most likely times of year to develop rotavirus.

Causes

Rotavirus infects the intestine (gut) causing gastroenteritis (inflammation of the stomach and intestines).

Rotavirus is spread through direct contact with the faeces (poos or stools) of an infected child or adult and from consuming food or touching surfaces that have been contaminated with the virus. The rotavirus can survive outside the body including on the hands for several hours. It can also survive on hard surfaces, such as a kitchen bench, utensils, toys, and other objects, for many weeks.

Many different strains of rotavirus exist so it is possible to be infected more than once, even after being vaccinated. However, subsequent infections are usually less severe.

Signs and symptoms

Symptoms usually appear two days after exposure to the rotavirus. Fever and vomiting are the first symptoms, followed by watery diarrhoea lasting three to eight days. The infection may also cause mild abdominal discomfort or pain.

Rotavirus in adults who are otherwise healthy may cause only mild symptoms or no symptoms at all.

Dehydration (due to the loss of body fluids from vomiting and diarrhoea) is a serious complication of rotavirus and is especially dangerous in infants. Severe dehydration is life-threatening if not treated.

General symptoms of dehydration include:

• Infrequent or no urination
• Dry mouth, tongue, and throat
• Excessive thirst
• Severe weakness
• Light-headedness and feeling dizzy when standing up.

An infant or young child who is dehydrated may also have the following symptoms:

• Crying with few or no tears
• Sunken eyes
• Cold hands and feet
• Unusual sleepiness or lack of energy
• Fewer wet nappies/not passing as much urine as usual.

A doctor should be contacted immediately if an infant or young child displays symptoms of dehydration. Further information on when to see a doctor can be found on our diarrhoea and gastroenteritis pages.

Diagnosis

Diagnosis of rotavirus is usually based on symptoms and a physical examination. A stool sample may be taken to confirm the diagnosis by laboratory detection of rotavirus in stool specimens.

Treatment

There is no specific medicine for the treatment of rotavirus. No antiviral drug is available to treat it and antibiotics do not help because antibiotics work against bacteria not viruses. Medications that prevent or reduce diarrhoea are not recommended for rotavirus.

The best way to treat and prevent dehydration is to drink plenty of liquids. Oral rehydration solutions available without prescription from pharmacies are helpful for mild dehydration because they replace lost minerals more efficiently than water or other liquids.

Severe dehydration may require hospitalisation for treatment with intravenous (IV) fluids, which are given to patients directly through their veins.

Infants should be left to nurse if being breast-fed. Otherwise, they should be offered small amounts of oral rehydration fluid or regular formula.

Older children should be encouraged to rest and drink plenty of fluids. They should be offered only bland foods, such as crackers and toast.

Taking frequent small sips of water, clear sodas, or broths is recommended. Apple juice, dairy products, and sugary foods are best avoided as they can make diarrhoea worse.

Any foods or beverages that can irritate the stomach, such as dairy products, fatty or spicy foods, caffeine, alcohol, and nicotine, should be avoided.

Prevention / vaccination

To help prevent the spread of rotavirus in the community, children with diarrhoea and/or vomiting infection should be kept home from school or early childhood care services for at least 48 hours after the last episode of diarrhoea or vomiting.

For older children and adults, who are less likely to develop serious symptoms from rotavirus infection, frequent and thorough hand washing, especially after using the toilet, changing nappies, cleaning up vomit, or helping a child to use the toilet, is the best way to prevent infection.

Vaccination can help prevent rotavirus in infants.

The rotavirus vaccine is taken as two doses by mouth. It is available free in New Zealand for infants at their six weeks and three months of age immunisation visits. The first of the two doses must be given before 15 weeks of age. The rotavirus vaccine provides protection during the time infants are at greatest risk of getting dehydrated.

Children, even those who have been vaccinated, may get sick from rotavirus more than once. Neither rotavirus vaccination nor natural infection with rotavirus will provide full protection from future infections. Nonetheless, vaccinated children are less likely to get sick from rotavirus and, if they do get sick, their symptoms are likely to be less severe than if they had not been vaccinated. Completion of the full course of rotavirus vaccines (i.e., two doses) protects eight infants in ten from severe infection and having to go to hospital.

There is a small risk of developing intussusception with rotavirus vaccination during seven to 10 days after the first dose. Intussusception is a rare condition where one part of the intestine folds into the next (like a telescope) causing an obstruction that requires treatment in a hospital. Signs of possible intussusception include intense crying and severe abdominal pain. In general, the overall benefits of rotavirus vaccination far outweigh the very small risk of intussusception.

Further information and support

For more information about rotavirus and rotavirus vaccination, please see your GP or practice nurse, or contact:

Healthline

Free phone: 0800 611 116

Website: www.healthline.govt.nz

Immunisation Advisory Centre

Free phone: 0800 IMMUNE (0800 466 863)

Website: www.immune.org.nz

Plunket

Free phone: 0800 933 922

Website: www.plunket.org.nz

References

KidsHealth NZ (2021). Rotavirus immunisation (Web Page). Auckland: Paediatric Society of New Zealand and Starship Foundation. https://www.kidshealth.org.nz/rotavirus-immunisation [Accessed: 18/01/23]

Mayo Clinic (2021). Rotavirus (Web Page). Rochester: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/rotavirus/symptoms-causes/syc-20351300 [Accessed: 18/02/23]

Ministry of Health (2021). Rotavirus (Web page). Wellington: Ministry of Health. http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/rotavirus [Accessed: 18/01/23]

Ministry of Health (2022). Immunise against rotavirus – protect your child (Web Page). Wellington: New Zealand Ministry of Health. https://healthed.govt.nz/products/immunise-against-rotavirus-protect-your-child [18/01/23]

Immunisation Advisory Centre (date not stated). Rotavirus (Web page). Auckland: University of Auckland. https://www.immune.org.nz/factsheets/rotavirus-infection [Accessed: 18/01/23]

Reviewed: January 2023