1. ROTAVIRUSES
Dr.T.V.Rao MD

2. Dr.T.V.Rao MD Email tvraodoctor2000@yahoo.co.in
Educational material on Rota viral Diarrhea for Graduate Medical Students
Dr.T.V.Rao MD

3. Importance of Rotaviruses
Rotaviruses are major cause of diarrheal illness in Human infants in the world
Adults too can get infected

4. 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.

5. Global Impact of Rotavirus Infections

6. 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 double-stranded RNA, which codes for six structural and five nonstructural proteins. The virus is stable in the environment

7. Rotavirus resembles a wheel ( Rota = Wheel )

8. 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.
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

9. 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

10. 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

11. 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 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.

12. Rota viral infection damages Intestines
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.

13. 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

14. Dehydration is leading cause in Morbidity and Mortality

15. 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

16. 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

17. 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.

18. 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.

19. 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