Rotavirus

Commonly referred to as a tummy bug or stomach flu. Also known as gastroenteritis

Rotavirus used to be a common viral infection that causes fever, vomiting and diarrhoea, mostly in babies and young children. Before vaccines, nearly every child would get this infection by the age of 5 years and it was the leading cause of severe diarrhoea in children. It has practically disappeared with the introduction of rotavirus vaccine in the immunisation schedule. It passes easily from one person to another.

Key points

  1. Vaccination against rotavirus prevents most rotavirus infections and the serious complications it can cause.
  2. Rotavirus is very infectious and is spread by contact with someone who has the virus or by contact with the faeces (poo, tūtae) of an infected child or adult. This can happen by not handwashing after changing nappies or from touching a surface that has been in contact with the virus.
  3. Rotavirus infection usually begins with a sudden fever, then vomiting and diarrhoea. The illness lasts from a few days to a week.
  4. Children can die from dehydration caused by diarrhoea and vomiting, so they need to drink lots of water and other diluted fluids. Read more about preventing dehydration in babies and children
  5. Careful hand washing is the most important way to stop the spread of rotavirus. Children with diarrhoea or vomiting should not go to school or daycare until they until they are well and for 48 hours after diarrhoea or vomiting has stopped.

How is rotavirus spread?

Rotavirus is spread from someone who has the virus or by contact with the faeces (poo, tūtae) of an infected child or adult. This can happen by not handwashing:

  • after changing nappies
  • after using the toilet
  • after touching toys or surfaces that have been in contact with the virus
  • before handling food or eating.

People who have rotavirus infection have a large amount of rotavirus in their poo when they are sick, and for about a week after they feel better. Rotavirus can survive on your hands for at least 4 hours and on surfaces and objects for about 2 months. Without vaccination, almost all children have been infected by the time they reach 5 years old.

What are the symptoms of rotavirus?

If your child has a rotavirus infection, they usually develop a sudden fever, then vomiting and diarrhoea. The illness lasts from 3 to 8 days and includes:

  • a fever that starts suddenly and usually lasts 1 to 2 days
  • vomiting that lasts for about 3 to 6 days
  • watery poos (diarrhoea) that last for about 5 to 6 days
  • tummy pain.

Children from 3 months to 2 years are most at risk of severe dehydration. In babies 3 months or younger, the symptoms of rotavirus are usually mild or they have no symptoms. This is possibly due to the developing gut of newborns or the passive protection passed on from their mother’s antibodies during breastfeeding.

Adults can be infected with rotavirus, but the symptoms are usually mild or they have no symptoms.

How serious is rotavirus infection?

The main risk of rotavirus is that babies and children will become dehydrated because of vomiting and diarrhoea. Children from 3 months to 2 years are most at risk of severe dehydration. In most cases, rotavirus infection can be managed at home. Children need to drink lots of water and other diluted fluids to prevent dehydration. If your child is unable to keep fluids down and is too sick to drink, or you are concerned they might be dehydrated, seek medical help immediately. Read more about dehydration in babies and children.

Who is most at risk?

Rotavirus carries the greatest risk for children:

  • aged between 3 months and 2 years
  • with a low birth weight who are still underweight
  • with high-risk medical conditions (eg, heart or kidney problems, or diabetes).

Rotavirus frequency and severity without vaccination. Without vaccination, out of 49 babies, 1 will not get rotavirus, 38 will have symptoms that clear within a few days, 9 will need to see a doctor or have severe symptoms and 1 will need to be hospitalised (approximate only).

Without vaccination, almost all children will get rotavirus before they are 5 years old. Without vaccination, rotavirus results in:

  • 1 in every 5 children needing to see a doctor by the time they are 5 years old.
  • 1 in every 43 children needing hospital treatment for dehydration.

How is rotavirus treated?

Rotavirus is not treated with antibiotics because it is caused by a virus, not a bacteria. The best thing to do if your child has rotavirus is to stop them becoming dehydrated by giving them small amount of fluids often, such as a quarter of a cup every 15 minutes or 1 teaspoon or 5 mLs in a syringe every minute. Keep offering your child fluids even if they are vomiting. Read more about preventing dehydration in babies and children

When to see a doctor

See your doctor immediately if your child:
  • Is less than 6 months of age and has diarrhoea and/or vomiting - babies can become very dehydrated very quickly.
  • Has lots of diarrhoea (8 to 10 watery poos a day).
  • Is vomiting so much they are unable to keep fluids down.
  • Has severe stomach pains.
  • If your child's diarrhoea continues for longer than 10 days.
  • If your child has signs of dehydration, such as: 
    • Little or no urine (pee) passed in the last 8 hours, or dark and smelly urine.
    • Dry mouth, no tears, sunken eyes, sunken fontanelle in infants.
    • Skin not springing back when pinched.

How can I prevent the spread of rotavirus?

Rotavirus is very infectious. It is spread by contact with poo from an infected person. If hands haven't been washed properly any surfaces that are touched (such as doorknobs, utensils and toys) can become contaminated. The virus can survive outside the body for a long time and is resistant to many disinfectants. Careful hand washing is important in preventing the spread of rotavirus.

Without vaccination, almost all children will be infected with rotavirus by the time they are 5 years old. Immunisation can prevent most rotavirus infections and almost all severe rotavirus infections.

Why is vaccination so important?

Vaccination against rotavirus is very effective. It prevents:

  • 5–8 babies in 10 from severe rotavirus infection
  • 9 in 10 from needing to be admitted to hospital because of rotavirus infection
  • 5–7 in 10 from having any rotavirus diarrhoea. 

Rotavirus vaccine is an oral vaccine that is given as drops that are squirted into your baby’s mouth. In New Zealand, rotavirus vaccination is given free to babies as part of their 6 weeks and 3-month immunisation. If you miss these dates, you can catch up, with the first dose being given before 15 weeks old (the latest is 14 weeks and 6 days), and the second dose before 25 weeks old (the latest is 24 weeks and 6 days). The rotavirus vaccine is not given to older babies because there is an increased risk of intussusception (a condition that causes obstruction of the bowel). Read more about rotavirus vaccine.

Learn more

Immunise against rotavirus HealthEd, NZ
Rotavirus  Immunisation Advisory Centre, NZ
ROTARIX® consumer information leaflet  Medsafe, NZ
Rotavirus vaccine consumer educational Q&A Medsafe, NZ

References

  1. Rotavirus Immunisation handbook 2017, New Zealand
  2. Immunise against rotavirus HealthEd, NZ
Credits: Editorial team. Reviewed By: Dr Osman David Mansoor, Medical Officer of Health, Hawke’s Bay DHB Last reviewed: 22 Dec 2017