Rotavirus - the leading cause of death from diarrhea in children

Rotavirus infection kills nearly half a million children under the age of five worldwide. The reasons why children are more likely to die from diarrhea are dehydration, electrolyte imbalance and malnutrition.

Rotavirus is the leading cause of severe diarrhea, hospitalization, and even death in young children globally as well as in Vietnam. Children with acute diarrhea caused by Rotavirus are three times more likely to be hospitalized than those with diarrhea caused by other causes. In Vietnam, 55% of acute diarrhea cases hospitalized in young children are caused by Rotavirus.

Acute diarrhea is a very common disease, second only to acute respiratory infections in children, with high morbidity and mortality rates.

Illustration: O5.com.

The main cause of death in children with diarrhea is dehydration and electrolyte loss, followed by malnutrition. Malnutrition and diarrhea form a vicious cycle: diarrhea leads to malnutrition, and when children are malnourished, they are at high risk of diarrhea, which greatly affects the child's growth and is an economic burden for the family and society.

- Source of disease: Humans and some animals such as cows, sheep, monkeys, dogs... can be virus reservoirs. Rotavirus can cause disease in immature animals such as monkeys, buffaloes, cows, sheep, horses, mice, dogs, cats, rabbits... and can then infect humans. Rotavirus in animals can be transmitted directly to humans or recombined with rotavirus strains that cause disease in humans.

- Age group most susceptible: Children from 6 months to 36 months. Rotavirus infection can occur in infants and adults but is often asymptomatic.

In Vietnam, there is a difference in the season of rotavirus diarrhea between the North and the South. The rate of rotavirus diarrhea increases in the winter and spring in the North, peaking from September to November, while in the South the disease is not seasonal.

- Transmission: Rotavirus is mainly transmitted through the fecal-oral route, but can also be transmitted through the respiratory tract. Rotavirus can be transmitted in the community or cross-infected in hospitals.

- The body's immunity to Rotavirus: Children under 3 months of age rarely get sick because they have antibodies passed on from their mothers. The types of antibodies that play an important role in protection include:

+ Secretory IgA antibodies: Present in breast milk and can last up to 24 months, so breastfed babies can be protected against rotavirus attacks. Secretory IgA in the small intestinal mucosa plays a major role in protecting against rotavirus infection.

+ IgM humoral antibodies: Appear early in the blood, reach the highest concentration in the acute phase and gradually decrease after 10 days. IgG reaches low concentration in the acute phase and increases in the recovery phase.

Risk factors:

- Children who are bottle-fed without proper hygiene have a much higher risk of diarrhea than children who are exclusively breastfed or not bottle-fed.

- Improper supplementary feeding: Feeding children cooked food left at room temperature for a long time, food contaminated before and after processing.

- Unclean drinking water (not boiled or left for a long time) or contaminated domestic water source.

- Tools and hands of people preparing food are infected.

- Improper disposal of infected waste, the belief that children's feces are not as dirty as adults' feces.

- No habit of washing hands after going to the toilet, before preparing food, before feeding children...

Clinical symptoms:

Rotavirus gastroenteritis is characterized by the sudden onset of watery diarrhea, fever, and vomiting. Symptoms usually appear after an incubation period of 2-3 days and last for about 5-7 days. The severity of the disease can range from asymptomatic to severe dehydration and even death. Vomiting and watery stools are two common clinical features of acute gastroenteritis caused by rotavirus that are rarely seen in other causes. Children usually start the disease with symptoms of vomiting and fever followed by watery diarrhea several times a day, which can last up to 10 days. The stools are usually free of blood and mucus. Most children hospitalized for rotavirus diarrhea have all three symptoms of diarrhea, vomiting, and fever.

Fever is a fairly common symptom of children infected with Rotavirus. Results from domestic and international studies show that almost all patients with acute diarrhea caused by Rotavirus have fever, of which nearly 50% of cases have a mild fever below 38.5 degrees Celsius. Other common symptoms include vomiting (100%), loss of appetite (97.67%), and discomfort (90.7%). Acute diarrhea caused by Rotavirus is the second leading cause of dehydration after cholera, because the number of diarrheas per day is usually 10-20 times, in some cases children can have more than 20 bowel movements per day.

Diarrhea can affect the child's overall health, such as malnutrition and other symptoms. Therefore, children need to be assessed for the following symptoms:

- Nutritional status and trace element deficiencies.

- Fever and other signs of infection.

- Metabolic acidosis: heavy, deep breathing, red lips.

- Potassium deficiency: Abdominal distension, functional ileus, arrhythmia, generalized myasthenia.

- Dehydration level: Based on signs of dehydration to classify dehydration in children with diarrhea. To assess the level of dehydration in children, it is necessary to:

+ Observe the child's general condition: Normal alertness when not dehydrated, restless and agitated when dehydrated or extremely tired and lethargic when severely dehydrated.

+ Thirst: Give your child water with a cup or spoon to assess their thirst level. A child who drinks normally but does not like it very much or refuses to drink is not showing signs of dehydration. A thirsty child who drinks eagerly, grabs the cup or spoon to drink or cries when you stop giving him water is showing signs of moderate dehydration. A child who may not drink or drink poorly due to lethargy is showing signs of severe dehydration.

+ Assess the elasticity of the baby's skin by pinching the baby's skin in the abdominal area along the body and then releasing it. Normally, the skin pinch disappears quickly. When the baby is moderately dehydrated, the skin pinch will disappear slowly (less than 2 seconds) or very slowly (over 2 seconds) when severely dehydrated.

+ Are the child's eyes sunken more than normal?

+ Observe whether the baby cries with tears. When the baby cries loudly without tears, the baby is moderately dehydrated.

+ Observe the child's mouth and tongue to see if it is dry. The mouth and tongue are dry when the child shows signs of dehydration.

+ Is the baby's fontanel sunken more than normal (for babies with fontanels)?

According to Vnexpress