Where do they come from?
Rotavirus-induced gastroenteritis can also be transmitted via the aerosol route, for example during vomiting. In most cases of bacterial infections of the intestines are caused by zoonoses (infections naturally transmitted between animals and humans), and therefore it is important to mention to your GP any former contact you or your child may have had with animals. Children can easily catch infections from pets- puppies up to 6 months old can carry campylobacter bacteria, and both kittens and puppies can carry yersinia. Chickens are the most common carriers of campylobacter bacteria but are not affected by it themselves. Most cases of campylobacter infection are due to poor hygiene protocols during the processing of raw poultry, and therefore one can get infected from undercooked meat (especially common when barbecuing). Salmonella has most commonly been transmitted through raw eggs; however undercooked meat is also a common culprit.
The incubation period for gastro-intestinal infections ranges from several hours to days. The most common manifestation in children is acute gastroenteritis with vomiting, abdominal pain and loose stools. The most common rotavirus gastroenteritis usually comes on as a fever (38–40 °C) and vomiting, and is then followed by sparse, watery stools with frequent bowel movements. A typical symptom is a painful stomach. Noroviruses are characterised by vomiting, abdominal pain, but a high fever is not common.
Fluids are the key
The first line of treatment that doctors recommend is fluids, as one of the main complications associated with acute diarrhea, especially in infants and toddlers, is severe dehydration and therefore a sufficient amount of fluids is necessary to rehydrate. Rotavirus infections cause dehydration most commonly. Doctors usually emphasise, that most childhood acute diarrhea can be treated and controlled by giving the child black tea, unflavoured mineral water, or oral rehydration solution. The amount of fluid depends on the age of the child - a general guide for infants: 150ml / kg / day, for toddlers:100-120ml / kg / day and decreases further with age. For more severe dehydration (severe loss of fluid leading to a 10% weight), rehydration via an infusion may be necessary.
Breast milk, rice and carrots
The re-introduction of solid food or “refeeding” strategy depends on the child’s age. Infants who are solely breastfed should continue to be fed as before. Infants until the age of 6 months can be given mushy rice. From 6 months of age and onwards, softly mashed carrots can be added to the rice. For infants that are formula fed, the milk should be prepared in the same way as before the infection. If the child suffered a Rotavirus infection, it is advisable to temporarily switch to a low lactose formula, as the virus may have damaged the lactase enzymes, and therefore lactose is poorly digested. Older infants can be given a choice of white bread rolls, mashed bananas, rice pudding, vegetable soup, mashed potato or grated apple. A similar diet with the addition of reduced- fat dairy products is recommended for older children and adults.
If medication is necessary, doctors recommend pathogen-trapping medication such as activated charcoal or diosmectite and probiotics (especially lactobacilli 8,9,10,11,12). From the selection of products available on the market, it is important to choose one with a large number and variety of living bacteria. Experts also see positive results with the yeast Saccharomyces boulardii. More recently, the racecadotril antisecretory drug has become more widely used, whereas controversially, anti-diarrheal medicines are highly inappropriate for children. Antibiotics are only administered in children with a severe course of bacterial diarrhea, especially salmonellosis, and less frequently in campylobacteriosis. However, as the experts emphasise, antibiotics should only be given in the indicated cases and should not be given blindly due to the possibility of side effects or the emergence of post antibiotic colitis.
Preventative measures have been taken
Children have been regularly vaccinated against rotavirus infections since 2006. There are two vaccines recommended by European pediatric companies and WHO on the market: pentavalent and monovalent vaccines. Both vaccines are given orally, are well tolerated and have minimal side effects. The first dose must be given between 6 and 12 week of life, and the vaccination course must be completed by 24 weeks, or 32 weeks of life.