Clinical Review

Diagnosis, management, and prevention of rotavirus gastroenteritis in children

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7204 (Published 30 December 2013) Cite this as: BMJ 2013;347:f7204
  1. Umesh D Parashar, lead, viral gastroenteritis epidemiology team1,
  2. E Anthony S Nelson, professor of paediatrics2,
  3. Gagandeep Kang, professor of microbiology3
  1. 1National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
  2. 2Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
  3. 3Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
  1. Correspondence to: U D Parashar uap2{at}cdc.gov

Summary points

  • Rotavirus is the leading cause of severe gastroenteritis in children worldwide, accounting for 35-40% of hospital admissions for gastroenteritis

  • Each year, 180 000-450 000 children under 5 years die from rotavirus gastroenteritis, with more than 90% of deaths occurring in developing countries

  • Because nearly all children are affected by rotavirus by age 5 years, good sanitation and hygiene alone are inadequate for prevention

  • Orally administered live attenuated vaccines offer the best protection against rotavirus; as of December 2013, national immunization programs of 51 countries include rotavirus vaccine

  • Such programs have greatly reduced morbidity and mortality from gastroenteritis

  • A low risk of intussusception has also been documented post-licensure in some countries, but this risk is greatly exceeded by the health benefits of vaccination

Rotavirus is the leading cause of severe childhood gastroenteritis. Each year, rotavirus is responsible for about 25 million clinic visits, two million hospital admissions, and 180 000-450 000 deaths in children under 5 years of age globally.1 2 3 Although rotavirus infection is prevalent worldwide, most deaths from this infection occur in developing countries (fig 1). Gastroenteritis caused by rotavirus cannot be clinically distinguished from that caused by other enteric pathogens; diagnosis requires testing of fecal specimens with commercially available assays. However, rotavirus is not routinely tested for in patients with gastroenteritis because the results do not alter clinical management, which relies mainly on appropriate rehydration therapy. Orally administered live attenuated vaccines that mimic natural infection offer the best protection against rotavirus. Two licensed rotavirus vaccines have been available since 2006 and have been implemented in many countries. We review approaches to diagnosis, management, and prevention of rotavirus gastroenteritis.

Sources and selection criteria

We looked at recent conference proceedings and searched PubMed, the Cochrane Database of Systematic Reviews, and Clinical Evidence online using the terms “rotavirus”, “rotavirus gastroenteritis”, and “rotavirus vaccines”. We focused on …

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