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| ROTAVIRUS |
Disease
Rotavirus causes an acute gastroenteritis in infants and young children and is associated with profuse watery diarrhoea, projectile vomiting and fever. Rapid dehydration can occur, especially in very young infants, requiring rehydration therapy. The virus is transmitted via the faeco–oral route and by direct person-to-person spread, although a respiratory mode of transmission has been proposed also. It replicates in the enterocytes of the small intestine, causing extensive damage to the microvilli that results in mal-absorption and loss of fluids and electrolytes.
Occurrence
Rotavirus is found worldwide. The virus is ubiquitous, infecting a large proportion of young children by their second or third birthday. Re-infection of older children and adults is common, although the infection is usually sub-clinical.
Risk for travellers
The potential risk for travellers is extremely limited since most individuals will have good immunity through repeated exposures early in life.
Vaccine
Rotavirus vaccine (live, oral) is licensed for immunization of infants over 6 weeks of age for protection against gastro-enteritis caused by rotavirus infection. Immunization is started between the age of 6-12 weeks, neither earlier than 6 weeks nor later than 12 weeks. Two to three doses are given at an interval of 1-2 months.
Rotavirus vaccine is contra-indicated in individuals with immunodeficiency and in those predisposed to, or with a history of intussusception. The administration of rotavirus vaccine should be postponed in infants with diarrhoea or vomiting.
The rotavirus vaccine virus is excreted in the stool and may be transmitted to close contacts; the vaccine should be used with caution in those with immunosuppressed close contacts. Carers of a recently vaccinated baby should be advised of the need to wash their hands after changing the baby's nappies.
To date, the clinical efficacy of the rotavirus vaccines has been demonstrated mainly in the Americas and in Europe. WHO recommends the inclusion of rotavirus vaccination into the national immunization programmes of regions where vaccine efficacy data suggest a significant public health impact. Vaccination is not currently recommended for travellers or older children outside the routine childhood immunization schedule. |
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