Rotavirus

Introduction .................................................................................................................................... 180 Classication and Host Range ....................................................................................................... 180 Epidemiology of Human Rotavirus Disease .................................................................................. 184 Seasonality ..................................................................................................................................... 184 Clinical Presentation ...................................................................................................................... 184 Diagnosis ........................................................................................................................................ 185 Pathogenesis ................................................................................................................................... 185 Treatment ....................................................................................................................................... 186 Transmission to Contacts ............................................................................................................... 186

Modes of Transmission ............................................................................................................. 186 Shedding of Rotavirus in Stool Facilitating Transmission ............................................................. 186 Rotavirus Disease in Adults ........................................................................................................... 187 Protection against Rotavirus Disease ............................................................................................. 187 Immune Response to Rotavirus Infection ...................................................................................... 187 Rotavirus Structure ........................................................................................................................ 188 Rotavirus Genome.......................................................................................................................... 189 Rotavirus Replication Cycle .......................................................................................................... 189 Genomic Diversity of Rotaviruses ................................................................................................. 190

Genetic Drift.............................................................................................................................. 190 Rearrangement .......................................................................................................................... 190 Recombination .......................................................................................................................... 191 Reassortment ............................................................................................................................. 191

Interspecies and Zoonotic Transmission ........................................................................................ 191 Rotavirus Outbreaks in Institutional Settings ................................................................................ 192 Community Settings....................................................................................................................... 192 Foodborne Transmission ................................................................................................................ 193 Transmission from Fresh Produce ................................................................................................. 193 Transmission from Prepared Food ................................................................................................. 193 Rotavirus Transmission from Seafood ........................................................................................... 194 Rotavirus Vaccines ......................................................................................................................... 194 Currently Licensed Vaccines .......................................................................................................... 195 RotaTeq® ........................................................................................................................................ 195 Rotarix® .......................................................................................................................................... 195 Other Candidate Vaccines .............................................................................................................. 196 Impact of Vaccine Introduction ...................................................................................................... 197

Burden of Disease ..................................................................................................................... 197 Age-Specic Incidence ............................................................................................................. 197 Herd Immunity .......................................................................................................................... 198 Seasonality ................................................................................................................................ 198 Intussusception in the Vaccine-Era............................................................................................ 198

References ...................................................................................................................................... 199

Diarrheal disease is the second most common cause of death in children under 5 years of age worldwide. Diarrheal disease is also responsible for an estimated 1.5 million deaths/year, accounting for almost 20% of mortality within that age group [1-3]. There are more than 20 different bacterial, viral, and parasitic pathogens that cause diarrheal disease and the proportion and range of pathogens can vary depending on the country [4]. Rotavirus, calicivirus, enteropathogenic, and enterotoxigenic Escherichia coli cause more than half of all diarrheal deaths in children under 5 years of age globally [5].