Review: Acute gastroenteritis among children in the developing world

Acute gastroenteritis among children

in the developing world
A Revelas

Angela Revelas, MD, PhD

General Practitioner, Department of Pathology, St Nicolas General Hospital, Crete, Greece
E-mail: Angela Revelas, donnoiko@gmail.com
Keywords: acute gastroenteritis, children, dehydration, malnutrition

Acute gastroenteritis represents a major cause of morbidity and mortality worldwide. Young children are affected most frequently,
with three to 10 episodes of diarrhoea per subject per year, a rate that decreases to less than one episode annually for children
over five years of age and adults. Usually, deaths are a result of dehydration, but malnutrition also plays an important role.
Furthermore, malnutrition increases the incidence and severity of diarrhoea, as well as of other infections. The clinician
encounters acute gastroenteritis in three settings. The first is sporadic gastroenteritis in infants, which is often caused by
rotavirus. The second is epidemic gastroenteritis, which occurs either in semi-closed communities (e.g. families, institutions, on
ships, at vacation spots) or as a result of classic food-borne or water borne pathogens. Most of these infections are caused by
caliciviruses. The third is sporadic acute gastroenteritis of adults, which is most likely to be caused by caliciviruses, rotaviruses,
astroviruses or adenoviruses.
Peer reviewed. (Submitted: 2011-10-14. Accepted: 2012-03-12.) © SAJEI South Afr J Epidemiol Infect 2012;27(4):156-162

Introduction Pathophysiology

Acute gastroenteritis is a clinical syndrome that is produced
by a variety of viral, bacterial, and parasitic enteropathogens.
At times, improperly prepared food or the reheating of meat
dishes, seafood, dairy and bakery products, also results
in gastroenteritis. Non-infectious causes of gastroenteritis
include poisoning with heavy metals, i.e. arsenic and cadmium;
seafood, i.e. ciguatera, scombroid and toxic encephalopathic
shellfish poisoning; or mushrooms, i.e. Amanita phalloides.
Young children are affected the most, experiencing three to
10 episodes of diarrhoea per subject per year, a rate that
decreases to less than one episode annually for children over
five years of age and adults. Deaths are usually as a result
of dehydration, but malnutrition also plays an important
role. Furthermore, malnutrition increases the incidence and
severity of diarrhoea, as well as other infections. The clinician
encounters acute gastroenteritis in three settings. The first is
sporadic gastroenteritis in infants, which is generally caused
by rotavirus.1 The second is epidemic gastroenteritis, which
occurs either in semi-closed communities (e.g. families,
institutions, on ships, at vacation spots) or as a result of
classic food-borne or water-borne pathogens.2 Most of these
infections are caused by caliciviruses. The third is sporadic
acute gastroenteritis in adults, usually caused by caliciviruses,
rotaviruses, astroviruses, or adenoviruses.
Viruses that cause gastroenteritis include rotavirus, norovirus,
adenovirus and astrovirus.3,4 Rotavirus is the most common
cause of gastroenteritis in children, both in the developed
and developing world.5 Viruses cause about 70% of infectious
diarrhoea episodes in this age group.6 Rotavirus is a less
common cause in adults, due to acquired immunity.7
In the developed world, Campylobacter jejuni is the primary
cause of bacterial gastroenteritis. Half of these cases are
associated with poultry.8 In children, bacteria are the cause
of 15% of cases.6 The most common types are Salmonella,
Shigella, Escherichia coli, and Campylobacter.6 If food
becomes contaminated with bacteria and remains at room
temperature for several hours, the bacteria can multiply and
increase the risk of infection in those who eat the food.9
Toxigenic Clostridium difficile is an important cause of
diarrhoea and usually occurs in the elderly.9 Infants can carry
these bacteria without developing symptoms.9 Generally,
traveller’s diarrhoea is a type of bacterial gastroenteritis.
Acid-suppressing medication appears to increase the risk
of infections by a number of organisms including C. difficile,
Salmonella, and Campylobacter.10 The risk is greater with
proton-pump inhibitors, than with histamine-2 antagonists.10

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 Review: Acute gastroenteritis among children in the developing world
A number of protozoa can cause gastroenteritis, most
commonly Giardia lamblia, but also Cryptosporidium and
Entamoeba histolytica.6 As a group, these contribute to 10%
of cases in children.11
Viral spread from person to person occurs through the faecal-
oral transmission of contaminated food and water. Some
viruses, like noroviruses, may be transmitted by an airborne
route. Clinical manifestations relate to intestinal infection, but
the exact mechanism of the induction of diarrhoea is not clear.
The most extensive studies have been carried out on rotavirus.
Rotaviruses attach and enter mature enterocytes at the tips
of the small intestinal villi. They cause structural changes
to the small bowel mucosa, including villus shortening and
mononuclear inflammatory infiltrates in the lamina propria.
Current knowledge on the mechanisms leading to diarrhoeal
disease by rotavirus is as follows.12 Rotavirus infections induce
maldigestion of carbohydrates and their accumulation in the
intestinal lumen (in the absence of lactase). Malabsorption of
nutrients and concomitant inhibition of water reabsorption can
lead to a malabsorption component of diarrhoea.
Rotavirus secretes an enterotoxin, NSP4, which leads
to a calcium-dependent chloride secretory mechanism.
Mobilisation of intracellular calcium, associated with NSP4,
expressed endogenously or added exogenously, is known to
induce transient chloride secretion.
Morphological abnormalities can be minimal, and studies
demonstrate that rotavirus can be released from infected
epithelial cells without destroying them. Viral attachment
and entry into the epithelial cell without cell death may be
enough to initiate diarrhoea. The epithelial cell synthesises
and secretes numerous cytokines and chemokines which can
direct the host immune response, and potentially regulate
cell morphology and function. Studies also suggest that one
of the nonstructural viral proteins may act as an enterotoxin,
promoting active chloride secretion mediated through
increases in intracellular calcium concentration. Toxin-
mediated diarrhoea would explain the observation that villus
injury is not necessarily linked to diarrhoea.
Aetiology
Unfortunately, assessing the relative importance of each agent
is not straightforward, and the following limitations should be
kept in mind:
• No study has evaluated all known enteropathogens,
especially the recently discovered agents.
• Studies have focused mostly on infants and small children.
Older children and adults can be infected by the same
agents, but the relative importance of each pathogen
may vary, owing to immunity acquired during previous
exposures.
• The frequency of isolation of enteropathogens varies
with the population being studied, i.e. children vs.
South Afr J Epidemiol Infect
adults; nutritional status; community vs. health facility;
environmental conditions; geography, climate, season,
and socio-economic factors; low- vs. high-income groups;
water supply and sanitation; and feeding practices.
• When comprehensive microbiological methods are used,
aetiological agents can be identified in only 50% of
diarrhoea cases in community-based studies, and in 70%
in health-facility cases.
• Finding an enteropathogen in the stool of a patient with
gastroenteritis does not establish a causal relationship. In
cases with two or more enteropathogens, it is impossible
to ascertain which, if any, is causing the illness. One or
more enteropathogens can also be found in the normal
population. This could represent asymptomatic infection,
a convalescent carrier, or the inability of the pathogen
to establish an infection because of previously acquired
immunity, or an insufficient infecting dose.
In developing countries, as a group, bacterial enteropathogens
account for the majority of diarrhoeal diseases. Diarrhoeogenic
Esherichia coli (enteropathogenic, enterotoxigenic, entero-
aggregative, enteroinvasive and enterohaemorrhagic) is the
most important group, followed by Campylobacter, Aeromo-
nas, Shigella, and Salmonella spp. Vibrio spp., especially
V. cholerae, are important in endemic areas and situations.
Rotaviruses are the most common viral enteropathogens in
children, accounting for approximately 5% (range 2-22%) of
diarrhoeal episodes in community-studies, and 20% (range
2-49%) in health-facility studies. In addition, rotaviruses are
the most common cause of severe watery diarrhoea in young
children, and are responsible for 40% of cases of dehydrating
diarrhoea.
Epidemiology
Acute gastroenteritis is a leading cause of infant mortality
throughout the world. By the age of three years, virtually all
children become infected with the most common agents.
Rotavirus causes two million hospitalisations, and 600 000-
875 000 deaths per year.
Morbidity and mortality
Severe cases are seen in the elderly, infant and immuno-
suppressed populations, including transplant patients.
Rotavirus infantile gastroenteritis is an important cause of
infant mortality in the developing world. Noroviruses are the
most common cause of gastroenteritis in nursing homes,
and several such outbreaks have resulted in deaths due
to aspiration, or exacerbation of another chronic disease.
Norovirus infections in hospitalised patients are more severe
than those seen in otherwise healthy persons.13
Findings on physic examination
A physical examination can be helpful in determining the
aetiology of gastroenteritis, and in assessing the presence and
degree of dehydration.
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 Review: Acute gastroenteritis among children in the developing world
A physical examination should take into account the following:
• Temperature, blood pressure, pulse and body weight can
provide evidence of the severity of the condition.
• Temperature may be slightly elevated. High fever suggests
a bacterial infection. Tachycardia, thready pulse and
hypotension suggest severe dehydration.
• The degree of weight loss may relate to dehydration and
the duration of the diarrhoea.
• The mucous membranes and the skin should be examined
carefully. A dry mouth, no tears, skin tenting, dry skin and
capillary refill are all signs of dehydration.
• The mental status in elderly patients and infants may be
abnormal, especially when blood pressure and circulation
are compromised.
• The abdominal examination may demonstrate mild
tenderness. Severe abdominal pain and tenderness
suggest bacterial infection, or an abdominal emergency.
Laboratory studies
Laboratory tests are not indicated in most cases that fit the
clinical features of viral gastroenteritis. If bacterial or protozoal
infection is suspected, stool studies for occult blood, white
blood cell count and microscopy for protozoa, Clostridium
difficile toxin, Giardia lamblia by enzyme immunoassay (EIA)
or bacterial culture may be indicated.
Consider investigating patients with low-grade fever, nausea,
vomiting, abdominal pain and extreme dehydration by
evaluating serum electrolytes, urea, creatinine, amylase and
complete blood count, and conducting abdominal imaging
studies.
Stool studies and culture
The presence of blood or leukocytes in the stool is a strong
indicator of inflammatory diarrhoea. Stool studies can be
performed efficiently and inexpensively by using a Wright
stain or methylene blue, directly observing for leukocytes, and
performing an occult blood test. Faecal leukocytes are present
in 80-90% of all patients with Salmonella or Shigella infections,
but are less common in the case of other infecting organisms,
such as Campylobacter and Yersinia. They may also be present
in ulcerative colitis and Crohn’s disease, but are usually absent
in viral infections, Giardia infection, enterogenic E. coli infection,
and toxigenic bacterial food poisoning.
A stool culture is not necessary or cost-effective in most
cases of diarrhoea, unless an unusual bacterial cause is
suspected, and it is needed for epidemiological purposes. A
lower threshold for performing stool cultures and examination
for ova and parasites is indicated in immunocompromised,
immunosuppressed patients, and those who have recently
travelled to remote locations or developing nations.
Fever, bloody stools, leukocytes in the stool, pain resembling
that associated with appendicitis (Yersinia), and diarrhoeal
illness associated with partially cooked hamburgers
South Afr J Epidemiol Infect
(cytotoxigenic E. coli O157:H7) are all indications for culture.
If possible, the laboratory should be informed of suspected
organisms.
Specific indications for stool cultures include bloody stools,
stools that test positive for occult blood or leukocytes,
prolonged diarrhoea that has not been treated with antibiotics,
an immunocompromised host, or for epidemiological
purposes, such as cases involving food handlers.
Routine stool cultures identify only Campylobacter, Shigella,
Salmonella, Aeromonas, and Yersinia species. Testing for
other pathogens, such as Vibrio spp., enterohaemorrhagic
E. coli O157:H7 and other shigatoxin-producing bacteria,
requires special media. The laboratory should be informed
of the need for appropriate media for suspected organisms,
e.g. MacConkey sorbitol agar for E. coli O157:H7. Additionally,
the laboratory may need to perform specialised testing to
specifically identify the organism.
Similarly, if parasitic illness is in the differential diagnosis, or if
the patient has recently travelled to an endemic region or has
chronic diarrhoea, the stool should be examined for parasites
or their ova, with the caveat that several samples may be
required to make the diagnosis. Ova and parasite studies are
indicated for patients who are immunocompromised, who have
a persistent or prolonged disease course, or whose conditions is
unresponsive to antibiotics. Travel to endemic regions, followed
by chronic diarrhoea without signs of acute bacterial diarrhoea,
should prompt a search for a parasitical aetiology.
The stool can be sent to reference laboratories for examination
for norovirus by polymerase chain reaction (PCR). This is
usually reserved for epidemiological purposes. Rapid assays
are available, with varying sensitivities and specificities, as
well as questionable clinical applicability.
Diagnosis of rotavirus infection
Rapid antigen testing of the stool, either by EIA (> 98%
sensitivity and specificity) or latex agglutination tests (less
sensitive and specific in comparison to EIA), is used to aid the
diagnosis of rotavirus infection.
Antirotavirus antibodies, i.e. immunoglobulin M and immuno-
globulin A, can be expected to be excreted in the stool after
the first day of illness. Antibody tests can remain positive for
10 days after primary infection, and longer after reinfection.
Therefore, they can be used as an adjunct to diagnosis.
Diagnosis of calicivirus infection
In epidemics, the stool and emesis specimens should be
saved for evaluation by public health officials. PCR is valuable
in both the outbreak setting and the sporadic case setting.
Researchers have cloned several of the caliciviruses and
placed the genome in a baculovirus that produces unlimited
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 Review: Acute gastroenteritis among children in the developing world
amounts of recombinant calicivirus capsid protein. EIAs, for
serum antibody and stool antigen, have been developed using
this antigen source.
A modification to the PCR has allowed many of the different
strains of caliciviruses to be recognised with just a few primers
(broadly reactive reverse-transcription PCR). These primers
are directed at a region of the genome that is common to
many of the strains of calicivirus. This has been an important
tool in identifying caliciviruses as the most common cause of
epidemic viral gastroenteritis.
Faecal viral concentration of norovirus correlates with the
duration of illness. As in most viral infections, active viral
replication determines the clinical disease. High faecal viral
concentrations suggest the need for both aggressive fluid
replacement and stringent infection control measures.14
Patient assessment
Management of gastroenteritis starts with a brief, focused
history that should include information on the nature of
symptoms (mainly diarrhoea and vomiting), their frequency
and duration, the amount and type of fluids ingested during
the last 24 hours, and urine output.
In general, patients with mild dehydration have a history of
vomiting or diarrhoea, with absent or minimal physical signs of
dehydration. Patients with moderate dehydration have normal
physical findings, while those with severe dehydration have
compromised cardiovascular or central nervous systems.
The evaluation should be global, and the clinician should be
careful to avoid some common pitfalls. For example, a child
who is dehydrated because of vomiting might have moist
oral mucosa, but may not be able to produce tears. Also,
children with underlying conditions, such as a metabolic
disorder, malnutrition or prematurity, might present sunken
eyes and decreased skin turgor due to loss of subcutaneous
and orbital fat, rather than dehydration. In particular, owing to
shifts in the extravascular fluid, a child with hypernatraemic
dehydration might appear less dehydrated than he or she
really is. Hypernatraemic dehydration should be suspected in
children who have been drinking mainly hypertonic fluids, e.g.
salt solutions, who have been losing hypotonic fluids, e.g. the
patient with profuse watery diarrhoea, and those who present
with a depressed sensorium beyond what would be expected
from the apparently mild signs of dehydration. Obtaining
an accurate weight at the initial evaluation is important to
monitor response to therapy.
Dietary therapy
Recommendations for maintenance dietary therapy depend
on the age and diet history of the patient.
Breastfed infants should continue nursing on demand.
Formula-fed infants should continue their usual formula
South Afr J Epidemiol Infect
immediately after rehydration, in amounts sufficient to
satisfy energy and nutrient requirements. Usually, lactose-
free or lactose-reduced formula is unnecessary. A meta-
analysis of clinical trials indicates that lactose-free formula
has no advantage over lactose-containing formula for the
majority of infants, although certain infants with malnutrition
or severe dehydration recover more quickly when given
lactose-free formula.15 Patients with true lactose intolerance
will exacerbate their diarrhoea when a lactose-containing
formula is introduced. The presence of a low pH (< 6) or
reducing substances (> 0.5%) in the stool is not diagnostic
of lactose intolerance in the absence of clinical symptoms.
Although medical practice has often favoured commencing
feeds with diluted, e.g. half- or quarter-strength, formula,
controlled clinical trials have demonstrated that this practice
is unnecessary, and is associated with prolonged symptoms16
and delayed nutritional recovery.17
Formula containing soy fibre has been marketed to physicians
and consumers in the US, and added soy fibre has been
reported to reduce liquid stools without changing overall stool
output.18 This cosmetic effect might have certain benefits
with regard to diminishing nappy rash and encouraging early
resumption of a normal diet, but is probably not sufficient to
merit its use as a standard of care. A reduction in the duration
of antibiotic-associated diarrhoea has been demonstrated
among older infants and toddlers who were fed formula with
added soy fibre.19
Functional foods
Functional foods can be defined as foods that have an effect
on the physiological processes in addition to their established
nutritional function.20 Probiotics have been defined as live
microorganisms that are present in fermented foods that
promote optimal health by establishing an improved balance
in the intestinal microflora. Reviews have evaluated their use
in preventing or reducing the severity or duration of diarrhoeal
illnesses among children,21 including diarrhoea caused by
rotavirus22 or associated with antibiotic use.23 Such products
have included various species of lactobacilli or bifidobacteria,
or the nonpathogenic yeast, Saccharomyces boulardii.
The mechanism of action might include competition with
pathogenic bacteria for receptor sites or intraluminal nutrients,
the production of antibiotic substances, and enhancement of
host immune defenses.24,25 One meta-analysis concludes that
Lactobacillus spp. are both safe and effective as treatment for
children with infectious diarrhoea. A positive recommendation
also emerged from a meta-analysis of probiotic use in
antibiotic-associated diarrhoea. Prebiotics differ from
probiotics in that they are complex carbohydrates, rather
than organisms used to preferentially stimulate the growth of
health-promoting intestinal flora.26 The oligosaccharides that
are contained in human milk have been called the prototypic
prebiotic, because they foster the growth of lactobacilli and
bifidobacteria in the colon of breastfed neonates.27 Data have
linked higher intakes of breast-milk oligosaccharides with
a lowered incidence of acute diarrhoea.28 Two randomised
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 Review: Acute gastroenteritis among children in the developing world
studies on supplemented infant cereal did not demonstrate
a reduced incidence of diarrhoeal disease among infants and
children living in an urban, economically depressed area.29
Pharmacological therapy
Antimicrobial agents acute diarrhoea is a common illness, cost-effective analyses
Because viruses (e.g. rotavirus, astrovirus, enteric adenovirus,
norovirus, and sapovirus) are the predominant cause of
acute diarrhoea in developed countries,30 routine use of
antimicrobial agents to treat diarrhoea wastes resources,
and might lead to increased antimicrobial resistance. Even
when a bacterial cause is suspected in an outpatient setting,
antimicrobial therapy is not usually indicated in children
because the majority of cases of acute diarrhoea are self-
limiting, and are not shortened by use of antimicrobial agents.
An exception to the rule is children with special needs, e.g.
immune-compromised hosts, premature infants, or children
with underlying disorders. Information regarding appropriate
antimicrobial therapy to treat the bacterial and parasitical
causes of acute infectious diarrhoea is available.31-34
Nonantimicrobial drug therapies
Non-specific antidiarrhoeal agents (e.g. adsorbents such
as kaolin-pectin; antimotility agents such as loperamide;
antisecretory drugs; and toxin binders, such as cholestyramine)
are commonly used among older children and adults, but data
are limited regarding their efficacy. The side-effects of these
drugs are well known, in particular in the case of antimotility
agents, and include opiate-induced ileus, drowsiness and
nausea caused by the atropine effects and binding of nutrients
and other drugs. In Pakistan, 18 cases of severe abdominal
distension, associated with the use of loperamide, included
six deaths.35 Bismuth subsalicylate has limited efficacy in
treating traveller’s diarrhoea36 and other causes of acute
gastroenteritis among children.37 Although the side-effects
are fewer than those that occur from the use of antimotility
agents, certain theoretical concerns regarding the potential
toxicity resulting from salicylate absorption remain.38 Trials
supporting its use have employed frequent doses, e.g. every
four hours for five days.39
None of these drugs address the underlying causes of
diarrhoea, specifically increased secretion by intestinal crypt
cells. Racecadotril, an oral agent, preserves the antisecretory
activity of encephalin, and does not slow intestinal transit or
promote bacterial overgrowth.40 It has demonstrated promise
in two controlled paediatric clinical trials through significantly
reduced stool output, compared with placebo.41,42 Although
the majority of acute diarrhoea cases require no adjunctive
therapy, racecadotril might prove to be a useful adjunct. More
studies are needed.
Usually, antiemetics are unnecessary in acute diarrhoea
management. Using phenothiazines might interfere with oral
rehydration, by causing sleepiness. Ondansetron, a serotonin
South Afr J Epidemiol Infect
antagonist, when taken by either orally43 or intravensously,44
can decrease vomiting and limit hospital admission.
However, reliance on pharmacological agents shifts the
therapeutic focus away from appropriate fluid, electrolyte and
nutritional therapy, can result in adverse events, and can add
unnecessarily to the economic cost of the illness. Because
should be undertaken before routine pharmacological therapy
is recommended.
Prevention
The agents of acute gastroenteritis are transmitted by
the faecal-oral route, either through direct person-to-
person contact, or through contaminated food or water.
Sanitation, good hand washing and hygienic measures
prevent person-to-person spread. However, since these
measures are difficult to enforce, especially among small
children, endemic transmission of the disease is hard to
control, even in developed countries. In settings such as
nurseries, paediatric and geriatric wards, and day care
centres, faecal contamination of surfaces and objects can
facilitate transmission of enteropathogens. The importance
of breastfeeding in reducing the incidence and severity of
diarrhoeal diseases cannot be overemphasised. Breastfeeding
reduces exposure to enteropathogens and provides a variety
of humoral and cellular factors that are protective against
intestinal infection. Infant formula is available in powder,
liquid concentrate, and ready-to-feed forms. It is designed to
be prepared by the parent or caregiver in small batches, and
fed to the infant, usually with either a cup, as recommended
by the World Health Organization (WHO),45 or a baby bottle.
Numerous types of infant formula are available:
• Cow’s milk formula is the most commonly used type.
• Soy protein-based formula is frequently given to infants
who are allergic to cow’s milk.
• Partially hydrolysed formula is marketed as having
improved digestibility.
• Extensively hydrolysed formula is considered to be
“hypoallergenic”. One study reported that 90% of
children with cow’s milk allergies will tolerate extensively
hydrolysed formula.46
• Amino acid-based formula is more expensive, but is
reported to be the least likely to cause an allergic reaction.47
Hypoallergenic formula, synthesised from raw amino acids,
and sometimes referred to as elemental infant formula,
is considered to reduce the likelihood of certain medical
complications in babies with specific health problems, such
as a severe allergy to cow’s milk and soy. Comprising purely
synthetic monomeric amino acids, it is often considered to
be quite foul tasting. It is not uncommon for infants to reject
elemental formula once they are familiar with a sweeter-
tasting regular formula.
Manufacturers and health officials advise that it is very
important to measure powders or concentrates accurately to
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achieve the intended final product concentration, otherwise
the child will become malnourished. It is advisable that all
equipment that comes into contact with the infant formula is
cleaned and sterilised before each use. Proper refrigeration is
essential for any infant formula that is prepared in advance.
These factors are especially important in developing countries,
where ready-to-feed formula is either not available or is
expensive, and bottles, nipples and other formula becomes
contaminated owing to poor sanitary conditions, making
the incidence of diarrhoea and malnutrition several times
greater in bottle-fed infants. In developing countries, formula
is frequently prepared improperly, resulting in high infant
mortality due to malnutrition, and diseases such as diarrhoea
and pneumonia. This is due to lack of clean water, lack of
sterile conditions, lack of refrigeration, illiteracy (written
instructions cannot be followed), poverty (diluting formula so
that it lasts longer), and lack of education of the mothers by
the formula distributors.
Rotavirus vaccine
A rotavirus vaccine protects children from rotaviruses, which
are the leading cause of severe diarrhoea among infants and
young children.48 Each year, an estimated 453 000 children
die from diarrhoeal disease caused by rotavirus,49 and
another two million are hospitalised.50 Nearly every child
in the world will suffer an episode of diarrhoea caused by
rotavirus before the age of five years.51 Although the severity
of rotavirus infections differs between children living in
developed and developing countries, the rates of infection
are similar in both settings.52 Clean water supplies and
good hygiene have little effect on the transmission of the
infection, and further improvements are unlikely to prevent
the disease.52
On 5 June 2009, the WHO recommended that the rotavirus
vaccine be included in all national immunisation programmes.
The Rotavirus Vaccine Program aims to reduce child morbidity
and mortality from diarrhoeal disease by accelerating the
availability of rotavirus vaccines in developing countries.
Conclusion
Acute gastroenteritis is one of most common entities seen
by the practising pediatrician. Treatment of diarrhoea has
relied upon simple and effective oral rehydration therapy.
Antimicrobials should be used judiciously, and antimotility
drugs should be discouraged.
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