Training for rotavirus vaccine introduction Module 4 Rotavirus vaccine administration.
Rotavirus infection in paediatrics
Transcript of Rotavirus infection in paediatrics
Rotavirus infection in paediatrics
Dr Angela Dramowski ([email protected]),
Paediatric Infectious Diseases, Stellenbosch University,
Cape Town, South Africa
ICAN Harare 2014
Outline
Epidemiology of RV diarrhoea
Virology
Clinical presentation
Case management
Prevention of RV disease
Diarrhoea kills 2,195 children every day:
more than AIDS, malaria, measles combined
Global deaths from Rotavirus
Rotavirus disease burden and
public health significance
Glass et al, Lancet 2006
Natural history of RV infection
Velazquez et al. NEJM. 1996; 335: 1022–1028.
• All children will get
at least 1 infection
• Natural infection
reduces severity of
subsequent
infections
• Infants become
immune after 1–3
infections.
Nosocomial RV infection
Twenty surveillance studies US and Europe
Pooled nRV incidence = 2.9 / 100 hospitalizations [CI]: 1.6–4.4
Highest incidence < 2 years and epidemic months (8.1/100)
Few studies of nRV in Africa (Botswana, Guinea)
2 x neonatal outbreaks in Cape Town, South Afica
Virology
Reoviridae (ds RNA virus)
icosahedral protein capsid
NON-enveloped virus
Types A –G
VP7 capsid protein-G : neutralization
VP4 protein spike-P: neutralization protein, cell attachment, virulence, haemagglutination
Fecal-oral spread
10 trillion infectious particles/gram of faeces
<100 particles infective dose!
Distribution of rotavirus strains from a
global collection of 2,748 strains
Viral heterogeneity
Pathogenesis
Destruction of enterocytes = malabsorption
Toxic protein : - reduces water reabsorption
reduces activity of brush-border disaccharides
deficiency of lactase enzyme with milk intolerance
Clinical presentation
Incubation period 2 days
Duration of symptoms: 3-7 days
Virus shedding: 5 - 21 days
Mild to severe vomiting
Profuse watery diarrhoea
Low grade fever
Complications: dehydration, electrolyte abnormalities,
febrile seizures (most severe 6 months - 2 years )
Diagnosis
Stool :
Rapid tests
ELISA
PCR
Electron microscopy
Management
Supportive care
Fluid replacement: ORS or IV
Zinc supplement
Breastfeeding/feeding
Vitamin A
15
Rehydration unit, Mogadishu, Somaliawww.voanews.com/content/doctors_without_borders_completes_cholera_campaign/1146248.html
Impact of oral rehydration
Prevention of Rotavirus disease
Reductions in death and hospital admissions, particularly in
developing countries (Cochrane review 2012)
Rotavirus vaccines
Live attenuated vaccine, 2 oral formulations,
2-3 doses before 6 months of age, WHO EPI since 2009
RV vaccine & intussuception
Rotashield vaccine (1998)
Withdrawn by CDC shortly thereafter
Adverse events reports: intussuception
Calculated risk of 1-2 extra cases of
intussusception caused among each
10,000 infants vaccinated with
RotaShield® vaccine.
Rotavirus vaccine access
7 point plan for DD
1. Fluid replacement
2. Zinc
3. Rotavirus + measles EPI
4. Early, exclusive breastfeeding
5. Handwashing with soap
6. Improved water supply/quality
7. Community-wide sanitation
promotion.
"It is a tragedy that diarrhoea, which is little
more than an inconvenience in the developed
world, kills an estimated 1.5 million children
each year.“
UNICEF Executive Director Ann M. Veneman.