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Extended excretion of rotavirus after severe diarrhoea in young children
S Richardson1, K Grimwood, R Gorrell
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia.
Insights
Severe rotavirus infection in children can lead to prolonged virus shedding for up to 57 days. This extended rotavirus excretion may increase transmission risk and contribute to post-gastroenteritis symptoms.
Area of Science:
- Virology
- Immunology
- Pediatrics
Background:
- Rotaviruses are a primary cause of severe diarrhea in children.
- Understanding rotavirus natural history, including shedding duration, is crucial for managing transmission and immune responses.
Purpose of the Study:
- To investigate the duration of rotavirus shedding in children hospitalized with severe rotavirus diarrhea.
- To identify factors associated with prolonged rotavirus excretion.
Main Methods:
- Studied 37 children with severe rotavirus diarrhea.
- Collected sequential fecal specimens over 100 days.
- Detected rotavirus using EIA and RT-PCR; measured IgA coproantibody.
Main Results:
- Rotavirus excretion lasted 4-57 days; 30% of children showed extended excretion (25-57 days).
- Extended excretion correlated with IgA coproantibody boosts (p=0.001) and recurrent mild diarrhea (p=0.006).
- Primary infecting strain often responsible for prolonged shedding.
Conclusions:
- Severe rotavirus disease can result in extended rotavirus shedding in young children.
- Prolonged shedding may elevate transmission risks beyond previous estimates.
- Extended excretion could explain some post-gastroenteritis syndromes.
Background:
Rotaviruses are the major cause of severe childhood diarrhoea. Knowledge of the natural history of infection, including duration of intestinal virus shedding, is important in the understanding of transmission, sources of infection, and immune responses.
Methods:
We carried out a study of rotavirus excretion in 37 children admitted to hospital with severe rotavirus diarrhoea. Sequential faecal specimens were collected from each child during 100 days of surveillance, and screened for rotavirus by EIA and by amplification of genome double-stranded RNA by reverse-transcription PCR. IgA coproantibody was estimated by EIA.
Findings:
Duration of rotavirus excretion ranged from 4 to 57 days after onset of diarrhoea. Excretion ceased within 10 days in 16 (43%) children, and within 20 days in 26 (70%) children. Extended excretion was detected for 25-57 days in the remaining 11 (30%) children owing mainly to continued excretion of the primary infecting strain. Extended excretion was significantly associated with antirotavirus IgA coproantibody boosts during 100 days of surveillance (p=0.001, log-rank test), and with recurrence of mild diarrhoea symptoms during convalescence (p=0.006, Fisher's exact test).
Interpretation:
Severe rotavirus disease in young children may be followed by extended excretion of rotavirus. The risk of transmission to others may be greater than previously believed. Extended excretion could also explain some cases of the postgastroenteritis syndrome.