Rotavirus is a leading cause of gastroenteritis in the United States and worldwide. Characterized by frequent watery stools, illness ranges from mild diarrhea to disease complicated by severe dehydration, especially in young children.


  • Rotavirus is a major cause of diarrheal disease and accounts for over 200,000 deaths in children <5 years of age worldwide.
  • The peak age for infection is between 6 and 24 months of age. Nearly all children acquire the virus by 5 years of age.
  • In temperate climates, rotavirus activity peaks during the cold weather months but can appear year round in warmer climates.
  • Transmission occurs primarily by the fecal–oral route.
  • Rotavirus is highly contagious. This is due to several factors.
    • The virus has a very low inoculum of infection, requiring as few as 10 infectious particles to cause disease.
    • A high density of virus is shed into the stool during acute illness and for 1 to 3 days before and after diarrhea.
    • There is prolonged survival of the virus on a variety of environmental surfaces.
  • The incubation period is 1 to 3 days.
  • Prior to the rotavirus vaccine, U.S. children <5 years of age with diarrhea had a hospitalization rate of 52/10,000 person-years and an emergency department (ED) visit rate of 185/10,000 person-years.
  • After the rotavirus vaccine was introduced in 2006, the hospitalization rate for all U.S. children <5 years with diarrhea fell by nearly 50% and ED visits by 25%.
  • Hospitalizations for rotavirus-coded gastroenteritis among vaccinated children fell by >90%, compared to unvaccinated children.
  • Rotavirus infection persists among older unvaccinated children and in the adult population.

Risk Factors

  • Young infants, especially preterm infants, are at higher risk for severe dehydration and gastrointestinal (GI) complications.
  • Immunocompromised patients, particularly with primary immunodeficiencies and hematopoietic stem cell transplantation are at higher risk for complications and prolonged shedding.

General Prevention

  • Proper hand hygiene and cleaning of contaminated surfaces is essential to reducing person-to-person transmission.
  • Contact precautions for hospitalized patients
  • Two live oral vaccines are licensed in the United States:
    • Live human/bovine reassortant pentavalent rotavirus (RV5); given as a 3-dose series
    • Live human attenuated monovalent rotavirus (RV1); given as a 2-dose series
  • Vaccine administration is contraindicated in patients with a history of intussusception or SCID.
  • The first dose of rotavirus vaccine should be administered between 6 weeks and 14 weeks and 6 days of age.


Rotavirus infects and replicates within the enterocytes of the small bowel. Several factors appear to contribute to secretory diarrhea.

  • The nonstructural protein (NSP4) acts as an enterotoxin that triggers secretory diarrhea by increasing Cl secretion and decreasing Na+ absorption.
  • NSP4 also appears to activate the enteric nervous system, which activates a secretory state that further contributes to intestinal fluid loss.
  • NSP1 is capable of inhibiting IFN induction.
  • Malabsorption develops due to disruption of microvilli and decreased surface transport of digestive enzymes.


  • Rotavirus is an 11-segment double-stranded RNA virus with seven different antigenic groups (A to G).
  • Types A, B, and C are responsible for most human infections, with group A being the most common.
  • Group A rotavirus is further divided into multiple serotypes based on two outer capsid viral proteins: VP7 (G) and VP4 (P).

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