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 and 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 and 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 the most common genotypes G1P[8], G2P[4], G3P[8], G4P[8] and G9P[8]
    • Effectiveness has also been demonstrated against the less common genotypes G9P[4] and G9P[6] and the uncommon genotypes G8P[4] (severe gastroenteritis) and G12P[6] (any gastroenteritis) 
  • Based on a clinical study done in Asia, the vaccine showed a 100% protective efficacy against severe gastroenteritis during the 1st year of life with the efficacy sustained up to 3 years of age
  • Can be simultaneously administered with the following vaccines without affecting the immune responses and safety profiles of the administered vaccines:
    • Hepatitis B vaccine (HBV)
    • Inactivated polio vaccine (IPV)
    • Haemophilus influenzae type b vaccine (Hib)
    • Pneumococcal conjugate vaccine (PCV)
    • Meningococcal serogroup C conjugate vaccine 
    • Diphtheria-tetanus-acellular pertussis vaccine (DTPa/DTaP)
    • Diphtheria-tetanus-whole cell pertussis vaccine (DTPw/DTwP)
    • Hexavalent vaccines (DTPa-HBV-IPV/Hib)
  • Concomitant administration with oral polio vaccine (OPV) 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 and bovine hosts
  • Prevents gastroenteritis caused by serotypes G1P1A[8], G2P1[4], G3P1A[8], G4P1A[8] and G9P1A[8]
    • 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 is 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 responses of the administered vaccines: HBV, IPV, OPV, Hib, PCV, DTPa, meningococcal serogroup C conjugate vaccine and hexavalent vaccines
  • Concomitant administration with OPV may reduce the immune response to rotavirus vaccine; however, there is evidence that a high level of efficacy against severe gastroenteritis is maintained 
    • It is advised that 2 weeks should lapse between administration of the 2 vaccines
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