Rotavirus, Vaccination, and Intussusception

15 01 2014

Rotavirus is a nasty little germ that targets our stomach and intestines, making them swollen, red, and sore.

The intestines help digest the food and liquid we take in, and they make poop out of what doesn’t get absorbed into our bodies.

When the rotavirus attacks, it can cause our poop to turn into watery diarrhea. Fever, vomiting, and pain are often part of the disease.

In younger kids and babies, the diarrhea and vomiting can be nonstop, causing a serious loss of body fluids (dehydration).

The CDC says that “Rotavirus is the leading cause of severe diarrhea in infants and young children worldwide. Globally, it causes more than a half a million deaths each year in children younger than 5 years of age.”

We have effective vaccines—hospitalization rates have dropped 96 percent in the US since the vaccines became available, and the overall number of infections has plummeted.

There’s something that can happen that’s a rare side effect of the rotavirus vaccine. It’s called intussusception. The important thing to know is that intussusception happens anyway in the infant population, but with the vaccine, there appears to be a tiny increase in numbers of those affected.

Intussusception is when one part of the intestine slides into another, similar to a telescope closing. This causes a blockage in the intestines which requires hospitalization and sometimes surgery.

In the US, there are about 34 intussusception-related hospitalizations per 100,000 babies in the first year of life.

These cases happen whether a baby has been vaccinated against rotavirus or not. It’s called the “background” rate.

There has been a slight uptick in cases of intussusception with vaccination against rotavirus. For those babies vaccinated, the increase in rates of intussusception appears to be 1 to 5 cases per 100,000 babies.

We’re talking about this because a couple of studies have been done and these are the findings. It’s important to know all that we can when making health decisions for our children.

We parents don’t want to expose our babies to anything that might harm them. In the case of rotavirus disease and vaccination, it’s clear that the greater risk by far is the disease.

Talk to your baby’s healthcare provider and make the informed decision to protect your young one against rotavirus. It can be a deadly disease.





Gastro Bugs

17 09 2012

There is no such thing as “stomach flu,” despite the cavalier use of the phrase in some circles. What’s really going on is usually viral gastroenteritis.

Viral gastroenteritis isn’t caused by just one thing—it can be the result of any one of many different viruses, such as norovirus or rotavirus.

A gastro bug, as I like to call it, can be in the food or water we consume and will most commonly cause diarrhea, nausea and vomiting, and/or abdominal pain or discomfort.

Sometimes, it can also cause you to have a fever or chills, clammy skin, muscle or joint pain, and may put you off your feed. (That’s a “duh,” isn’t it!)

With liquids of various sorts pouring out of you, dehydration is a concern. Here are the signs, symptoms, and potential treatments to consider, as specified by NIH:

Signs and tests

The healthcare provider will look for signs of dehydration, including:

  • Dry or sticky mouth
  • Lethargy or coma (severe dehydration)
  • Low blood pressure
  • Low or no urine output; concentrated urine that looks dark yellow
  • Markedly sunken soft spots (fontanelles) on the top of an infant’s head
  • No tears
  • Sunken eyes

Tests that examine stool samples may be used to identify which virus is causing the sickness. This is usually not needed for viral gastroenteritis. A stool culture may be done to find out whether diarrhea are causing the problem.

Treatment

The goal of treatment is to prevent dehydration by making sure the body has enough water and fluids. Fluids and electrolytes (salt and minerals) that are lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals.

  • Older children and adults can drink sports beverages such as Gatorade, but these should not be used for younger children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores.
  • Do NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), Jell-O, or broth. All of these have a lot of sugar, which makes diarrhea worse, and they don’t replace lost minerals.
  • Drink small amounts of fluid (2-4 oz.) every 30-60 minutes. Do not try to force large amounts of fluid at one time, which can cause vomiting. Use a teaspoon or syringe for an infant or small child.
  • Breast milk or formula can be continued along with extra fluids. You do NOT need to switch to a soy formula.

Food may be offered often in small amounts. Suggested foods include:

  • Cereals, bread, potatoes, lean meats
  • Plain yogurt, bananas, fresh apples
  • Vegetables

People with diarrhea who are unable to drink fluids because of nausea may need intravenous (directly into a vein) fluids. This is especially true in small children.

Antibiotics do not work for viruses.

Drugs to slow down the amount of diarrhea (anti-diarrheal medications) should not be given without first talking with your healthcare provider. DO NOT give these anti-diarrheal medications to children unless directed to do so by a healthcare provider.

People taking water pills (diuretics) who develop diarrhea may be told by their healthcare provider to stop taking the diuretic during the acute episode. However, DO NOT stop taking any prescription medicine without first talking to your healthcare provider.

The risk of dehydration is greatest in infants and young children, so parents should closely monitor the number of wet diapers changed per day when their child is sick.

You can buy medicines at the drugstore that can help stop or slow diarrhea.

  • Do not use these medicines without talking to your healthcare provider if you have bloody diarrhea, a fever, or if the diarrhea is severe.
  • Do not give these medicines to children.

Viral gastroenteritis can become a serious illness, so watch for the symptoms and alert your healthcare provider if symptoms worsen.

Washing hands is the best prevention, along with vaccination when available (babies can be vaccinated against rotavirus).

Visit these websites for more information on gastro bugs

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001298/
http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm
By Trish Parnell (really by the NIH with a few asides from me)

Image courtesy of Examiner





Rotavirus At Any Age

1 03 2012

Dr. Mary Beth Koslap-Petraco, PKIDs’ advice nurse practitioner, fills us in on the reach of rotavirus. Any of us can be at risk.

Listen Now!

Right-click here to download podcast (7 min/3.5 mb)