With the improvement of hygiene, the main pathogens of pediatric acute diarrhea are changing from bacterial to viral infections, especially rotavirus. Rotavirus gastroenteritis occurs in children under 5 years of age, especially in infants and children between 6 months and 2 years of age, with the highest incidence and most severe symptoms.
The epidemiological characteristics of rotavirus
1,Source of infection.
Patients, recovering detoxified persons and asymptomatic infected persons.
The incubation period is 1 to 3 d. A large amount of virus is excreted in the feces 2 days before the onset of diarrhea and continues until 10 days after the onset of symptoms. In addition, the clearance of rotavirus is poor in immunodeficient patients, and the detoxification time can be prolonged for more than 30 days. The concentration of RV in the feces and vomit is also significantly higher after infection than in normal patients.
Transmission is mainly through the fecal-oral route, followed by human-to-human contact transmission, and also through aerosol transmission. Rotavirus can be transmitted by hands, contaminants, contaminated food and water. 3.
Children under 5 years of age; therefore, infants and children under 2 years of age are a priority target for RVGE prevention.
Clinical features of rotavirus gastroenteritis
The typical clinical manifestations are vomiting, diarrhea, and fever. Children with the disease often start with vomiting, followed by diarrhea, which can be more than 10 to dozens of times a day. The stools are thin and watery, light green or yellowish green, with occasional mucus and no pus or blood.
The fever is usually below 39.0 ℃, but heavy cases often present with high fever (39.0 ℃ to 40 ℃). Fever and vomiting usually disappear after 2 days of onset. Due to fever, vomiting, and diarrhea, children with this disease are prone to varying degrees of dehydration, electrolyte disturbances, and acid-base imbalance. In addition, rotavirus can attack extraintestinal tissues including the brain, liver, pancreas, lungs, kidneys, and heart, causing the corresponding disease.
The diagnosis of rotavirus infection is confirmed by laboratory testing of fecal specimens. Enzyme-linked immunosorbent assay (ELISA) and latex particle agglutination tests are commonly used to detect rotavirus antigens in stool.
Treatment and dietary recovery
There are no specific anti-rotavirus drugs available. Clinical management is mainly symptomatic with oral rehydration salts or intravenous rehydration, correction of dehydration, electrolyte disturbance and acid-base imbalance.
1.How to fast during frequent vomiting?
At the beginning of the disease, children are often temporarily fasted due to frequent vomiting, but their appetite is still very strong after vomiting, so they often cry continuously due to unbearable hunger, and parents’ anxiety increases.
For children with appetite after vomiting, they are temporarily fasted and given oral rehydration salts at a slightly cooler temperature of 3-5 ml every 2-3 min to reduce stimulation of the gastric mucosa, and those who still vomit are given rehydration salts after a 10-minute pause. After 2 hours of vomiting, the child can gradually resume the diet with light, easily digestible and nutritious food, such as milk and white porridge.
If the child has no appetite after vomiting and the gastrointestinal function of the child is very poor, eating will increase the gastrointestinal burden, so the child can temporarily fast for 3 hours and resume eating early after the condition improves.
2.How to balance frequent meals with increased gastrointestinal burden?
Patients with acute nutrient loss due to frequent vomiting and diarrhea are encouraged to continue feeding with small and frequent meals. However, the high frequency of eating will increase the gastrointestinal burden.
It is recommended that breast-feeding patients should be fed every 2-2.5 hours for 15-20 minutes, without covering the milk; artificial feeding patients and those who have added supplementary foods such as white porridge and noodles should be fed every 3 hours; for children with poor appetite, feeding can be delayed for 0.5-1 hour.
Do not add food randomly during the interval between meals, so that the gastrointestinal tract can get sufficient rest. Do not prohibit water during this period.
For older children, there is no restriction on diet. It includes cereals, meat, yogurt, fruits and vegetables. The main objective is to ensure adequate energy intake. A diet high in simple sugars, including carbonated beverages, jellies, canned juices, desserts and other sugary drinks, and high-fat foods is not recommended.
The recommended dose: ≥6 months of age: 20 mg/d for 10-14 d. 20 mg of zinc is equivalent to 100 mg of zinc sulfate or 140 mg of zinc gluconate.
4.probiotics and mucosal protectants may also be given as appropriate.
How to prevent nosocomial infection?
Isolation of patients with confirmed disease in a single room, improved hand hygiene, disinfection and ventilation of the air in the ward, and strict disinfection of utensils.
Summary of key points
1,Rotavirus gastroenteritis is most common in children under 5 years of age, especially in infants and children between 6 months and 2 years of age, with the highest incidence and most severe symptoms.
2,The typical clinical manifestations are vomiting, diarrhea and fever.
3,The diagnosis of rotavirus infection is confirmed by laboratory testing of fecal specimens.
4,There are no specific anti-rotavirus drugs available. The main clinical treatment is oral rehydration salts or intravenous rehydration, correction of dehydration, electrolyte disturbance and acid-base imbalance.
5,Resuming diet as soon as possible can shorten the course of the disease and improve the nutritional status of the child.
6,To prevent rotavirus infection, vaccination can be administered.