Rotavirus infection

Last updated: November 9, 2022

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Rotaviruses are a common cause of viral gastroenteritis in infants and young children and are transmitted via the fecal-oral route. After a short incubation period of one to three days, patients present with symptoms of variable severity, which may include vomiting, watery diarrhea, high-grade fever, and malaise. Most patients with rotavirus infection receive a clinical diagnosis of acute viral gastroenteritis; diagnostic studies are usually not necessary, as they do not alter management. For patients with severe disease or in whom the diagnosis is uncertain, rotavirus infection can be confirmed by antigen detection in the stool. Treatment is supportive and mainly involves fluid replacement and managing symptoms as needed. Rotavirus infection can be prevented by vaccination.

  • A major cause of severe diarrhea in infants and children in the US (especially during the winter) [1]
  • Leading cause of severe diarrhea among infants and children worldwide, although all age groups are susceptible to infection.
  • Most commonly occurs in daycare centers and kindergartens

Epidemiological data refers to the US, unless otherwise specified.

  • Pathogen: Rotavirus is a nonenveloped, segmented, double-stranded RNA reovirus.
  • Transmission: fecal-oral route (e.g., by contact with hands, objects, food, water contaminated with the virus)



General principles [5]

  • Diagnosis is usually clinical.
    • Young children: variable presentation, ranging from no symptoms to severe disease [1][5]
    • Older children and adults: usually asymptomatic or mild symptoms [1][5]
  • Consider diagnostic studies for:

Confirmatory stool studies [5]

Additional studies [5][6]

Although a stool sample analysis can be used for diagnostic confirmation of rotavirus infection, management remains the same. [7]

The differential diagnoses listed here are not exhaustive.

Most children with gastroenteritis can be safely managed at home. [6][11]

General measures [5][6][12]

Exclusive breastfeeding during the first months of life reduces the risk of rotavirus infection in young infants. [6]

Rotavirus vaccination [1][13]

Children who are HIV-positive can safely receive the rotavirus vaccination, regardless of CD4 count. [12]

Older infants have a higher risk of intussusception following rotavirus vaccination; to reduce this risk, do not start the immunization series in infants > 15 weeks of age and ensure the series is completed by 8 months of age. [13][15][17]

  1. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases.. Updated: January 1, 2021. Accessed: September 21, 2022.
  2. Rotavirus - Transmission. Updated: August 12, 2016. Accessed: March 27, 2017.
  3. Haaheim LR, Pattison JR, Whitley RJ. A Practical Guide to Clinical Virology. John Wiley & Sons ; 2002
  4. Epidemiology and Prevention of Vaccine-Preventable Diseases - Rotavirus.
  5. Crawford SE, Ramani S, Tate JE, et al. Rotavirus infection. Nat Rev Dis Primers. 2017; 3 (1). doi: 10.1038/nrdp.2017.83 . | Open in Read by QxMD
  6. Hartman S, Brown E, Loomis E, Russell HA. Gastroenteritis in Children. Am Fam Physician. 2019; 99 (3): p.159-165.
  7. Parashar UD, Nelson EAS, Kang G. Diagnosis, management, and prevention of rotavirus gastroenteritis in children. BMJ. 2013; 347 (dec30 1): p.f7204-f7204. doi: 10.1136/bmj.f7204 . | Open in Read by QxMD
  8. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017; 65 (12): p.e45-e80. doi: 10.1093/cid/cix669 . | Open in Read by QxMD
  9. Riddle MS, DuPont HL, Connor BA. ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. Am J Gastroenterol. 2016; 111 (5): p.602-622. doi: 10.1038/ajg.2016.126 . | Open in Read by QxMD
  10. Rossignol JF. Nitazoxanide: A first-in-class broad-spectrum antiviral agent. Antiviral Res. 2014; 110 : p.94-103. doi: 10.1016/j.antiviral.2014.07.014 . | Open in Read by QxMD
  11. Hospital JH. The Harriet Lane Handbook. Elsevier ; 2020
  12. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021 : p. 407-417
  13. AAP. Prevention of Rotavirus Disease: Updated Guidelines for Use of Rotavirus Vaccine. Pediatrics. 2009; 123 (5): p.1412-1420. doi: 10.1542/peds.2009-0466 . | Open in Read by QxMD
  14. Vaccine Information Statements (VISs): Rotavirus VIS. Updated: October 18, 2016. Accessed: March 27, 2017.
  15. Catch-up Immunization Schedule. Updated: February 6, 2017. Accessed: March 16, 2017.
  16. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Public Health Foundation ; 2021
  17. Le Saux N. Recommendations for the use of rotavirus vaccines in infants. Paediatr Child Health. 2017; 22 (5): p.290-294. doi: 10.1093/pch/pxx072 . | Open in Read by QxMD

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