Transmission of rotavirus and other enteric pathogens in the home

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In the United States gastroenteritis is a common infection second only to viral respiratory infections. The Centers for Disease Control and Prevention has estimated that in children <5 years of age ∼35 million episodes of diarrhea occur yearly, resulting in >200 000 hospitalizations and ∼500 deaths. Rotavirus is the cause of ∼50% of diarrhea-related pediatric admissions to hospitals and 20 to 25% of pediatric diarrhea in outpatient clinics, resulting in a significant number of physician visits, hospitalizations and deaths. 1–4Rotavirus infections in children can be very costly. In addition to the direct medical costs, the indirect expenses associated with parental lost wages and changes in child care arrangements because of the illness must be considered. 5, 6 To control the transmission of rotavirus, parents, child care providers and health care personnel must be able to recognize the clinical symptoms of rotavirus infection, the modes of rotaviral transmission and how rotaviral transmission can be minimized once a child is infected.CLINICAL MANIFESTATIONS AND OUTCOMEIn the United States rotavirus causes seasonal peaks of gastroenteritis from November to May each year, with activity beginning in the Southwest United States and spreading to the Northeast. 7, 8 The spectrum of rotavirus illness ranges from mild, watery diarrhea of limited duration to severe, dehydrating diarrhea with vomiting and fever, possibly resulting in death. 4, 9, 10 Virtually all children become infected in the first 3 to 5 years of life, but severe diarrhea and dehydration occur primarily among children 3 to 35 months of age. 3, 4, 11 Most children are infected more than once although subsequent infections tend to be milder. 11 Protective immunity acquired from infection is incomplete, but is strongest against moderate to severe infection.Rotavirus infection is characterized by the abrupt onset of fever and vomiting followed by watery diarrhea. Neonatal infections are often asymptomatic. 12 Symptomatic cases among adult family contacts are infrequent, although subclinical infections occur frequently. 13 In any single patient illness caused by rotavirus is not distinguishable from that caused by other enteric viruses, although rotavirus diarrhea may be more severe and is more frequently associated with fever and vomiting than is acute diarrhea caused by other agents. Therapy for rotavirus infection is focused on replacement of fluids and electrolytes, given that no antiviral agents are currently available.Rotavirus is a major cause of nosocomial diarrhea in infants and young children 3, 14 and has been associated with outbreaks of gastroenteritis in the day-care setting. 15, 16 In day-care centers rotavirus has been identified in 25 to 40% of outbreaks of diarrheal illness with an attack rate of 40 to 70%. 16 The tendency of rotavirus to rapidly involve many children in a day-care center indicates the need for intervention strategies or disease control practices to be in place before the identification of rotavirus illness.MANAGEMENT OF ROTAVIRUS INFECTION: PREVENTION OF TRANSMISSIONRotavirus has a short incubation period of 1 to 3 days. Viral shedding begins before symptoms develop, and children may be shedding the virus for up to 48 h before they exhibit symptoms. 17 High rates of asymptomatic shedding of rotavirus have been reported in young children. The virus is shed in feces for a mean of 4 days although excretion of virus for >30 days has been reported in immunocompromised patients.Rotavirus is known to be transmitted person-to-person by the fecal oral route. 18 In developing countries rotavirus can also be transmitted via fecally contaminated water.

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