gastroenteritis%20-%20viral
GASTROENTERITIS - VIRAL
Acute gastroenteritis is a diarrheal disease of rapid onset.
Viruses are one of the common causes of gastroenteritis.
Rotavirus, enteric adenovirus serotypes 40 & 41, astrovirus and calicivirus (eg "Norwalk-like" virus) are the established viral agents causing gastroenteritis.
Rotavirus is the most common pathogen causing diarrhea in patients 3-24 months old.
Patients <3 months old are protected by maternal rotavirus antibodies that are passed transplacentally and possibly by breastfeeding.
Transmission is through fecal-oral route.
Incubation period may vary from 1-10 days depending on the causative agent.

Prevention

  • Prevention of most cases of viral gastroenteritis depends on the use of safe & effective vaccines
  • Currently, 2 vaccines are available to prevent severe diarrhea caused by rotavirus infection
    • Several studies support that early vaccination simulate initial natural infection, thus preventing subsequent severe cases of rotavirus gastroenteritis
Human Rotavirus Vaccine
  • Contains live attenuated human rotavirus strain
  • Prevents gastroenteritis caused by serotypes G1, G2, G3, G4 & G9
  • Based on clinical studies on the efficacy during the 1st year of life, it showed that the vaccine has a protective efficacy of 87.1% against any rotavirus gastroenteritis, 95.8% against severe cases & 100% against hospitalization due to rotavirus gastroenteritis
  • Can be simultaneously administered with the following vaccines without affecting the immune response of the administered vaccines: Hepatitis B vaccine, inactivated polio vaccine (IPV), Haemophilus b conjugate vaccine (Hib), pneumococcal conjugate vaccine (PCV), diphtheria & tetanus antigens in diphtheria-tetanus-acellular pertussis vaccine
  • Concomitant administration with oral polio vaccine may slightly reduce the immune response to rotavirus vaccine, however the clinical protection of rotavirus vaccine against severe gastroenteritis would not be affected
    • It is advised that 2 weeks should lapse between administration of the 2 vaccines
Pentavalent Rotavirus Vaccine
  • Contains live reassortant rotaviruses developed from human & bovine hosts
  • Prevents gastroenteritis caused by serotypes G1, G2, G3 & G4
    • Efficacy in preventing any grade of gastroenteritis severity reached 72.5-74% based on 2 studies done from the time of completion of 3-dose regimen through the 1st rotavirus season after the vaccination
    • The 2 trials also showed that the vaccine has clinical efficacy of 98-100% in preventing severe cases
    • There’s a 95.8 % reduction in hospitalizations for severe gastroenteritis during the 1st 2 years following the final dose
  • May be simultaneously administered with the following vaccines without affecting the immune response of the administered vaccines:
    • Hepatitis B vaccine (recombinant)
    • IPV, Hib, PCV
    • Diphtheria & tetanus antigens in diphtheria-tetanus-acellular pertussis vaccine
      • Immunogenicity data are insufficient to confirm the lack of interference of immune response between rotavirus & acellular pertussis vaccines; validation of pertussis assays is still under study
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