Have You Heard of Rotavirus?
This is a question Sheila, mother of two year old Jeremy would give a big nod to. Two years ago, during a routine visit to the clinic with Jeremy, the nurse had introduced Sheila to the Rotavirus vaccine via a disease information leaflet and a brief explanation on the need to come for the next visit with the required amount of money to secure the vaccine for her child.
‘I didn’t think it was important then”, Sheila reminisces. “And the amount of money being asked for was it really what I considered too high”. Choosing to give the drops a ‘pass’, was one of the biggest mistake she ever made, she now asserts, as six months later, her son was hit by a terrible bout of diarrhoea. “It was one of the most frightening things that a parent can go through. Here was a child who had been normal and suddenly was having an attack of vomiting and severe diarrhoea. I was not sure of what we had done wrong, as we all were keen to observe high standards of hygiene when handling the baby’s food. That evening when I came home from work, we rushed Jeremy to the hospital”.
The World Health Organisation (W.H.O) estimates that each year, 114 million children aged below five will suffer from rotavirus diarrhoea. Out of these, an estimated 610,000 will die from rotavirus diarrhoea. 85% of these deaths occur in tire developing countries of Asia and Africa. Dr. Zipporah Gatheru is no newcomer to the area of research in childhood diarrhea. A paediatrician and pioneer researcher who worked at the KEMRI for 14 years, ostensibly on diarrhea in children and specifically the rotavirus, she not only confirms the ever-present threat of diarrhoeas in children, but also the research findings that reveal that about 30 % of the diarrhoeas that occur in 3 month to 2 year old children are due to the rotavirus. “The causes of diarrhoea in children are many”, she explains. “They range from infections with bacteria, viruses, parasites, to unexpected causes such as allergies, changes in diet and even a reaction to a medicine such as an antibiotic. During the dry season in Kenya, Rotavirus is responsible for up to 80% of the diarrhoeas in this age group”, she further confirms. Although a laboratory test is usually used to confirm the cause of diarrhoea, the first test does not always identify the virus in the child’s stool. This was the test that confirmed rotavirus as the cause of Sheila’s son’s diarrhoea.
Rotavirus is found in man – both adults and children. The virus can survive for hours on hands and for days on solid surfaces; in human faeces, it remains stable and infective for up to one week. Because rotavirus is stable in the environment, transmission occurs by person to person spread, ingestion of contaminated water or food and contact with contaminated surfaces such as toys and food preparation counters. “Transmission of the rotavirus is highly efficient and a very low dose of the virus is enough to cause infection and disease”, further elaborates Dr. Gatheru.
Almost every child will have encountered the virus by the age of five years. Older children and adults however, may not develop symptoms of the disease or may only get a mild infection that does not require a hospital visit. Children between the ages of three months and two years are the most susceptible and usually suffer severe life threatening rotavirus diarrhoea.
A Rotavirus infection begins with mild to moderate fever and vomiting. A caregiver at this time may not see much cause for alarm. These symptoms are later followed by abdominal discomfort and diarrhoea. The fever and vomiting last up to three days on average, while the diarrhoea usually persists for 5-8 days. The diarrhoea may be mild and watery or severe, with life-threatening dehydration as a result of severe fluid loss. Other symptoms include the loss of appetite and depression. “Any unusual stool in children should be watched and when accompanied by pain or vomiting a doctor should be immediately called’, Dr. Gatheru says.
When a child loses more body fluids than he takes in, he becomes dehydrated. This can be life threatening. “Diarrhoea affects the body’s ability to process and absorb necessary water, salts (electrolytes) and nutrients. Severe dehydration if not well managed through the replenishment of the water, salts and nutrients can cause death.” Dr. Gatheru explains.
The younger the child, the faster mild dehydration progresses to a dangerous, even life-threatening level. Shelia was surprised at how fast tire situation could change with rotavirus diarrhoea. ‘I did not know about the virus or how fast it could affect a child…on examination by the doctor, Jeremy was immediately put on a drip. This was to restore fluids that he had lost, I was told. My child had changed from the chubby happy baby to a pale shadow of himself. Indeed, based on WHO research data, it is estimated that rotavirus accounts for about 40% of the hospitalisations for diarrhoea worldwide among children below five years.
Signs of severe dehydration include a decrease in urination, sunken eyes, no tears when crying, unusual drowsiness or fussiness, shriveled skin that lacks tone and a dry, sticky mouth. “I believe the right diagnosis and working fast saved my child’s life”, say’s Sheila.
As with all viral infections, antibiotics do not work. Management of the rotavirus diarrhoea is through giving the child lots of fluids to replace the ones he is losing. “If a child is still breastfeeding, a mother should continue to breastfeed as this will aid in re-hydrating the baby. If a child is admitted in hydrating the baby. If a child is admitted in hospital, the doctor may put your child on an intravenous drip to replace lost fluids. There is no anti-viral agent effective against rotavirus,” Dr. Gatheru emphasises.
The advent of vaccines that protect children against the rotavirus has been heralded as a major milestone towards saving children’s lives. It is estimated that 1.87 million children under the age of five years die of diarrhoea every year; of these deaths, 32% are caused by the rotavirus. “Although exclusive breastfeeding during the first six months of life, observing good hygiene like the regular disinfection of surfaces and toys, as well as the regular washing of hands have been the most promoted public health measures against the rotavirus, these do not guarantee 100% safety from the virus. Children who have been infected once can be re-infected. Recurrent infections are however less severe than the first infection. Vaccination is the most effective way to protect our children”, advises Dr.Gatheru.
The first vaccine against rotavirus was introduced in the USA in 1998 and it is only in 2006, that rotavirus vaccines were introduced in Kenya. It is indeed reassuring to know that with two doses of this vaccine, which is incidentally given as drops in the mouth, a child is saved from a disease that could lead to illness, hospitalisation or death.
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