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Traveler Summary

Key Points

  • Rotavirus infection is a viral infection, occurring worldwide, acquired primarily through fecal-oral transmission, contact with contaminated objects, and inhalation of infected aerosolized respiratory droplets.
  • Risk is increased for children younger than 5 years worldwide and for adult travelers going to developing countries with poor sanitation.
  • Symptoms include fever, vomiting, and explosive, watery diarrhea; however, rotavirus infection can also be symptom free.
  • Consequences of infection may include severe dehydration.
  • Prevention includes observing good respiratory hygiene measures (cough and sneeze etiquette) and frequent, thorough handwashing.
  • Rotavirus vaccine is given to children 8 months and younger 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, a highly contagious viral infection transmitted primarily via the fecal-oral route, is the most common cause of severe digestive tract infection of infants and young children, especially in developing countries worldwide.

Risk Areas

Rotavirus infection occurs worldwide and often results in death in children younger than 5 years, especially in developing countries. Rotavirus is one of the main causes of travelers' diarrhea in both children and adults in developing countries, especially in Latin America and Africa. Infection commonly occurs during fall and winter in temperate climates and during cooler, drier months in tropical climates.

Transmission

Rotaviruses are transmitted via the fecal-oral route, close person-to-person contact, contact with contaminated objects (e.g., toys and other environmental surfaces contaminated by stool), inhalation of infected aerosolized droplets, and consumption of contaminated food and water.

Risk Factors

Risk exists for children younger than 5 years and adult travelers going to developing countries. Infection can occur as early as 2 months old, but most cases occur between the ages of 6 months and 2 years.

Other persons at increased risk include caretakers and parents of children in child care settings or hospitals and children and adults with diseases that affect the immune system's ability to fight infection.

Symptoms

Symptoms most commonly appear less than 48 hours after exposure and include fever, vomiting, and explosive, watery diarrhea. Symptoms generally last 3 to 8 days, but the virus can remain in stools for as long as 3 weeks. Rotavirus infection can sometimes be symptom free.

Children can be infected with rotavirus several times during their lives, but the initial infection protects against subsequent severe illness.

Consequences of Infection

Severe diarrhea and dehydration can result. Death may occur, especially in children who are not immediately treated.

Need for Medical Assistance

Persons who develop symptoms of rotavirus infection should self-treat with oral rehydration solutions designed for this purpose and seek immediate medical attention. No antiviral drugs exist for treating rotavirus infection.

Prevention

Nonvaccine

Observe good respiratory hygiene measures (cough and sneeze etiquette) and frequent, thorough handwashing, especially after using the bathroom, changing diapers (including of infants who received rotavirus vaccine), and before preparing or eating food.

Vaccine

Rotavirus vaccines are given routinely as a childhood vaccination to infants 6 to 32 weeks old, including infants who have had rotavirus infection before receiving the full vaccine series.

Rotavirus vaccine is not recommended for older children or adult travelers.

Side effects

Side effects of rotavirus vaccine include mild, temporary diarrhea or vomiting, cough or runny nose, and fussiness or irritability.

Rarely, intestinal obstruction due to intussusception (telescoping of the intestine) may occur in children, usually within a week of the first or second vaccine dose.

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.

Timing

Two rotavirus vaccines exist (RotaTeq and Rotarix) and are given as follows:

  • Routine, regardless of travel for infants aged 6 through 32 weeks:
    • RotaTeq: 3 doses, given at ages 2, 4, and 6 months.
    • Rotarix: 2 doses, given at ages 2 and 4 months.

An accelerated schedule for travelers consists of 3 doses of RotaTeq given at ages 6, 10, and 14 weeks or 2 doses of Rotarix given at ages 6 and 10 weeks.