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Primary reference(s)

WHO, 2018. . Accessed 10 October 2020.

Additional scientific description

Rotavirus, a member of the reovirus family, causes watery diarrhoea, vomiting and severe dehydration in young children. Rotavirus is common, accounting for 35–60% of acute severe diarrhoea in children less than 5 years of age in countries without rotavirus vaccine, with the highest attributable percentage in infants. Rotavirus diarrhoea is ubiquitous and children are infected at an early age. It often causes nosocomial outbreaks on paediatric wards where handwashing and other infection prevention and control measures are lax (WHO, 2018a).

Rotavirus is highly communicable; it is shed in the stool at high concentration, and transmission is through the faecal-oral route, either person-to-person or through fomites in the environment. The incubation period is one to three days. There is a spectrum of clinical disease with the typical presentation being acute, watery, non-bloody diarrhoea often accompanied by vomiting and fever (WHO, 2018a). Symptoms also include loss of appetite and dehydration due to loss of body fluids (WHO, 2017).

Rotavirus peaks in cool, dry seasons in temperate climates but exhibits less pronounced seasonality in tropical settings (WHO, 2018a).

Rotavirus has a case-fatality rate of approximately 2.5% among children in developing countries who present to health facilities. This case-fatality rate is higher in areas without good access to health care. In 2013, rotavirus caused an estimated 215,000 deaths worldwide (WHO, 2018a).

Rotavirus diarrhoea cannot be distinguished clinically from other types of diarrhoea, but laboratory confirmation can be done if necessary (WHO, 2017).

The World Health Organization (WHO) has published guidance on case classification and surveillance standards (WHO, 2018a).

Metrics and numeric limits

Not available.

Examples of drivers, outcomes and risk management

Key measures to prevent diarrhoea include access to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive breastfeeding for the first six months of life, good personal and food hygiene, health education about how infections spread and rotavirus vaccination (WHO, 2017).

Rotavirus diarrhoeal disease is a vaccine preventable disease (WHO, 2018b). Four oral, live, attenuated rotavirus vaccines, Rotarixâ„¢ (derived from a single common strain of human rotavirus); RotaTeqâ„¢ (a reassorted bovine-human rotavirus); Rotavacâ„¢ (naturally occurring bovine-human reassortant neonatal G9P, also called 116E); and RotaSiilâ„¢ (bovine-human reassortant with human G1, G2, G3 and G4 bovine UK G6P[5] backbone) are available internationally and are WHO prequalified. All four vaccines are considered highly effective in preventing severe gastrointestinal disease. In low income countries vaccine efficacy can be lower than in industrialised settings, similar to other live oral vaccines. Even with this lower efficacy, a greater reduction in absolute numbers of severe gastroenteritis and death is seen in lower income countries due to the higher background rotavirus disease incidence (WHO, 2018b).

The WHO recommends that rotavirus vaccines should be included in all national immunisation programmes and considered a priority particularly in countries in South and Southeast Asia and sub-Saharan Africa. The WHO continues to recommend that the first dose of rotavirus vaccine be administered as soon as possible after 6 weeks of age, along with DTP (diptheria, tetanus and pertussis) vaccination. Apart from a low risk of intussusception (up to 6 per 100,000 infants vaccinated) the current rotavirus vaccines are considered safe and well tolerated (WHO, 2018b).

The public health impact of rotavirus vaccination has been demonstrated in several countries. For example, in the USA, a measurable decrease was seen in the number of rotavirus gastroenteritis hospitalisations accompanied by a suggested herd effect protecting older non-vaccinated children, while in Mexico a decline of up to 50% in diarrhoeal deaths in children under 5 years of age was attributed directly to the use of the vaccine (WHO, 2018b).

The WHO reiterates that the use of rotavirus vaccines should be part of a comprehensive strategy to control diarrhoeal diseases with the scaling up of both prevention (promotion of early and exclusive breastfeeding, handwashing with soap, improved water and sanitation) and treatment packages (including low-osmolarity oral rehydration salts and zinc (WHO, 2018b).