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PRIMEVIEW

ROTAVIRUS INFECTION
For the Primer, visit doi:10.1038/nrdp.2017.83

Rotavirus infections are one of the EPIDEMIOLOGY


PREVENTION RV1 is a
leading causes of diarrhoeal diseases in live attenuated,
children <5 years of age and can also lead monovalent human
In 2003, 114 million cases of rotavirus infection were
to vomiting, fever and malaise. Ten species virus vaccine containing
reported in children <5 years of age worldwide and,
of rotavirus have been identified, although rotavirus strain
of these, 2.3 million cases required hospitalization.
species A rotaviruses are the most common 89–12 of genotype
G1P[8] In 2013, >200,000 cases of fatal rotavirus
cause of infection in children.
infection were reported. More
than 90% of children with fatal
Two rotavirus rotavirus infections live in
MECHANISMS low-income countries,
vaccines are
broadly used where there is a high
Rotaviruses infect and replicate in mature worldwide: the RV5 In countries prevalence of comorbid
enterocytes and enteroendocrine cells in the vaccine and the that introduced conditions and they
small intestine. The diarrhoea caused by rotavirus RV1 vaccine RV5 is a live rotavirus vaccines have limited access
infection might be due to malabsorption (due attenuated, into the national child to health care.
to a reduced absorptive function or the loss or pentavalent vaccine immunization schedule,
destruction of enterocytes) or the effects of the viral composed of five bovine– all-cause diarrhoeal deaths
enterotoxin non-structural protein 4. In addition, human mono-reassortant were reduced by a
activation of the enteric nervous system rotaviruses that express median of 42% in the MANAGEMENT
has been proposed to underlie human VP7 (G1–G4) first 10 years
rotavirus-associated diarrhoea. or VP4 (P[8]) Management of
Both vaccines
Indeed, serotonin release from rotavirus infection is
Rotavirus efficiently prevent
enteroendocrine cells can activate severe rotavirus- non‑specific; all children
is transmitted
nerves that innervate the small associated disease in presenting with acute
through the faecal–
intestine, leading to increased high-income countries but diarrhoea are assessed for
oral route; only a few
intestinal motility and vomiting reduce the incidence of dehydration and treated accordingly,
virions are needed
(via vagal afferents that project to rotavirus diarrhoea by regardless of the infecting agent. Fluid and
to cause disease
the vomiting centre in the brain). only 50–60% in low- electrolyte management is the mainstay of
in susceptible
income countries therapy for children with acute diarrhoea.
individuals
Oral rehydration therapy is indicated in
DIAGNOSIS children with mild or moderate dehydration;
intravenous therapy is indicated in children
with severe dehydration, hyperemesis or severe
Rotavirus disease cannot be distinguished from electrolyte imbalances. In addition, dietary
diarrhoeal diseases caused by other infectious An entirely management is important to maintain adequate
agents on the basis of clinical signs alone. For plasmid-based protein–calorie intake.
laboratory-confirmed diagnosis, rotavirus can reverse genetics
system for rotavirus
be detected in stools using enzyme-linked Mild cases of rotavirus
can be used to engineer
immunosorbent assay, immunochromatography viruses of defined genetic disease require observation
or reverse transcription–PCR. OUTLOOK composition and has great only, whereas more
potential for basic and severe disease (such as
Although rotavirus infections are translational research
Understanding the correlates the efficacy of current repeated watery diarrhoea
common throughout life, the severity of protection from rotavirus vaccines and to develop and severe vomiting)
of disease decreases with repeat infections is essential to improve next‑generation vaccines. requires treatment

Written by Louise Adams; designed by Laura Marshall Article number: 17084; doi:10.1038/nrdp.2017.84; published online 9 Nov 2017
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