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Virus infections causing diarrhoea and vomiting 

Virus infections causing diarrhoea and vomiting

Chapter:
Virus infections causing diarrhoea and vomiting
Author(s):

Philip Dormitzer

and Ulrich Desselberger

DOI:
10.1093/med/9780199204854.003.070509_update_002

July 30, 2015: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Chapter thoroughly overhauled, with enhanced and updated discussion of vaccine developments against both rotavirus and norovirus.

Updated on 28 Aug 2014. The previous version of this content can be found here.
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date: 23 April 2017

Acute gastroenteritis is frequently caused by rotaviruses, human caliciviruses (noroviruses, sapoviruses), astroviruses and enteric adenoviruses (group F): these cause much disease worldwide and considerable mortality, mainly in developing countries. Other viruses found in the human gastrointestinal tract are not regularly associated with diarrhoeal disease, except in patients who are immunosuppressed and in whom herpes simplex virus, cytomegalovirus, and picobirnaviruses can cause diarrhoea, as can HIV itself.

Epidemiology—(1) Rotaviruses—a major cause of endemic infantile gastroenteritis worldwide; transmission is by the faeco-oral route; there is a strict winter peak of infections in temperate climates, but these occur year round in tropical and subtropical regions; many animals and birds harbour a large diversity of rotaviruses and may act as a reservoir for human infections. (2) Human caliciviruses—the most important cause of nonbacterial gastroenteritis outbreaks worldwide—frequently spread by contamination of food (oysters, green salads, fresh fruit, cold foods, and sandwiches) and water.

Clinical features and management—following an incubation period of 1 to 2 days, there is sudden onset of watery diarrhoea lasting between 4 and 7 days, vomiting, and varying degrees of dehydration. Other features include abdominal cramps, headache, myalgia and fever. Treatment is supportive, mainly with oral rehydration solutions or—in more severe cases—intravenous rehydration.

Diagnosis—viral infection can be demonstrated by virus-specific enzyme-linked immunosorbent assays, and by viral genome detection using the polymerase chain reaction (PCR) (for adenoviruses) or reverse transcription-PCR (RT-PCR) (for rotaviruses, caliciviruses, and astroviruses).

Prevention and control: two live attenuated oral rotavirus vaccines have been licensed in numerous countries since 2006. In countries where universal mass vaccination of children as part of childhood vaccination schemes has been established, a significant reduction of rotavirus-associated acute gastroenteritis has been recorded. Vaccines against human norovirus disease are under development. Outbreak control measures focus on the interruption of person-to-person transmission, the removal of common sources of infection (food, water, etc) and improvement of general environmental hygiene.

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