Ph.D. Public Health Student Increasing the Knowledge for and Reducing the Incidence of Food Borne Illnesses Caused by Rotavirus Claret Onukogu Walden University Ph.D. Public Health Student Dr. Raymond Thron PUBH 8165 Wk9AssgnOnukoguC 4 August, 2012 Audience- General Public Stakeholders: Giovanni Italian Restaurant Long-Horn Steak House Miyako Restaurant Cobb-Wellstar Hospital Italian Oven South Cobb High School The purpose of this presentation is to educate the public about rotavirus, its symptoms, prevention, transmission, treatment, clinical information and vaccinations.

Expected Learning Outcomes At the end of the presentation, the targeted audience will become familiarized with the following information pertaining to Rotavirus disease. Identification of its symptoms, prevention, treatment and transmission of the disease Vaccinations Clinical features pertaining to the disease

Introduction: Rotavirus It causes 85% of the deaths in low-income countries in Asia and Africa (WHO, 2011). More than two million individuals become hospitalized every year because of severe dehydration (WHO, 2011). Out of the 43 countries that take part in the Global Surveillance network, 36% of children less than the age of 5 were hospitalized in 2009 due to diarrhea caused by rotavirus (WHO, 2011). World Health Organization (WHO). (2011, October). Rotavirus. New and Under-Utilized Vaccines Implementation (NUVI). Retrieved from http://www.who.int/nuvi/rotavirus/en/ Children who are between 6 months and 2 years old are susceptible to rotavirus infection more than any other age group (WHO, 2011). The Expanded Program on Immunization (EPI) has approved two vaccines to be administered orally and they are licensed in countries such as Europe, America, and in the eastern Mediterranean (WHO, 2011). There are currently other vaccines for rotaviruses in different stages of development in third world countries.

Introduction: Rotavirus Rotavirus causes the following: Gastroenteritis (Inflammation of the intestines and stomach) Severe Diarrhea Dehydration Death Doctor Visits Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html Abdominal pain, extreme watery diarrhea, fever and vomiting are caused by Rotavirus (CDC, 2011). The virus can lead to the loss of body fluids (dehydration) in children and babies. It is responsible for a worldwide prevalence of severe diarrhea for young children and infants. Rotavirus leads to more than 500,000 deaths annually for children who are less than 5 years of age (CDC, 2011). Prior to the introduction of rotavirus vaccine in 2006 for infants in the United States, the virus was the main cause of severe diarrhea for children (CDC, 2011). During the period of pre-vaccine, over 400,000 visits to doctors, 55,000 to 70,000 hospitalizations, emergency room visits of 200,000, 20 to 60 deaths in children less than five years old occurred (CDC, 2011). The annual rate of death caused by rotavirus is 527,000 for children in the united states (CDC, 2011).

Symptoms of Rotavirus Vomiting Fever Abdominal Pain Diarrhea Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html Although rotavirus disease is mainly common in young children and infants, older children and adults can also develop rotavirus infection (CDC, 2011). Symptoms associated with rotavirus exposure appears in 2 days (CDC, 2011). For a child with rotavirus infection, watery diarrhea and vomiting could occur in 3 to 8 days (CDC, 2011). Loss of appetite and bodily fluids (dehydration) are additional symptoms associated with rotavirus infection and is particularly harmful for children and infants. Because there are different types of rotaviruses, unvaccinated and vaccinated children could develop the disease more than once. Natural infection and vaccine cannot provide full protection or immunity from further rotavirus infections. Symptoms that are most severe with rotavirus comes with the first infection of an individual (CDC, 2011).

Transmission Objects Hands Water Food Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html The spread of rotavirus is rapid and easy among children. Through diarrhea, children can spread the virus during and after sickness. The family members and close contacts of a sick individual can also become infected. The spread of rotavirus into the environment is through the feces of an infected person and it is transmitted to other individuals through the fecal-oral route. In other words, an infected person has to shed the virus and a susceptible individual will ingest it in order for infection to occur (CDC, 2011). Contaminated food, hands, water and objects such as surfaces and toys can facilitate the spread of the virus (CDC, 2011). Diarrhea can be caused by rotavirus in travelers, older adults and those who take care of children. Winter and spring, precisely December to June, are the period of time when children are most susceptible to rotavirus infection (CDC, 2011).

Prevention Cleanliness Hand-washing Vaccines RotaTeq (RV5) Rotarix (RV1) Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html The spread of rotavirus is very easy. Although cleanliness and good hygiene are essential in the prevention of diseases, it takes more than these qualities for the spread of diseases to be controlled. The inflammation of the intestines and stomach (gastroenteritis), diarrhea and other symptoms can be effectively prevented through rotavirus vaccines. The two vaccines that are recommended by the Center for Disease Control and Prevention (CDC) for infant vaccination against rotavirus illness are RotaTeq (RV5) and Rotarix (RV1) vaccines (CDC, 2011). By 2 and 4 months of age, Rotarix (RV1) is recommended to be given to infants in 2 doses (CDC, 2011). RotaTeq (RV5) is administered at the ages of 2, 4 and 6 months (CDC, 2011). The doses of the vaccines given orally are different. There is an 85% to 98% effectiveness rate for the prevention of rotavirus infection in infants and children, including those requiring hospitalization, if rotavirus vaccines are used (CDC, 2011). The rotavirus vaccines do not work in the prevention of infections caused by other viruses.

Treatment No anti-retroviral drugs exists for the treatment of retrovirus. Naturalyte Infalyte Lectrolyte Intravenous fluids Oralyte Pedialyte Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html Antibiotics do not treat rotavirus because they are meant for bacteria and not viruses. Dehydration can occur due to the severe diarrhea and vomiting caused by rotavirus infection (CDC, 2011). Older adults, children, infants and individuals who are already suffering from other illnesses are more susceptible to the loss of fluids due to infections caused by rotavirus. Illnesses that are related to gastroenteritis caused by rotavirus are self-limited for individuals with healthy immune systems. Usually, 1 out of 70 children who have gastroenteritis will need to be hospitalized and given intravenous fluids (CDC, 2011).

Dehydration The common symptoms of dehydration in adults and children are as follows: Reduction in urination Dry throat and mouth Dizziness while standing Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html A child who is dehydrated can become very fussy and sleepy with little or no tears while crying (CDC, 2011). Serious problems could arise from dehydration which may require hospitalization with intravenous fluid treatments. Oral rehydration therapy or plentiful consumption of fluids is the most appropriate preventive method for dehydration. A doctor can be contacted if in the case of severe dehydration. Mild dehydration can be treated or prevented with products that have similar ingredients with those in oral rehydration fluids. The most common oral rehydration solutions in the United States that are sold in drug and food stores include Oralyte, Naturalyte, Pedialyte, Kao Lectrolyte, and Infalyte (CDC, 2011). A doctor should be contacted if there is any uncertainty about how to use the pre-mixed fluids (CDC, 2011).

Pictures of Rotavirus The picture on the bottom left is the electron micrograph transmission of rotavirus virions. The picture on the bottom right of the page is the electron micrograph transmission of rotavirus particles that are intact and double-shelled. Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html Rotavirus has the appearance of a wheel when it is viewed under a microscope. It is a non-enveloped viruses. The genome comprises of 11 double stranded RNA segments (CDC, 2011).

Picture of Rotavirus Revealed RNA virions of rotavirus on an electron micrograph and some unknown virion particles of 29 nanometer (CDC, 2011). Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html

National Surveillance National Respiratory and Enteric Virus Surveillance System (NREVSS) New Vaccine Surveillance Network (NVSN) Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html The surveillance systems that are responsible for the monitoring of the rotavirus outbreaks are the National Respiratory and Enteric Virus Surveillance System and the New Vaccine Surveillance Network (CDC, 2010). The National Respiratory and Enteric Virus Surveillance System is a laboratory-based system that was developed to monitor geographic and temporal patterns linked with human para-influenza viruses (HPIV), respiratory syncytial virus (RSV), rotavirus, enteric and respiratory adenoviruses (CDC, 2010). The New Vaccine Surveillance Network (NVSN) was founded in 1999 for the evaluation of newly introduced vaccines and the policies associated with them (CDC, 2011). The network operates by actively conducting surveillance at three medical centers in the United States. It serves as a complimentary program for surveillance programs that are already in existence for diseases that can be prevented by vaccine through active population surveillance conducted seasonally for hospitalizations related to acute gastroenteritis and acute respiratory illness in young children whose residents are among the NVSN surveillance counties such as Hamilton County Ohio, Davidson County Tennessee and Monroe County New York (CDC, 2011). In outpatient clinics and emergency departments, active surveillance is also carried out.

Additional Facts about Retrovirus 2003- Rotavirus Vaccine Program (RVP) established, 600,000 Annual Rotavirus Deaths 2004- Immunogenicity Trial in South Africa, Reference Labs in Asia and Africa 2005- Immunogenicity Data from South Africa, Immunogenicity Trial in Infants with HIV, Efficacy Trial in South Africa, Immunogenicity Trial in Bangladesh, Regional Surveillance Established 2006- Ongoing Surveillance, Efficacy Trial in Malawi, Immunogenicity Data from Bangladesh, Rotavirus Proportion Grows, Vaccine in US and Developing World (CDC, 2011). Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html

Additional Facts about Retrovirus 2007- Immunogenicity Data from South Africa, Immunogenicity Trial in Infants with HIV, Efficacy Trial in South Africa, Immunogenicity Trial in Bangladesh, Regional Surveillance Established. Regional Surveillance Established 2008- Enrollment complete in Kenya, Ghana, Mali, Bangladesh, and Vietnam; population effectiveness study, vaccine effectiveness study, global advocacy efforts, interim data show high efficacy. Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html

Additional Resources Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus Surveillance- Worldwide, 2009. Morbidty and Mortality Weekly Report (MMWR). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6016a5.htm Cortes, J., Curns, A., Tate, J., Cortese, M., Patel, M., Zhou, F., & Parashar, U. (2011, September). Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children. The New England Journal of Medicine. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa1000446 Center for Disease Control and Prevention (CDC). (2011, February). Recommended Adult Immunization Schedule- United States, 2011. Morbidity and Mortality Weekly Report (MMWR). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6004a10.htm Payne, D., Staat, M., Edwards, K., Szilagyi, P., Weinberg, G., Hall, C., Chappell, J., Curns, A., Wikswo, M., Tate, J., Lopman, B., & Parashar, U. (2011). Direct and Indirect Effects of Rotavirus Vaccination Upon Childhood Hospitalizations in 3 U.S. Counties 2006-2009. Clinical Infectious Diseases. Retrieved from http://cid.oxfordjournals.org/content/early/2011/06/14/cid.cir307.long

Additional Resources Parashar, U., Gentsch, J., Patel, M., Lopman, B., Cortes, J., Esposito, D., Yen, C., Curns, A., Payne, D., Cortese, M., & Tate, J. (2011, January). Uptake, Impact, and Effectiveness of Rotavirus Vaccination in the United States: Review of the First 3 Years of Postlicenture Data. PUBMED. Retrieved http://www.ncbi.nlm.nih.gov/pubmed/21183842 Parashar, U., Harris, M., Wenk, J., Tate, J., & Yen., C. (2010, September). Diarrhea-Associated Hospitalizations Among US Children Over 2 Rotavirus Seasons After Vaccine Introduction. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/early/2010/12/20/peds.2010-1393.abstract

References Center for Disease Control and Prevention (CDC). (2011, April). Rotavirus. Rotavirus Topics. Retrieved from http://www.cdc.gov/rotavirus/index.html Cortes, J., Curns, A., Tate, J., Cortese, M., Patel, M., Zhou, F., & Parashar, U. (2011, September). Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children. The New England Journal of Medicine. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa1000446 Rotavirus Vaccine Program (RVP). (2008). Clinical Research. Rotavirus Vaccine Program. A Path Affiliate. Retrieved from http://www.rotavirusvaccine.org/ World Health Organization (WHO). (2011, October). Rotavirus. New and Under-Utilized Vaccines Implementation (NUVI). Retrieved from http://www.who.int/nuvi/rotavirus/en/