Rotavirus

Sophie Matzik is a freelance writer for the medical team.

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The rotavirus is an infectious disease caused by the viruses of the same name, the rotaviruses. The rotavirus is the most common cause of diarrhea in children worldwide. It is accompanied by severe diarrhea, vomiting and fever. The rotavirus can be very dangerous, especially for young children, but deaths are rare in Germany. Read everything you need to know about the rotavirus here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A08

Rotavirus: description

The rotavirus is the most common cause of severe diarrheal diseases in infants and children worldwide. The rotavirus is highly contagious and easily transmitted. It can spread so quickly, especially in the winter months, that it leads to a veritable rotavirus epidemic.

The term rotavirus is used synonymously. It is used to describe both the disease and the pathogens of the same name. The name rotavirus is based on the visual similarity of the virus with a wheel (lat. Rota = wheel).

So far, seven subgroups of rotaviruses are known. Doctors call these subgroups serotypes and divide them into serotypes A to G. Serogroup A is the most important worldwide and is responsible for most of the disease cases.

According to the Robert Koch Institute (RKI), around 453,000 children under the age of five die each year from an infection with the rotavirus and an estimated 2.4 million children are hospitalized for rotavirus every year. Children between the ages of six months and two years are particularly often affected because they have not yet developed antibodies against the rotavirus. By the age of two, 90 percent of all children have had rotavirus infection.

But older children and people over 60 years of age are not safe from infection either. An infection with the rotavirus in adults is less common. Younger adults in particular are more likely to develop noroviruses, which also cause severe diarrhea, than rotaviruses. Symptoms such as diarrhea and vomiting are usually much easier in affected adults than in children with rotaviruses.

Infection usually takes place through pain, that is, through faeces or contaminated objects as well as food or drinking water in the mouth.

An infection with the rotavirus has been notifiable in Germany since 2001. According to the RKI, there were more than 52,000 cases of illness in this country in 2010, and more than 42,000 cases were reported in 2011. The actual number of sick people is probably even higher, since not all infections are recognized and reported.

Rotavirus: symptoms

It takes about three days after infection (rotavirus incubation period) until symptoms show up when infected with the rotavirus. During this time the virus multiplies and spreads in the body. A few days after infection and up to eight days after infection, those affected can excrete the rotavirus in their stool (small children also for longer).

As a rule, rotaviruses first appear as mild diarrhea, which can be watery. This diarrhea gets worse and worse within a few hours. Often there are nausea and vomiting as well as severe stomach pain. Children in particular, and less often when rotaviruses affect adults, often have a high fever.

The combination of diarrhea (in extreme cases, vomiting diarrhea) and fever is very dangerous. The diarrhea causes the body to lose a lot of fluid and also important minerals such as electrolytes. In most cases, sufferers have no appetite at all during the illness and cannot keep anything to themselves. The fever also removes water from the body. Especially if the rotavirus affects babies or toddlers, hydration needs to be closely monitored. In Germany around 2,000 babies and toddlers are treated as inpatients for rotavirus every year, around 50 of them in the intensive care unit. Rotaviruses are a very rare cause of death in Germany.

Symptoms last for about four to seven days, then slowly go away. Around half of those affected also show flu-like symptoms such as coughing, body aches or breathing problems during this time. In children, all symptoms are usually more pronounced than in adults. Under certain circumstances, the high fluid loss caused by fever and diarrhea can be life-threatening.

Rotavirus: causes and risk factors

The rotavirus belongs to the Reoviridea family. It is very environmentally resistant and can survive for a surprisingly long time on surfaces, for example. The rotavirus is difficult to kill with disinfectants. The most common route of transmission is faecal-oral infection. Babies and toddlers are particularly at risk here with rotaviruses, as they simply put toys or other objects in their mouths, for example. Contaminated food or water can also be a source of infection.

Rotaviruses are one of the most common causes of death for children in developing countries. Vacationers, especially in regions of Africa and South America, should carefully study the respective regulations and recommendations for drinking water and fresh food in the respective country of travel before traveling.

Rotavirus infection is more dangerous for young children and people with weakened immune systems than for otherwise healthy adults. In young children, the immune system is not yet well developed. Even a single rotavirus infection does not protect against re-infection. Because there are many different subgroups of the virus, rotavirus can affect adults and children many times.

Rotavirus: contagion

Rotavirus infection can occur as long as the virus is excreted in the stool. This is usually the case from the time the symptoms first appear up to eight days later. This can take longer, especially with small children.

Rotavirus: examinations and diagnosis

If you suspect that you have rotavirus, the first point of contact is the family doctor for adults and the pediatrician for children. Usually the doctor can make an initial diagnosis based on the symptoms. First, the medical history is recorded (anamnesis). Here you have the opportunity to describe all the symptoms and changes in your child's behavior. The doctor can then ask questions such as:

• Since when exactly have the symptoms been present?
• What exactly does the diarrhea look like (is it bloody, for example)?
• What did you / your child eat in the last few days?
• Have you heard of similar cases in your environment (for example, with children in school or kindergarten)?

After taking the medical history, a physical exam will take place. Among other things, the abdomen is scanned in order to rule out other causes of gastrointestinal complaints. Differentiation from other viral infections is also essential, as rotavirus disease in adults and children is notifiable.

Rotaviruses can be detected in the stool of those affected under the microscope. Alternatively, the rotaviruses can be diagnosed using an electron microscope or molecular biological methods. These methods can provide the doctor with additional data and clarify the origin of the pathogen. However, they are more complex and are therefore only rarely used.

Rotavirus: treatment

Treatment of the rotavirus is purely symptomatic. It is not possible to fight the viruses directly with drugs (antivirals). It is of particular importance that those affected drink enough to compensate for the high loss of fluids. The lack of fluids can be life-threatening, especially in children, as it also removes important mineral salts from the body. As a result, around half of all children with rotavirus infection are treated in the hospital. Mineral water, tea and diluted fruit juices are particularly suitable for drinking. Fatty drinks such as milk or, in the case of adults, alcohol should definitely be avoided. Babies who are still breastfed should continue to receive breast milk after consulting their doctor.

Antibiotics cannot be used with rotaviruses. They only help with a bacterial infection, but not with a viral disease. Even means that help against diarrhea and thus inhibit intestinal motility should not be taken. Antipyretic drugs may be given to lower the fever. In adults, these are primarily acetylsalicylic acid (ASA) and novalgin. These active substances must not be given to children. Here ibuprofen and paracetamol are prescribed.

Pay attention to special hygiene measures during the illness. There are special disinfectants that can be used against rotaviruses. During the acute phase of the illness, you should regularly clean everything that you or your child use. In the case of children, especially clean toys, dishes and the changing mat and all objects used. Wash your hands regularly and be careful not to have too much contact with other people to avoid transmission of the rotavirus.

Two different vaccines against rotaviruses have been approved in Germany since 2006. Rotavirus vaccination is recommended for all children. One effect of the vaccination can already be seen in a decrease in the number of cases of illness.

Rotavirus: disease course and prognosis

Mortality from rotaviruses is low in Germany - it is around 0.1 percent of infections. Almost half of all children under the age of five need hospital treatment. Adults infected with rotavirus are hospitalized about 20 percent of the time. In Germany, the number of new infections has also fallen sharply due to vaccinations. However, many parents still consider vaccination against rotavirus to be unnecessary. As a result, local epidemics occur again and again - especially in public institutions such as schools, kindergartens and hospitals.

In countries that do not yet have such a high standard of medical care as in Germany, infection with the rotavirus is much more dangerous in adults and children. According to the RKI, over 100 million children develop rotaviruses every year in countries such as Africa, Asia and Latin America. An estimated 350,000 to 600,000 children under the age of five die here from an infection with the rotavirus.

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