Conclusionssummary

The Revised Authoritative Guide To Vaccine Legal Exemptions

Vaccines Have Serious Side Effects

Get Instant Access

Viral diarrhea still represents a major threat to childhood health, worldwide. It has an immense, but distinct, impact in poor and rich countries, being responsible for a substantial number of deaths in the former and of heavy money loss in the latter. Rotavirus is the leading agent and its pathophysiology involves multiple mechanisms, several of which are triggered by NSP4 entero-toxin. Diarrhea is the hallmark of viral diarrhea and is usually self-limiting. However, it may run a severe course and have a fatal outcome in children with malnutrition or immune impairment and in those who have no access to rehydration. Diagnosis is usually based on clinical grounds, and investigations are not necessary. Treatment is based on carbohydrate and electrolyte solution administered through the oral or parenteral route. Selected probiotics may be effective in reducing the duration of symptoms, whereas, in severe cases in which rotavirus is involved, oral administration of human serum immunoglobulin may be effective. Efforts towards vaccine development have been hampered by withdrawal of anti-rotavirus vaccine, because of its association with intussusception, but novel vaccines are currently under investigation.

REFERENCES

  1. Taterka JA, Cuff CF, Rubin DH. Viral gastrointestinal infections. Gastroenterol Clin North Am 1992; 21: 303-330.
  2. Kosek M, Bern C, Guerrant RL. The magnitude of the global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 2003; 81:197-204.
  3. Glass RI, Bresee J, Jiang B et al. Gastroenteritis viruses: an overview. Novartis Found Symp 2001; 238: 5-25.
  4. Zimmermann CM, Bresee JS, Parashar UD et al. Cost of diarrhea-associated hospitalizations and outpatient visits in an insured population of young children in the United States. Pediatr Infect Dis J 2001; 20: 14-19.
  5. Fruhwirth M, Karmaus W, Moll-Schuler I et al. A prospective evaluation of community acquired gastroenteritis in paediatric practices: impact and disease burden of rotavirus infection. Arch Dis Child 2001; 84: 393-397.
  6. de Wit MAS, Koopmans MPG, van der Blij JF et al. Hospital admission for rotavirus in the Netherlands. Clin Infect Dis 2000; 31: 698-704.
  7. Avendano P, Matson DO, Long J et al. Costs associated with office visits for diarrhea in infants and toddlers. Pediatr Infect Dis J 1993; 12: 897-902.
  8. Berni Canani R, Cirillo P, Mallardo G et al. Effects of HIV-1 Tat protein on ion secretion and on cell proliferation in human intestinal epithelial cells. Gastroenterology 2003; 124: 368-376.
  9. Ciarlet M, Estes MK. Human and most animal rotavirus strains do not require the presence of sialic acid on the cell surface for efficient infectivity. J Gen Virol 1999; 80: 943-948.
  10. Ciarlet M, Crawford SE, Estes MK. Asymmetric infection of epithelial cell lines of sialic-acid-dependent rotaviruses. Gastroenterology 2000; 118: A101.
  11. Reynolds D, Hall G, Debney T et al. Pathology of natural rotavirus infection in clinically normal calves. Res Vet Sci 1985; 38: 264-269.
  12. Collins J, Benfield D, Duimstra J. Comparative virulence of two porcine group A rotavirus isolates in gnotobiotic pigs. Am J Vet Res 1989; 50: 827-835.
  13. Osborne MP, Haddon SJ, Worton KJ et al. Rotavirus-induced changes in microcirculation of intestinal villi of neonatal mice in relation to the induction and persistence of diarrhea. J Pediatr Gastroenterol Nutr 1991; 12: 111-120.
  14. Lundgren O, Timar Peregrin A, Persson K et al. Role of the enteric nervous system in the fluid and electrolyte secretion of rotavirus diarrhea. Science 2000; 287: 491-495.
  15. Ruiz MC, Cohen J, Michelangeli F. Role of Ca2+ in the replication and pathogenesis of rotavirus and other viral infections. Cell Calcium 2000; 28: 137-149.
  16. Obert G, Peiffer I, Servin AL. Rotavirus-induced structural and functional alterations in tight junctions of polarized intestinal Caco-2 cell monolayers. J Virol 2000; 74: 4645-4651.
  17. Brunet JP, Cotte-Laffitte J, Linxe C et al. Rotavirus infection induces an increase in intracellular calcium concentration in human intestinal epithelial cells: role in microvillar actin alteration. J Virol 2000; 74: 2323-2332.
  18. Guarino A, Casola A, Bruzzese E et al. Human serum immunoglobulin counteracts rotaviral infection in Caco-2 cells. Pediatr Res 1996; 40: 881-887.
  19. Ball JM, Tiam P, Zeng CQ-Y et al. Age-dependent diarrhoea is induced by a viral nonstructural glycoprotein. Science 1996; 272: 101-104.
  20. Zhang M, Zeng CQ-Y, Morris AP et al. A functional NSP4 enterotoxin peptide secreted from rotavirus infected cells. J Virol 2000; 74: 11663-11670.
  21. Au KS, Chan WK, Burns JW et al. Receptor activity of rotavirus nonstructural glycoprotein NS28. J Virol 1989; 63: 4553-4562.
  22. Meyer JC, Bergmann CC, Bellamy AR. Interaction of rotavirus cores with nonstructural glycoprotein NS28. Virology 1989; 171: 98-107.
  23. Taylor JA, O'Brien JA, Lord VJ et al. The RER-localized rotavirus intracellular receptor: a truncated purified soluble form is multivalent and binds virus particles. Virology 1993; 194: 807-814.
  24. Bergmann CC, Maass D, Poruchynsky MS et al. Topology of the non-structural rotavirus receptor glyco-protein NS28 in the rough endoplasmic reticulum. EMBO J 1989; 8: 1695-1703.
  25. Tian P, Hu Y, Schilling WP et al. The nonstructural glycoprotein of rotavirus affects intracellular calcium levels. J Virol 1994; 68: 251-257.
  26. Tian P, Estes MK, Hu Y et al. The rotavirus nonstructural glycoprotein NSP4 mobilizes Ca2+ from the endoplasmic reticulum. J Virol 1995; 69: 5763-5772.
  27. Newton K, Meyer JC, Bellamy AR et al. Rotavirus nonstructural glycoprotein NSP4 alters plasma membrane permeability in mammalian cells. J Virol 1997; 71: 9458-9465.
  28. Richardson SC, Grimwood K, Bishop RF. Analysis of homotypic and heterotypic serum immune responses to rotavirus proteins following primary rotavirus infection by using the radioimmunoprecipitation technique. J Clin Microbiol 1993; 31: 377-385.
  29. Johansen K, Hinkula J, Espinoza F et al. Humoral and cell-mediated immune responses to the NSP4 entero-toxin of rotavirus. J Med Virol 1999; 59: 369-377.
  30. Estes MK, Morris AP. A viral enterotoxin. A new mechanism of virus-induced pathogenesis. Adv Exp Med Biol 1999; 473: 73-82.
  31. Salim AF, Phillips AD, Walker-Smith JA et al. Sequential changes in small structure and function during rotavirus infection in neonatal rats. Gut 1996; 36: 231-238.
  32. Ciarlet M, Estes MK. Rotaviruses and calicivirus infections of the gastrointestinal tract. Curr Opin Gastroenterol 2001; 17: 10-16.
  33. Halaihel N, Lievin V, Alvarado F et al. Rotavirus infection impairs intestinal brush-border membrane Na+-solute cotransport activities in young rabbits. Am J Physiol Gastrointest Liver Physiol 2000; 279: G587-G596.
  34. Casola A, Estes MK, Crawford SE et al. Rotavirus infection of cultured intestinal epithelial cells induces secretion of CXC and CC chemokines. Gastroenterology 1998; 114: 947-955.
  35. Rollo EE, Kumar KP, Reich NC et al. The epithelial cell response to rotavirus infection. J Immunol 1999; 163: 4442-4452.
  36. Guarino A, Spagnuolo MI, Russo S et al. Etiology and risk factors of severe and protracted diarrhea. J Pediatr Gastroenterol Nutr 1995; 20: 173-178.
  37. de Wit MAS, Koopmans MPG, Kortbeek LM et al. Etiology of gastroenteritis in sentinel general practices in the Netherlands. Clin Infect Dis 2001; 33: 280-288.
  38. Pang XL, Honma S, Nakata S et al. Human caliciviruses in acute gastroenteritis of young children in the community. J Infect Dis 2000; 181: S288-S294.
  39. Capano G, Guandalini S, Guarino A et al. Enteric infections, cow's milk protein intolerance and parenteral infections in 118 consecutive cases of acute diarrhea in children. Eur J Pediatr 1984; 142: 281-285.
  40. Bishop RF, Davidson GP, Holmes IH et al. Virus particles in epithelial cells of duodenal mucosa from children with viral gastroenteritis. Lancet 1973; 2: 1281-1283.
  41. Parashar UD, Hummelmann E, Brese JS et al. Global illness and deaths caused by Rotavirus disease in children. Emerg Infect Dis 2003; 9: 565-572.
  42. Glass RI, Kilgore PE, Holman RC et al. The epidemiology of rotavirus diarrhea in the United States: surveillance and estimates of disease burden. J Infect Dis 1996; 174: S5-11.
  43. Ho MS, Glass RI, Pinsky PF et al. Rotavirus as a cause of diarrheal morbidity and mortality in the United States. J Infect Dis 1988; 158: 1112-1116.
  44. Velasquez FR, Matson DO, Calva JJ et al. Rotavirus infection in infants as protection against subsequent infections. N Engl J Med 1996; 335: 1022-1028.
  45. Prince DS, Astry C, Vonderfecht S et al. Aerosol transmission of experimental rotavirus infection. Pediatr Infect Dis 1986; 5: 218-222.
  46. Bishop RF. Natural history of rotavirus infection. In AZ Kapikian, ed. Viral Infections of the Gastrointestinal Tract, 2nd edn. New York: Marcel Dekker, 1994; 131-167.
  47. Gentsch JR, Woods PA, Ramachandran M et al. Review of G and P typing results from a global collection of rotavirus strains: implications for vaccine development. J Infect Dis 1996; 174: S30-S36.
  48. Nakata S, Gatheru Z, Ukae S et al. Epidemiological study of the G serotype distribution of group A rotaviruses in Kenya from 1991 to 1994. J Med Virol 1999; 58: 296-303.
  49. Unicomb LE, Podder JR, Gentsch PA et al. Evidence of high-frequency genomic reassortment of group A rotavirus strains in Bangladesh: emergence of type G9 in 1995. J Clin Microbiol 1999; 37: 1885-1891.
  50. Santos N, Lima RCC, Pereira CFA et al. Detection of rotavirus types G8 and G10 among Brazilian children with diarrhea. J Clin Microbiol 1998; 36: 2727-2729.
  51. Aijas S, Gowda K, Jagannath HV et al. Epidemiology of symptomatic human rotaviruses in Bangladore and Mysore, India from 1988 to 1994 as determined by elec-tropherotype, subgroup and serotype analysis. Arch Virol 1996; 141: 715-726.
  52. Ramachandran M, Gentsch JR, Parashar UD et al. Detection and characterization of novel rotavirus strains in the United States. J Clin Microbiol 1998; 36: 3223-3229.
  53. Gouvea V, Santos N. Rotavirus serotype G5: an emerging cause of epidemic childhood diarrhea. Vaccine 1999; 17: 1291-1292.
  54. Cascio A, Vizzi E, Alaimo C et al. Rotavirus gastroenteritis in Italian children: can severity of symptoms be related to the infecting virus? Clin Infect Dis 2001; 32: 1126-1132.
  55. Madeley CR, Cosgrove BP. Virus in infantile gastroenteritis. Lancet 1975; 2: 451-452.
  56. Glass RI, Noel J, Mitchell D et al. The changing epidemiology of astrovirus-associated gastroenteritis: a review. Arch Virol Suppl 1996; 12: 287-300.
  57. Unicomb LE, Banu NN, Azim T et al. Astrovirus infection in association with acute, persistent and nosocomial diarrhea in Bangladesh. Pediatr Infect Dis J 1998; 17: 611-614.
  58. Mitchell DK, Monroe SS, Jiang X et al. Virologic features of an astrovirus diarrhea outbreak in a day care center revealed by reverse transcriptase-polymerase chain reaction. J Infect Dis 1995; 172: 1437-1444.
  59. Grohmann GS, Glass RI, Pereira HG et al. Enteric viruses and diarrhea in HIV-infected patients. Enteric Opportunistic Infections Working Group. N Engl J Med 1993; 329: 14-20.
  60. Cox GJ, Matsui SM, Lo RS et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology 1994; 107: 1398-1407.
  61. Cubitt WD, Mitchell DK, Carter MJ et al. Applications of electronmicroscopy, enzyme immunoassay, a RT-PCR to monitor an outbreak of astrovirus type 1 in a paediatric bone marrow transplant unit. J Med Virol 1999; 57: 313-321.
  62. Wyatt RG, Dolin R, Blacklow NR et al. Comparison of three agents of acute infectious nonbacterial gastroenteritis by cross-challenge in volunteers. J Infect Dis 1974; 129: 709-714.
  63. Monroe SS, Jiang B, Stine SE et al. Subgenomic RNA sequence of human astrovirus supports classification of Astroviridae as a new family of RNA viruses. J Virol 1993; 67: 3611-3614.
  64. Adler JL, Zickl R. Winter vomiting disease. J Infect Dis 1969; 119: 668-673.
  65. Kapikian AZ, Wyatt RG, Dolin R et al. Visualization by immune electron microscopy of a 27nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol 1972; 10: 1075-1081.
  66. Madeley CR, Cosgrove BP. 28 nm particles in faeces in infantile gastroenteritis. Lancet 1975; 2: 451-452.
  67. Chiba S, Sakuma Y, Kogasaka R et al. An outbreak of gastroenteritis associated with calicivirus in an infant home. J Med Virol 1979; 4: 249-254.
  68. Fankhauser RI, Noel JS, Monroe SS et al. Molecular epidemiology of 'Norwalk-like viruses' in outbreaks of gastroenteritis in the United States. J Infect Dis 1998; 178: 1571-1578.
  69. Lopman BA, Reacher MH, van Duijnhoven Y et al. Viral gastroenteritis outbreaks in Europe, 1995-2000. Emerg Infect Dis 2003; 9: 90-96.
  70. Brown DWG. The pattern and burden of disease due to human calicivirus infections in the UK (abstract S1-2). In Proceedings of the International Workshop on Human Caliciviruses, Atlanta GA, 29-31 March 1999. Atlanta: Centers for Disease Control and Prevention,1999.
  71. Sawyer LA, Murphy JJ, Kaplan JE et al. 25 to 30 nm virus particle associated with a hospital outbreak of acute gastroenteritis with evidence for airborne transmission. Am J Epidemiol 1988; 127: 1261-1271.
  72. Mounts AW, Ando T, Koopmans M et al. Cold weather seasonality of gastroenteritis associated with Norwalk-like viruses. J Infect Dis 2000; 181: S284-S287.
  73. Jiang Xi, Pickering LK. Update on caliciviruses and human acute gastroenteritis. Pediatr Infect Dis J 2002; 21: 1069-1070.
  74. Zahorsky J. Hyperemesis hiemis or the winter vomiting disease. Arch Pediatr 1929; 46: 391.
  75. Green J, Vinje J, Gallimore CI et al. Capsid protein diversity among Norwalk-like viruses. Virus Genes 2000; 20: 227-236.
  76. Favier AL, Schoehn G, Jaquinod M et al. Structural studies of human enteric adenovirus type 41. Virology 2002; 293: 75-85.
  77. Kotloff KL, Losonsky GA, Morris JG et al. Enteric aden-ovirus infection and childhood diarrhea: an epidemio-logic study in three clinical settings. Pediatrics 1989; 84: 219-225.
  78. Soares CC, Volotao EM, Albuquerque MC et al. Prevalence of enteric adenoviruses among children with diarrhea in four Brazilian cities. J Clin Virol 2002; 23: 171-177.
  79. Waters V, Ford-Jones EL, Petric M et al. Etiology of community-acquired pediatric viral diarrhea: a prospective longitudinal study in hospitals, emergency departments, pediatric practices and child care centers during the winter rotavirus outbreak, 1997 to 1998. The Pediatric Rotavirus Epidemiology Study for Immunization Study Group. Pediatr Infect Dis J 2000; 19: 843-848.
  80. Weiss M, Horzinek MC. The proposed family, Toroviridae: agents of enteric infections. Arch Virol 1987; 92: 1-15.
  81. Woode GN, Reed DE, Runnels PL et al. Studies with an unclassified virus isolated from diarrheic calves. Vet Microbiol 1982; 7: 221-240.
  82. Woode GN, Saif LJ, Quesanda M et al. Comparative studies on three isolates of Breda virus of calves. Am J Vet Pies 1985; 46: 1003-1010.
  83. Beards GM, Green J, Hall C et al. An enveloped virus in stools of children and adults with gastroenteritis resembles the Breda virus of calves. Lancet 1984; 1: 1050-1052.
  84. Snijder E, Horzinek MC. Toroviruses: replication, evolution and comparison with other members of the coron-avirus-like family. J Gen Virol 1993; 74: 2305-2316.
  85. Cavanagh D, Horzinek M. Genus Torovirus assigned to the Coronaviridae. Arch Virol 1993; 128: 395-396.
  86. Cavanaugh D. Nidovirales: a new order comprising Coronaviridae and Arteriviridae. Arch Virol 1997; 142: 629-633.
  87. Jamieson FB, Wang EEL, Bain C et al. Human Torovirus: a new nosocomial gastrointestinal pathogen. J Infect Dis 1998; 178: 1263-1269.
  88. Yamashita T, Kobayashi S, Sakae K et al. Isolation of cytophathic small round viruses with BS-C-1 cells from patient with gastroenteritis. J Infect Dis 1991; 164: 954-957.
  89. Yamashita T, Sakae K, Tsuzuki H et al. Complete nucleotide sequence and genetic organization of Aichi virus, a distinct member of Picornaviridae associated with acute gastroenteritis in humans. J Virol 1998; 72: 8408-8412.
  90. King AMQ, Brown F, Christian P et al. Picornaviridae. In van Regenmortel MHV, Fauquet CM, Bishop DHL, et al., eds. Virus Taxonomy: Seventh Report of the International Committee on Taxonomy of Viruses. San Diego: Academy Press, 2000: 657-678.
  91. King AMQ, Brown F, Christian P et al. Picornavirus taxonomy: a modified species definition and proposal for three new genera. XIth International Congress of Virology, Sidney, Australia, 1999.
  92. Yamashita T, Ito M, Tsuzuki H et al. Identification of Aichi virus infection by measurement of immunoglobu-

lin responses in a enzyme linked immunosorbent assay. J Clin Microbiol 2001; 39: 4178-4180.

  1. Stohr K. A multicentre collaboration to investigate the cause of severe acute respiratory syndrome. Lancet 2003; 361: 1730-1733.
  2. Chandra R. Picobirnavirus, a novel group of unde-scribed viruses of mammals and birds: a minireview. Acta Virol 1997; 41: 59-62.
  3. Guarino A, Albano F, Guandalini S et al. Oral rehydration solution: toward a real solution. J Pediatr Gastroenterol Nutr 2001; 33: S2-S12.
  4. Guarino A, Albano F. Guidelines for the approach to outpatient children with acute diarrhoea. Acta Paediatr 2001; 90: 1087-1095.
  5. Guarino A, Berni Canani R, Russo S. Developments in the treatment of rotaviral gastroenteritis: oral therapy with immunoglobulins and prospects for a vaccine. Clin Immunother 1995; 3: 476-484.
  6. Guarino A, Guandalini S, Albano F et al. Enteral immunoglobulin for treatment of protracted Rotaviral diarrhea. Pediatr Infect Dis J 1991; 10: 612-614.
  7. Guarino A, Berni Canani R, Russo S et al. Oral immunoglobulins for treatment of acute rotaviral gastroenteritis. Pediatrics 1994; 93: 12-16.
  8. Guarino A, Russo S, Castaldo A et al. Passive immunotherapy for Rotavirus-induced diarrhoea in children with HIV infection. AIDS 1996; 10: 1176-1178.
  9. Guarino A, Albano F, Berni Canani R et al. HIV, fatal rotavirus infection, and treatment options. Lancet 2002; 359: 74.
  10. De Marco G, Bruzzese E, Di Nardo G et al. Rotavirus induces a galanin-dependent chloride secretion which is inhibited by human immunoglobulin in a Caco-2 experimental model. J Pediatr Gastroenterol Nutr 2003; 36: 521(abstr).
  11. De Zoysa I, Feachem RG. Interventions for the control of diarrhoeal disease among young children: rotavirus and cholera immunization. Bull World Health Organ 1985; 62: 569-583.
  12. Rennels MB. The rotavirus vaccine story: a clinical investigator's view. Pediatrics 2000; 106: 123-125.
  13. Cunliffe NA, Bresee JS, Hart CA. Rotavirus vaccines: development, current issues and future prospects. J Infect 2002; 45: 1-9.
  14. Ball JM, Graham DY, Opekun AR et al. Recombinant Norwalk-like particles given orally to volunteers: phase I study. Gastroenterology 1999; 1117: 40-48.
  15. Mason H, Ball JM, Shi J et al. Expression of Norwalk virus capsid protein in transgenic tobacco and potato and its oral immunogenicity in mice. Proc Nat Acad Sci USA 1996; 93: 5335-5340.
  16. Tacket C, Mason H, Losonsky G et al. Human immune responses to a novel Norwalk virus vaccine delivered in transgenic potatoes. J Infect Dis 2000; 182: 302-305.

Was this article helpful?

0 0
Living Gluten Free

Living Gluten Free

A beginners guide that will reveal how living "G" free can help you lose weight today! This is not a fad diet, or short term weight loss program that sometimes makes you worse off than before you started. This is a necessity for some people and is prescribed to 1 out of every 100 people on earth by doctors and health professionals.

Get My Free Ebook


Post a comment