A Nasty Bug
Wendy Singer-Lowry will never forget how dramatically her 11-month-old's behavior changed that day. One moment, Jacob was full of energy and starting to cruise around the house, and the next, he was lying perfectly still, barely moving his eyelids. Before long, he spiked a fever, began vomiting, and had continual diarrhea. "It had the most foul, distinctive smell," says Singer-Lowry, of Gladwyne, Pennsylvania. "He got dehydrated so quickly, and lost almost a pound in two days." Fortunately, Jacob recovered, but not before a trip to the pediatrician, a late-night visit to the emergency room, and three days of intensive home care. "We fed him one teaspoon of liquid every five minutes all day," says Singer-Lowry.
Jacob was struck by rotavirus, a virulent stomach bug that's actually the second most common cause (after asthma) of hospitalization in young children. Although most parents have never even heard of it, rotavirus is responsible for more than half a million doctor's visits, more than 200,000 trips to the emergency room, and 20 to 60 deaths in children under age 5 in the U.S. each year. It's so pervasive -- not only in this country, but worldwide, where it kills about 600,000 children annually -- that doctors had been trying to develop a vaccine to prevent it for more than 25 years.
Until now, almost all kids got a bout of rotavirus by age 5. Babies and toddlers are most vulnerable because the hallmarks of the infection -- fever, vomiting, and diarrhea -- can last for a week and cause severe dehydration in just a few hours, says Penelope Dennehy, MD, professor of pediatrics at Brown Medical School, in Providence. The only treatment is rehydration therapy.
The very good news: Not only is there a new vaccine, but it's injection-free. RotaTeq is an oral vaccine that will be given to infants at 2, 4, and 6 months. (Babies need to get the first dose by 12 weeks and all three doses by 32 weeks.) In fact, once children start getting the vaccine routinely, doctors expect that severe cases of rotavirus will virtually disappear in the U.S.
A Safe Solution
RotaTeq is actually the second rotavirus vaccine. The first one was pulled off the market in 1999 after it was linked to intussusception, a rare type of bowel obstruction. Because of these concerns, RotaTeq was tested extensively -- in nearly 35,000 babies in 11 countries -- before it was approved. The results, published last year in The New England Journal of Medicine, found that RotaTeq reduced ER visits and hospitalizations due to rotavirus by 94 percent. "This is a very safe vaccine," says Paul Offit, MD, chief of infectious diseases at Children's Hospital of Philadelphia, who developed RotaTeq with two other researchers. "It didn't cause serious side effects in any of the children we studied."
Certainly, the fact that this vaccine doesn't involve a shot will make things easier for parents. Oral vaccines work by eliciting an immune response directly in the intestines, which is important for a bug like rotavirus, which enters the body through the mouth, rather than the lungs (like measles or mumps), explains Dr. Dennehy, who helped test the vaccine. While stomach acid can break down many substances, rotavirus isn't one of them. "It's a pretty hardy virus," says Dr. Offit.
Some babies who've been vaccinated may still catch the virus, but they'll have much milder symptoms. Similarly, toddlers and preschoolers, who are too old to get the vaccine, are unlikely to have a severe case because they've probably already been exposed to rotavirus -- which has only a few variations -- at least once, says Nathan Litman, MD, director of pediatrics and pediatric infectious diseases at the Children's Hospital at Montefiore, in New York City.
Take Treatment Seriously
Although rotavirus causes only 5 to 10 percent of cases of so-called stomach flu, it usually makes children sicker than other bugs do. If your child has diarrhea and is vomiting, give her frequent sips of a pediatric electrolyte solution. If she has symptoms of dehydration -- a dry mouth, sunken eyes, dry diapers, no tears when crying -- call your doctor. Go to the ER if your child is lethargic, listless, or unable to keep any liquid down. She'll probably need IV fluids.
Although no medicine has been approved to treat rotavirus, a recent study found that the drug nitazoxanide may shorten the duration of the illness in young children. Nitazoxanide is currently approved to treat two diarrheal infections that are commonly contracted when swimming in contaminated lakes and streams. Larger studies would have to confirm its safety and effectiveness before it could be approved for rotavirus.
Despite the potential severity of rotavirus, Dr. Offit knows there will still be some parents who'll choose not to vaccinate their children. "If you consider the numbers -- 100 percent of children will be infected by age 5 -- you might change your mind," he says. "With other vaccines, you might wonder whether your child could ever catch the illness, but with rotavirus, he'll definitely get the infection."
Is It Rotavirus?
Many pediatricians don't test for rotavirus, simply because the treatment -- except in severe cases -- is the same as it is for other tummy bugs (many of which are grouped under the name norovirus). Remember that "stomach flu" is not the same as the flu or influenza. Stomach flu affects the gastrointestinal tract, while influenza primarily affects the respiratory system.
- Symptoms: Fever, vomiting, diarrhea (usually foul-smelling), abdominal pain, dehydration
- Treatment: Plenty of electrolyte fluids; in severe cases, may require IV fluids
- Duration: 3 to 8 days
- Peak Season: November through April
- Vaccine: Oral vaccine recommended for infants at 2, 4, and 6 months
- Symptoms: Nausea, vomiting, diarrhea, stomach cramps
- Treatment: Electrolyte fluids
- Duration: 1 to 3 days
- Peak Season: October through April
- Vaccine: None available
- Symptoms: Fever, dry cough, sore throat, muscle aches; in children, may cause occasional vomiting or diarrhea
- Treatment: Plenty of fluids, rest, acetaminophen or ibuprofen
- Duration: 7 to 10 days
- Peak Season: December through March
- Vaccine: Annual vaccine recommended for all children between ages 6 months and 5 years, and older children with asthma and other chronic conditions