Rotavirus Infections

Rotavirus is a contagious virus and, among children, is the leading cause of severe infectious diarrhea. In some infants and children, diarrhea may be so severe that they become dehydrated and may require emergency care or hospitalization.

• Prior to the use of the rotavirus vaccine in 2006, as many as 55,000 children were hospitalized each year in the U.S. due to rotavirus infections.

• The virus peaks during the cooler months of the year starting in the fall and ending in the spring.

• The majority of children acquire the virus between 3 months and 35 months.

• A child or adult may become infected with rotavirus more than once, but, usually, the initial case is the most severe and subsequent infections are milder.

Transmission of rotavirus most often occurs through fecal-oral contact. Usually, this occurs from poor hand washing or from ingestion of contaminated food or water. The virus may also be transmitted through the respiratory tract or by other body fluids, but these routes are less common. The virus may live on inanimate surfaces, such as doorknobs, toys, and hard surfaces, for quite some time. For this reason, outbreaks can occur in child care centers and within families who share a household. The hospitalized child will need to be isolated from other children to prevent transmission of the virus.

• After coming in contact with the virus, it may take up to two days for symptoms to develop.

The symptoms for rotavirus can range from mild to severe. The following are the most common symptoms of rotavirus. However, each child may experience symptoms differently. Symptoms may include.

• Fever, which usually subsides within the first couple of days

• Nausea and vomiting

• Abdominal pain

• Diarrhea (usually watery and frequent; may last between three to eight days)

• Dehydration, which can occur quickly, especially in infants. Symptoms of dehydration may include:

  • Lethargy or sleepiness

  • Irritability

  • Thirst

  • Pale color to skin or mottling

  • Less elasticity in the skin

  • Eyes appear deeply sunken

  • Baby's fontanelle (or soft spot) may feel sunken

  • Decreased or absent tears

  • Decreased urine output or fewer wet diapers

  • Dry mouth

In addition to a complete medical history and physical examination, a stool culture may be used to detect the virus.

There is no cure for rotavirus, so treatment of the disease is supportive (aimed at treating the symptoms present). Treatment may include:

• Oral rehydration with water, formula, breast milk and/or special electrolyte--containing fluids (fluids containing sugars and salts), such as Pedialyte (very young children should NOT be rehydrated with soda, juices, or sports drinks)

• Continue feeding your child solid foods (if he or she is able to tolerate it)

• It is no longer recommended to restrict a child's diet when he or she has diarrhea. Restricting the child's diet may actually make the diarrhea last longer. 

About one out of every 70 children may develop severe enough dehydration to require hospitalization. In these children treatment may include:

• Intravenous (IV) fluids

• Nasogastric (NG) tube feedings. A small tube may be placed into your child's stomach through his or her nose so that formula or fluids may be administered.

• Blood work. The blood work measures your child's electrolyte levels--sugar, salt, and other chemicals in the blood.

The following will help to prevent the spread of the rotavirus:

• Proper hygiene and hand-washing technique — washing with soap and water before eating and after going to the bathroom 

• Cleaning hard surfaces, toys, and doorknobs

• Proper handling and disposal of dirty diapers, even after your child no longer has symptoms

If your child develops rotavirus, he or she may not be able to attend day care or school while he or she is ill. If your child is hospitalized, he or she will be isolated from other children to prevent an outbreak in the hospital.

A rotavirus vaccine that was approved by the FDA in 1998 was pulled from the market in 1999 because of an association between the vaccine and an increased risk for intussusception in infants age 1 and younger. (Intussusception means a portion of the intestine telescopes within another immediately adjacent portion of intestine.) However, no direct link was established to the vaccine as a cause of intussusception.

The FDA has approved two oral rotavirus vaccines, RotaTeq® and Rotarix®. No risk for intussusception was found in clinical trials with the vaccines in the United States. Studies in certain other countries have shown a possible association with intussuseption. The CDC recommends that infants receive either the RotaTeq oral vaccine at age 2 months, 4 months, and 6 months or the Rotarix oral vaccine at age 2 months and 4 months.

Learn more about rotavirus and the rotavirus vaccine at CHOP's Vaccine Education Center.