Rotavirus Flashcards by Shadin Hassan

What family/Genus does the Rotavirus belong to?

Reovirdea
Rotavirus

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What is the most common serotype of Rotavirus?

Serotype A

*Serotypes A-1: vaccine protect against serotype A

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What classification system is used for Rotavirus genotypes?

Dual classification based on

Antigenic (serotypes)

and

Genetic/sequence differences of VP7 (G gylcosylated type) and VP4 proteins (P protease sensitive type)

*VP7 and VP4 are the two outer capsid protein

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How many G and P types of Rotavirus have been identified in humans?

10 G types and 11 P types

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What is the structure of the Rotavirus viron?

Non-Enveloped, icosahedral, with a triple capsid structure, 80 nm in diameter

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What type of genome does Rotavirus have?

dsRNA, Linear, Segmented (11 segments)

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What is the incubation period for Rotavirus?
What is the InP?

IP: 1-3 days

InP: 2D before onset of symptoms to 10D after symptoms resolve (ECDC 1-3W)

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What is the typical duration of Acute Gastroenteritis (GE) caused by Rotavirus?

3-8 days

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What are the common symptoms of Rotavirus infection?

Mild fever
Severe diarrhea
Vomiting
Stomach cramps

Can lead to Dehydration

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What is the transmission route for Rotavirus?

Person-person via
*Fecal-oral route
*Air-borne droplets
*Contaminated environment
*Contaminated food and water

An important HAI

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True or False: Rotavirus can be transmitted through respiratory routes.

True

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Why are good hygiene measures ineffective in halting Rotavirus transmission?

Robustness of rotavirus
Low infectious dose (10–100 virus particles)
Resistance to physical inactivation

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What is the pattern of Rotavirus infection in the UK?

Its seasonal

Mostly in Winter and early spring (Jan-March)

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What age are most affected with infection?

Any age can be infected BUT MOST infections occur in children between 1M -4Y of age.

Infection in newborns is COMMON but tends to be either mild/asymptomatic, probably because of protection by circulating maternal Ab.

Infections in adults are rarely reported, although not UNcommon in those caring for/in contact with sick kids

Older children and adults can develop asymptomatic infection, which may be important in maintaining rotavirus infection in the community

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What are the characteristic of Rotavirus infection?

Infections are OFTEN recurrent

Once infected —> develop immunity (although maybe short)

2nd/subsequent infections with a previous encountered strain are OFTEN asymptomatic.

Symptomatic 2nd infections are USUALLY associated with a different GT/strain.

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What type of immunity do individuals develop after a Rotavirus infection?

Short-lived immunity

What are the commonest Rotavirus serotypes circulating in the UK?

G1P(8)
G2P(4)
G3P(8)
G4P(8)
G9P(8)

What are the two authorized Rotavirus vaccines in the EU?

Rotarix
RotaTeq

Is it permissible to interchange Rotavirus vaccines?

No, the same vaccine product should be used for the complete course.

Which Rotavirus vaccine is part of the UK national childhood immunisation programme?

Rotarix

What type of vaccine is Rotarix?

Live attenuated vaccine

Derived from a virus initially isolated from a 15M child and then attenuated by serial cell culture passage.

What is the efficacy of Rotarix in protecting against severe GE?

Over 85% effective in the 1st 2Y of life.

Shown to protect against GE due to rotavirus serotypes

What is the recommended schedule for Rotarix vaccination?

1st dose: 1.5ml at 8W
2nd dose: 1.5ml at least 4W after the 1st dose (12W)

What is the rationale for completing the Rotarix vaccination course before 16 weeks?

To provide early protection and avoid temporal association with intussusception.

What are the cut off for infants to receive the Rotarix vaccine (in line with WHO)?

Infants should ONLY receive the 1st dose of Rotarix® if they are <15W. Infants who receive the first dose before W15 should receive the 2nd dose by 24W. If the course is interrupted, it should be resumed but not repeated, provided that the second dose can be given before the 24W cut-off.

What to do if children inadvertently received the 1st dose at age 15W or older?

They should still receive their 2nd dose at least 4W later-providing that they will still be under 24W of age at the time. ***No specific clinical action needs to be taken if the first dose of vaccine is inadvertently given after 15W and zero days of age or if the second dose is given after 24W of age

What are the recommendation for use of the vaccine?

NOT for UNDER 6W 6W- <15W: minimum age for 1st dose is 6W 0D, maximum age for 1st dose is 14W and 6D. 15W- <24W: Vaccination should NOT be started for infants aged 15W and 0D/older. Infants who have received their first dose of vaccine under 15W and 0D of age should receive their second dose after a minimum interval of 4W and by 23W and 6Dof age. Infants =/> 24W vaccine should NOT be given

What are the contraindications for administering Rotarix?

* Anaphylactic reaction to previous dose * Anaphylactic reaction to vaccine components * Previous history of intussusception * Infants aged >= 24 weeks * Infants with SCID * Malformations of the GIT * Hereditary fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency

What precautions should be taken before administering Rotarix?

Postpone in infants with acute severe febrile illness or acute diarrhea/vomiting.

What is the most common adverse effect of Rotarix?

* Diarrhea * Nausea * Vomiting * Abdominal pain * Irritability

What is the potential risk associated with Rotarix vaccination?

Very small increased risk of intussusception within seven days of vaccination. Which occurs naturally, usually in the Uk by age of 5M.

What is the recommendation for infants with other IS disorders regarding rotavirus vaccination?

Benefits outweigh risk —> actively consider vaccination and d/w dr caring for infant.

Should HIV infected infants receive the rotavirus vaccine?

Yes, advised in HIV infected infants. ## Footnote This also applies to infants with unknown HIV status born to HIV positive mothers.

What is the potential risk of transmission associated with the LA vaccine in Rotarix®?

Potential for transmission of LA vaccine from the infant to severely IS contacts through faecal material for at least 14 days. BUT Vaccination offers protection to HH contacts from wild-type rotavirus disease --> give vaccine and advice good HH

What are the most common adverse actions associated with rotavirus vaccination?

D/N/V/abd pain/irritability.

What risk is associated with Rotarix® within seven days of vaccination?

Very small increased risk of intussusception, possibly two cases per 100,000 first doses given.

What does the Rotarix® prescribing information include as a possible side effect?

Includes intussusception as a possible side effect. ## Footnote This highlights the importance of monitoring post-vaccination.