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Traveler Summary

Key Points

  • Rotavirus infection is a viral infection acquired primarily through fecal-oral transmission (direct or indirect) and aerosolized respiratory droplets.
  • Risk is highest for all young children (5 years and younger) everywhere and for adult travelers going to developing countries with poor sanitation.
  • Symptoms vary depending on whether the infections is the first infection (severe) or a reinfection (mild) and include fever, vomiting, and explosive, watery diarrhea; however, rotavirus infection can also be symptom free.
  • Consequences of infection in young children may include severe dehydration.
  • Prevention includes good respiratory hygiene and personal protection measures (e.g., handwashing with soap and water and use of disinfectants).
  • Rotavirus vaccine is given to young children in a series of 2 or 3 doses; no vaccine is available for adults or older children who travel.
  • Vaccine side effects include mild diarrhea, vomiting, coughing, and irritability.
  • Duration of vaccine protection is unknown; no booster is required.

Introduction

Rotavirus infection is caused by a virus that is very stable and can remain viable in the environment for weeks or months if not disinfected. It is the most common cause of severe infection of the digestive tract in infants and young children worldwide.

Risk Areas

Rotavirus infection occurs throughout the world, causing nearly 500,000 deaths annually from severe, dehydrating diarrhea in children younger than 5 years, mostly in developing countries. Rotavirus is one of the main causes of travelers' diarrhea in developing countries, especially in Latin America and Africa. It is more prevalent during fall and winter in temperate climates and more common during cooler, drier months in tropical climates.

Transmission

Rotaviruses, which are highly contagious, are shed in the stool of infected persons. Transmission is fecal-oral, typically through close person-to-person contact and contact with objects (e.g., toys and other environmental surfaces contaminated by stool). Rotaviruses may also be transmitted through contaminated food and water and aerosolized respiratory droplets.

Risk Factors

Infection with rotavirus is nearly universal, and almost all children have been infected by age 5 years. Infection can occur as early as age 2 months, but most cases occur between ages 6 months and 2 years.

Other persons at increased risk include caretakers and parents of children in child care or hospitals, children and adults with diseases that affect the immune system's ability to fight infection (e.g., severe combined immunodeficiency disease, HIV, and bone marrow transplant), and adult travelers going to developing countries with poor sanitation.

Symptoms

The incubation period for rotavirus diarrhea is usually less than 48 hours. Symptoms generally last 3 to 8 days, but the virus can persist in stools for as long as 3 weeks. Onset of disease is abrupt, with fever, vomiting, and explosive, watery diarrhea.

Infections might be symptom free, mild (self-limited watery diarrhea), or severe (dehydrating diarrhea).

Symptoms vary and depend on whether the infection is a first infection or a reinfection. The first infection, if it occurs after age 3 months, is generally the most severe. Children can be infected with rotavirus several times during their lives, but the initial infection protects against subsequent severe illness (although subsequent symptom-free infection and mild disease may still occur).

Consequences of Infection

Infection can result in severe dehydration and may be fatal in children who are not immediately treated.

Need for Medical Assistance

Persons with severe vomiting and diarrhea should seek immediate medical care because these symptoms can lead to dehydration. No antiviral drugs exist for treating rotavirus infection.

Prevention

Non-vaccine: Observe good respiratory hygiene (cough and sneeze etiquette) and handwashing practices.

Vaccine: Two oral rotavirus vaccines are approved in the U.S. for use in infants aged 6-32 weeks. Although vaccination early in life will not prevent all subsequent disease, it should prevent most cases of severe disease. Duration of protection is unknown. No vaccine is available for adults or older children who travel.

Persons who have children with underlying medical conditions or who have concerns about the vaccine should speak to their child’s health care provider before vaccine administration.

Side effects: Reported side effects may include mild, temporary diarrhea or vomiting, cough or runny nose, and fussiness or irritability.

A small increase in risk of intestinal obstruction due to intussusception (telescoping of the intestine) exists in children, usually within a week of the first or second vaccine dose. However, the benefits of rotavirus vaccination continue to outweigh the risks associated with vaccination, including intussusception.

Timing: RotaTeq: 3 doses are given, 1 each at ages 2, 4, and 6 months. If an accelerated schedule is needed (e.g., for travel), the 3 doses may be given 4 weeks apart starting at age 6 weeks: 1 dose each at ages 6, 10, and 14 weeks.

Rotarix: 2 doses are given, 1 each at ages 2 and 4 months. If an accelerated schedule is needed (e.g., for travel), the 2 doses may be given 4 weeks apart starting at age 6 weeks: 1 dose each at ages 6 and 10 weeks.