What you need to know about rotavirus infection in children
Probably millions of children have been suffering from rotavirus infection for hundreds of years, only it did not have a name. Fever, diarrhea, vomiting - after all, many diseases have similar symptoms. Rotavirus infection was first identified in 1973 in Australia, and diagnosed in Lithuania since 1994. It was named after the discoverers because the virus resembled a wheel. In developed and developing countries, this virus is the main cause of acute infectious intestinal diseases in children. Rotavirus infection is an acute intestinal infection caused by rotaviruses, characterized by general body intoxication, inflammation of the stomach and small intestine, often, especially in children, there are mild upper respiratory tract catarrhal symptoms (runny nose, sneezing, redness of the throat, slight pain in it).
What is rotavirus
Rotavirus is a wheel-shaped virus that is very resistant to environmental factors, various disinfectants, and can survive in the environment for a long time. At temperatures of 4-20 degrees Celsius, it remains viable for several months. Rotaviruses are quite resistant to household mild detergents, but quickly die when exposed to chlorine-containing disinfectants, when boiled. Rotaviruses are found in rivers, lakes, seas, as well as in groundwater and tap water. Rotaviruses are excreted in large quantities with the patient's feces, and infection can occur with just 10 virus particles. The virus is excreted during the acute phase of the disease, on average for 4-6 days. Therefore, the resistance of rotaviruses in the external environment and a very small infectious dose create conditions for their wide spread in society.
How is rotavirus infection transmitted
The main source of infection is a sick child and carriers of the virus who are asymptomatic. This infection is not transmitted from animals, as the circulating viruses among them are not dangerous to the child. Rotavirus is transmitted through the mouth, as the infection spreads through dirty hands and contaminated environment. Since the viruses remain viable in the environment for a long time, they spread through various objects that children can put in their mouths. It is believed that rotavirus infection can also be transmitted through the respiratory tract, like the flu or other acute respiratory infections. This disease can also be contracted through food, if it was prepared with dirty hands, or with thermally untreated food products: sandwiches, salads. There is evidence that the infection can spread through water. In children's groups (kindergartens, schools), children most often infect each other. Infants breastfed by their mothers acquire immunity to this disease, so typical disease symptoms may not appear, but they excrete large amounts of the virus with their feces into the environment. If such patients are in children's healthcare facilities, there may be a risk for premature and weak infants and older children. In such cases, rotavirus infection manifests as a hospital infection. Rotavirus infection is seasonal. Like the flu, it most often occurs in the cold season - from November to April, as the viruses of both of these diseases survive better in the cold. After contracting this disease, immunity is only temporary, and small children do not have personal hygiene skills, so they can become infected and sick with rotavirus infection several times. Many people can be carriers of this virus, so it is very important to wash hands frequently when caring for a sick child.
What are the ailments that afflict those infected with rotavirus infection
The first symptoms of the disease appear within 24-72 hours of infection. During this period, the child appears healthy, but the virus establishes itself in the body and multiplies to the extent of causing the disease. There are three clinical forms of the disease: mild, moderate, and severe.
Mild forms of the disease, which are characteristic of individual cases, are rarely elucidated. Moderate forms are more common. The disease begins acutely and is characterized by nausea, vomiting, and diarrhea. Vomiting occurs 3-4 times a day. Diarrhea is frequent, even up to 15-20 times a day. The stools are liquid or semi-liquid, watery, yellow in color, and have an acidic odor. Diarrhea lasts longer than vomiting. At the onset of the disease, there is abdominal pain. The child may also experience mild upper respiratory tract infection symptoms.
Almost 90 percent of children have a fever. The temperature rises to 37-38°C and lasts for 1-2 days, sometimes longer. Signs of intoxication appear - weakness, lethargy, drowsiness. Those with moderate or severe forms of the disease (especially infants or children under 3 years old) quickly lose a lot of fluids, along with essential human electrolytes, which can pose a danger to the life of a small patient. Clinical symptoms in infants under 3 months of age are rare because they receive antibodies through breast milk, so typical symptoms may not appear. Upon repeated infection, clinical signs and symptoms of the disease are significantly milder. Rotavirus infection cannot be diagnosed solely based on disease symptoms, as diarrhea can also be caused by other viruses and bacteria. Laboratory tests are crucial for diagnosis, so it is necessary to consult a doctor to determine the diagnosis and prescribe appropriate treatment.
What a pharmacist could advise
There is no specific treatment for diarrhea caused by rotavirus. It is crucial to start treatment at home as soon as the child starts to have diarrhea and vomit. First and foremost, it is necessary to restore fluid and electrolyte levels and maintain their balance. Therefore, the pharmacist should advise to start giving the child special solutions containing salts and glucose immediately. Tea, juices, fruit drinks are not suitable. Fluid intake should be frequent and in small amounts: 15-30 ml every 5-10 minutes. If the child vomits - 5 ml every 2-3 minutes. Infants, especially breastfed ones, should be given with a spoon or from a cup. It is essential to advise to monitor the child's condition carefully: repeated vomiting, frequent and copious diarrhea, decreased urination, dry lips, thick saliva., a change in a child's behavior (lethargic or agitated) indicates a fluid deficiency. In this case, it is necessary to increase the intake of oral rehydration salts and glucose and immediately consult a doctor. If these solutions do not help, the child is sent to the hospital. Breastfeeding is not interrupted and is continued according to the baby's needs. In case of fever, vomiting, bloating, appropriate preparations reducing these symptoms are used. When treating dehydration, it is important to restore the children's intestinal microflora as soon as possible. For this purpose, it is advisable to administer Enterol, which contains the probiotic Saccharomyces boulardii (S. boulardii). This probiotic is an effective auxiliary treatment for acute diarrhea. S. Boulardii is a non-pathogenic yeast isolated from tropical fruits grown in Indonesia (lychees and mangosteens). The strain of probiotic S. boulardii was discovered in 1920 by the French microbiologist Henri Boulard, who was searching for a yeast strain suitable for fermentation in Indochina. Lyophilized S. boulardii is stable at room temperature, with its optimal growth temperature being almost the same as the natural human body temperature - 37°C. S. boulardii travels through the digestive tract almost unchanged because it is resistant to acidic environments and the effects of bile acids, unlike other Saccharomyces species that require a lower temperature (30-33°C) for extraction and are not resistant to acidic environments. The live S. boulardii microorganisms in the digestive tract act similarly to normal intestinal flora. When treating diarrhea or taking a medication for diarrhea prevention, the main way S. boulardii works is by inhibiting the pathogenic effects of certain microorganisms or their toxins (the most important of these microorganisms are Clostridium difficile - the main cause of antibiotic-associated diarrhea, and Vibrio cholerae - a typical toxin-producing bacterium causing secretory diarrhea) or by promoting trophic and immune functions in the digestive tract - there is a significant increase in the overall and specific disaccharidase (sucrase, maltase, and lactase) activity and secretory IgA concentration in the intestine. In May 2008, a working group of experts from the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition and the European Society of Paediatric Infectious Diseases defined that, in the absence of sufficient evidence of the effectiveness of many probiotics, only those probiotic strains whose effectiveness is evidence-based and recommended as an additional treatment alongside appropriate rehydration for children with acute gastroenteritis can be used. Based on clinical trial data (properly designed, with sufficient scope), S. boulardii and Lactobacillus GG probiotics are considered to have a suitable level of evidence as clinically effective. In October 2011, the World Gastroenterology Organization published recommendations online regarding the use of probiotics in treating acute diarrhea. According to evidence-based recommendations, the use of S. boulardii and L. reuteri ATCC 55730, L. rhamnosus GG, and L. casei DN-114 001 is beneficial in reducing the severity and duration of acute infectious diarrhea in children (by approximately 1 day). The World Gastroenterology Organization noted that these probiotics are safe and effective to use. And already this year, the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) together with the European Society of Paediatric Infectious Diseases (ESPID) updated the guidelines for the treatment of acute gastroenteritis in children in Europe. They summarize that the addition of probiotics to active treatment with oral rehydration solution effectively reduces the duration and intensity of gastroenteritis symptoms (strong recommendation, moderate-quality evidence). Several probiotics are recommended for this purpose. Only recommendations for the administration of Lactobacillus rhamnosus GG and Saccharomyces boulardii are strong.
How to protect against rotavirus infection
Hand hygiene is the main preventive measure to reduce the risk of rotavirus infection spread. Rotaviruses remain viable on hands for almost 4 hours. Hands should be washed not only with soap but also with alcohol-based hygiene products. Hands should be washed after using the toilet, after contact with a sick child's stool, after returning from the store, before each meal, and before preparing food.
If a child has diarrhea, starts feeling nauseous, vomiting, they should not be allowed to attend kindergarten, school, or any other institution where children gather, as children are very susceptible to this infection and can infect others, still healthy children.
The child needs to be isolated, i.e. have a separate room or part of a room.
The child's room should be well ventilated. The toilet and its room should be cleaned with separate tools, using disinfectants containing chlorine or ethanol. Rotaviruses are quite resistant in the external environment: they can remain viable on dry surfaces for up to 10 days.
The child should use separate dishes, a towel.
It is necessary to safely dispose of the sick baby's diapers, keep and wash his dirty towels, linens separately. It is advisable to boil them with laundry detergent for 15 minutes. Iron the dried laundry thoroughly with a hot iron.
Wash the child's toys with soap or soda solution, rinse with running water, and dry.
Vaccination. A special vaccine against rotavirus infection has recently been discovered and already started to be used in Lithuania
Prepared by Dr. R. Jasiukevičiūtė
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