Rotavirus

About rotavirus

Rotavirus causes a serious infectious form of gastroenteritis. The illness usually begins suddenly with vomiting, followed by diarrhoea.

Some people show no symptoms, but very young children are more likely to develop serious symptoms ranging from mild diarrhoea to life-threatening dehydrating diarrhoea that requires hospitalisation and can lead to death.

Prior to the introduction of rotavirus vaccines in Australia, the best available estimates suggest that rotavirus accounted for about 10,000 hospitalisations and 115,000 doctor visits every year for children under 5 years of age.

Since the introduction of the rotavirus vaccines onto the National Immunisation Program in 2007, both rotavirus-specific and all-cause hospital presentations for gastroenteritis in children under 5 have declined by more than 70%.

Symptoms of rotavirus

The symptoms and signs of rotavirus gastroenteritis range from mild to potentially life threatening, and may include:

• vomiting
• sudden onset of diarrhoea
• fever
• dehydration
• drowsiness.

Spread of rotavirus

In Victoria and other temperate regions of Australia, rotavirus gastroenteritis had previously been reported to be more common during winter. In recent years, however, peaks of rotavirus infections in Victoria have occurred during late spring and early summer.

Infection is spread by person-to-person contact and touching contaminated hands, faeces (faecal-oral transmission) and vomit. Rotavirus is highly infectious.

The onset of symptoms occurs one to 3 days after infection. An infected person's faeces usually remains infectious for approximately 10 days but can remain infectious for up to 2 months.

Rotavirus infection can occur several times

It is possible to be infected with rotavirus several times.

The first infection is usually the most severe. After an initial infection, the risk of being infected again is reduced by approximately 40%. Children who do get infected multiple times generally have less severe symptoms with each infection.

High-risk groups for rotavirus

Certain people are at increased risk of severe or even life-threatening symptoms. High-risk groups include:

• Aboriginal children
• children or adults with immune system problems
• organ transplant recipients
• people with gastrointestinal problems such as short gut syndrome.

Treatment for rotavirus

Treatment for rotavirus depends on the severity of symptoms.

Most children have a mild illness that can be treated at home and resolves within a few days to one week. The main treatment is generally to ensure your child keeps drinking fluids often (depending on the child’s age, this may include water, breastmilk, formula, diluted apple juice or oral rehydration drinks), and gets plenty of rest.

See your doctor immediately or go to the emergency department of your nearest hospital if your child refuses to drink or has worrying symptoms, for example, very frequent diarrhoea or vomiting, drowsiness, severe stomach pain, blood in their faeces, or green vomit. Children under 6 months old should always be seen by a doctor if they have gastroenteritis.

In severe cases, children may need to be admitted to hospital to get fluids through a tube in their nose or through a vein.

Prevention of rotavirus

Immunisation can dramatically reduce the risk of infection, but general tips to prevent spreading the disease if someone is infected include:

• Wash your hands thoroughly, especially after changing a nappy.
• Use disposable nappies while the child is sick – the elasticised leg bands help to prevent leakage of contaminated faeces.
• Dispose of nappies and used tissues carefully.
• Wash and disinfect the change table often.
• Wash and disinfect toys and other shared items regularly.
• Keep sick babies and children at home – rotavirus gastroenteritis can spread quickly through a crèche or kindergarten.
• Wash your hands before handling, preparing or eating food or drink.

Immunisation for rotavirus

Rotavirus vaccine is free under the National Immunisation Program for children aged 2 months and 4 months.

The vaccine contains a weakened form of rotavirus and works by prompting the body to make antibodies. In most cases, immunised children are protected against infection. Immunised children who do still become infected are less likely to become seriously unwell compared to children who are not immunised.

Rotavirus vaccine

The rotavirus vaccine is delivered by mouth in two separate doses - at 2 and 4 months of age. For best protection, it is important these doses are given as close to these ages as possible. The first dose can be given from 6 weeks of age.

• If a baby has not received the first dose by 14 weeks and 6 days of age, they should not receive any doses of the vaccine.
• If a baby has received the first dose, but not received the second dose, and is older than 24 weeks and 6 days, should not have any further doses.

The oral rotavirus vaccine is given at the same time as other free vaccines under the National Immunisation Program. No special diet or dietary restrictions are required before or after immunisation.

Catch-up immunisation with the rotavirus vaccine is not recommended for older children and adults, as its safety and effectiveness in these age groups has not been established.

The rotavirus vaccine does not protect against other types of diarrhoea, but it reduces the risk of severe, life-threatening diarrhoea caused by rotavirus.

Before rotavirus immunisation

Before receiving the vaccine, make sure that you tell your doctor or nurse if your baby:

• is older than the recommended age ranges for the first or second dose
• is unwell (temperature over 38.5°C)
• has had a serious reaction to any vaccine
• has had a severe allergic reaction to anything
• has a history of a chronic gastrointestinal disease
• has had intussusception or a congenital abnormality that may lead to intussusception (bowel blockage)
• is taking steroid medication
• has received a blood transfusion or blood products
• has lowered immunity due to immune deficiency, abnormal blood conditions or disorders, cancer, HIV or certain medications
• lives in a household with someone who has lowered immunity.

Side effects of the rotavirus vaccine

The oral rotavirus vaccine is generally effective and safe, although all medication can have unwanted side effects.

See your doctor for further information if you are worried about your baby.

Rare side effects of the rotavirus vaccine

There is a very small risk of a serious allergic reaction called anaphylaxis, to any vaccine. This is why you are advised to keep your child at the clinic for at least 15 minutes following immunisation, in case further treatment is required.

There is a very small risk of intussusception (bowel blockage caused by one portion of bowel sliding into the next like a telescope) in the first one to 7 days following the first or second dose of rotavirus vaccine. Take your baby to your doctor or to the hospital if they:

• have repeated, sudden bouts of crying
• are pulling their legs up to their stomach
• look pale
• develop vomiting
• pass blood in their stools (poo).

Babies who are treated for intussusception usually don’t have any long-term health problems. A baby who has already had intussusception in the past should not be given the rotavirus vaccine.

Concerns about immunisation side effects

If any side effect following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child’s condition after an immunisation, see your doctor or immunisation nurse as soon as possible or go directly to a hospital.

Unexpected or severe side effects after immunisation may be reported to SAEFVIC, the Victoria’s vaccine safety reportingservice.

Where to get help

• In an emergency, always call triple zero (000)
• Your GP (doctor)
• Emergency department of your nearest hospital
• Your local council immunisation service - know your council
• NURSE-ON-CALL. Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Immunisation Program, Department of Health, Victorian Government Email: immunisation@health.vic.gov.au
• Maternal and Child Health Line Tel. 132 229 (24 hours, 7 days)
• National Immunisation Information Line Tel. 1800 671 811
• SAEFVIC Tel: 1300 882 924