Rotavirus Infection

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Causative agent

Rotavirus, which has a characteristic wheel-like appearance under electron microscopy, is one of the most common causes of severe diarrhoea among children aged less than 5 years worldwide. The disease is more commonly seen in cooler months.

Clinical features

The disease is characterised by fever, vomiting and watery diarrhoea for 3 – 7 days. Abdominal pain is also frequently reported. Rotavirus gastroenteritis is a self-limiting illness in healthy persons. However, it is occasionally associated with severe dehydration in young children. Immunity after first infection is not permanent; subsequent reinfections can occur at any age, but are generally less severe than the first infection.

Mode of transmission

The primary mode of transmission is predominantly faecal-oral. Transmission can also occur through ingestion of contaminated water or food, or contact with contaminated surfaces. Outbreaks can more easily occur among children in day care settings.

Incubation period

Usually less than 48 hours, but can be up to 72 hours.

Management

There is no antiviral drug to treat rotavirus infection. Patients should ensure drinking adequate fluid to protect against dehydration. Patients suspected to have dehydration should seek medical advice for proper management.

Prevention

Prevention of rotavirus infection is similar to that of other viral gastroenteritis. Good personal, food and environmental hygiene are the mainstay of prevention.

1. Maintain good personal hygiene

• Perform hand hygiene frequently, especially before handling food or eating, and after using the toilet. Wash hands with liquid soap and water, and rub for at least 20 seconds, then rinse with water and dry with a disposable paper towel or hand dryer. If hand washing facilities are not available, or when hands are not visibly soiled, hand hygiene with 70 to 80% alcohol-based handrub may be considered.
• Wear gloves and a surgical mask while disposing of or handling vomitus and faeces, and wash hands thoroughly afterwards.
• Refrain from work or attending class at school, and seek medical advice if suffering from fever, vomiting or diarrhoea.
• Exclude infected persons and asymptomatic carriers from handling food and from providing care to children, the elderly and immunocompromised people.

2. Maintain good food hygiene

• Adopt the 5 Keys to Food Safety in handling food, i.e. Choose (Choose safe raw materials); Clean (keep hands and utensils Clean); Separate (Separate raw and cooked food); Cook (Cook thoroughly); and Safe Temperature (keep food at Safe Temperature) to prevent foodborne diseases.
• Drink only boiled water from the mains or bottled drinks from reliable sources.
• Avoid drinks with ice of unknown origin.
• Purchase fresh food from hygienic and reliable sources. Do not patronise illegal hawkers. In general, you can eat fruit skin after thorough washing. However, if you would like to reduce the risk of illness especially when you travel abroad, peel the fruits before eating and do not eat the peelings.
• Cook all food (especially shellfish) thoroughly before consumption.
• High risk groups (e.g. pregnant women, infants, young children, the elderly and people with weakened immune systems) should avoid eating food that is to be consumed without heat treatment (e.g. raw shellfish, especially oyster) or food containing ingredients that are not cooked (e.g. prepared or pre-packaged salads).

* Please visit the website of the Centre for Food Safety for more information on food safety.

3. Maintain good environmental hygiene

• Maintain good indoor ventilation.
• Regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), leave for 15-30 minutes, and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
• Clean vomitus/ faeces and disinfect the contaminated areas properly and immediately (please refer to the guidance on disinfection below for details).
• Maintain proper function of sanitary facilities and drainage system.
• Clean and disinfect toilets used by infected persons and the soiled areas.

4. Vaccination

• There are oral vaccines for infants which can prevent rotavirus infection effectively. Parents can approach their family doctors for further advice and information.