A few weeks ago the Department of Health announced that from September 2013 all babies under four months of age will be offered a vaccination against rotavirus, a common cause of diarrhoea and vomiting in infants and young children. The notorious norovirus or ‘winter vomiting bug’ also causes diarrhoea and vomiting. In this article we will examine the similarities and differences between the two viruses, the symptoms they produce and ways of managing them.
While the symptoms of both infections are similar, the groups of people affected are different. Norovirus can affect a person of any age while Rotavirus most commonly affects children under five years of age. The norovirus is actually a group of viruses which are the main cause of gastroenteritis in the UK. Figures released by the Health Protection Agency show that an estimated 666,144 have fallen ill with the norovirus this winter. Although not generally serious, it can be extremely debilitating for the very young, the very old and those whose immune system is already compromised. It is more common in the winter – hence its informal name - but infection can occur all year round. It is notorious for spreading rapidly round hospitals and schools as it is highly contagious. As the norovirus changes rapidly, a person can be affected many times as it is difficult to build up immunity.
Rotavirus causes about 450,000 infant deaths worldwide a year although they are rare in the UK. However it is estimated that in this country it results in 140,000 cases of gastroenteritis a year in infants and children under five, and of these, 14,000 need to be hospitalised as they become so ill. It is thought that by the age of five every child has had a least one bout of this illness. After that most people have acquired immunity and it is no longer a problem.
The symptoms of both conditions may include vomiting, diarrhoea, fever, abdominal pain, headache and painful muscles. The severity of the illnesses varies from person to person. The National Institute of Allergy and Infectious Diseases (NIAID) in the USA is supporting research into why some people suffer more with norovirus than others by studying the genetic make-up of sufferers. The danger in both illnesses is dehydration, which is easily treated when mild, but, if severe, can lead to seizures and death.
While both conditions are very contagious, there are some slight differences in the way that they are transmitted. Both can be transmitted by direct contact with an infected person and touching surfaces where the virus is present, but while exposure to contaminated food or fluid is a common source of infection with the norovirus, it is rarer with the rotavirus.
This leads on to how to prevent the spread of these unpleasant conditions. Personal hygiene is essential. Washing of hands with soap and water is an effective measure in stopping contamination, especially if done after contact with an infected person, their bedding, crockery etc, after using the toilet and before eating and drinking. Avoid sharing towels and launder bedding on a hot wash. Surfaces should be kept clean and a bleach based product can be useful. Someone who has been ill should avoid going to work or school until they have had no diarrhoea or vomiting for 48 hours.
Once someone has symptoms the main treatment is to keep hydrated. Regular drinks of water or squash are good – an adult normally requires about seven glasses of fluids a day so more will be needed if they have diarrhoea. Foods that are easily digested should be favoured and paracetamol can be taken to reduce fever and aches and pains. Infants should be given their normal feeds although extra water may needed as well. Special rehydration sachets can be bought from chemists and added to water to provide salts and sugars if needed. If treating children the correct sachets for that age should be used. If a baby, toddler, elderly person or someone already weakened by illness, becomes very dehydrated they will need intravenous fluids in hospital.
Other than these basic treatment measures there is no other remedy for the norovirus. However, as mentioned in the introduction, there is a vaccination for the rotavirus. This has been used routinely in the USA since 2006 and admissions to hospitals for rotavirus related illnesses have decreased by two thirds since then. In this country the plan is to offer the vaccine as oral drops at two months and again at four months to all babies from September 2013. While most people see the avoidance of this infection in infants as a good thing, some people are concerned that it will mean that people will not build up their own immunity. However, countries like the States which have already introduced the vaccine, report positive feedback. A Finnish study looked at whether the vaccine for rotavirus offered any protection against norovirus, and came to the conclusion that it did not.
To summarise, from September next year, rotavirus should no longer cause the current number of vomiting and diarrhoea outbreaks in young children, but norovirus outbreaks will continue to affect all ages. This means that we all need to continue with taking preventative measures such as washing hands and generally looking after our health.