Contents

What is rota virus?

Complications

Epidemiology

Seasonality

Diagnosis

Therapy

Why vaccine against rota virus?

Rotarix

What is Rota virus????

Rotavirus is a virus that causes gastroenteritis, in particular in infants and young children .

Estimated that all children will become infected with rotavirus at least once by the time they are 5 years old .

Estimated that rotavirus causes around half of all gastroenteritis in children aged under 5 years

Incubation period The incubation period is approximately 2 days ,

Infectious period Shedding of the virus in faeces may begin before the onset of major symptoms and may continue for several days after symptoms have resolved ,

Rotavirus is found in the stool of infected. Rotavirus is easily spread by hand-to-mouth contact with stool from an infected person. Most children with rotavirus diarrhea recover on their own. Some children become very ill with severe vomiting, diarrhea, and life-threatening loss of fluids that requires hospitalization.

Structure

The genome of rotavirus consists of 11 unique double helix molecules of RNA which are 18,555 nucleotides in total.

Each helix, or segment, is a gene, numbered 1 to 11 by decreasing size. Each gene codes for one protein, except genes 9, which codes for two.[78] The RNA is surrounded by a three-layered icosahedral protein capsid. Viral particles are up to 76.5 nm in diameter[79][80] and are not enveloped.

Common Replication process

Enter cells by receptor mediated endocytosis and form a vesicle known as an endosome. Proteins in the third layer (VP7 and the VP4 spike) disrupt the membrane of the endosome, creating a difference in the calcium concentration.

This causes the breakdown of VP7trimers into single protein subunits, leaving the VP2 and VP6 protein coats around the viral dsRNA, forming a double-layered particle (DLP).

Eleven dsRNA strands remain within the protection of the two protein shells And the viral RNA-dependent RNA polymerase creates mRNA transcripts of the double-stranded viral genome. By remaining in the core, the viral RNA evades innate host immune responses called RNA interference that are triggered by the presence of double-stranded RNA.

During the infection, rotavirus produces mRNA for both protein biosynthesis and gene replication. Most of the rotavirus proteins accumulate in viroplasm, where the RNA is replicated and the DLPs are assembled. Viroplasm is formed around the cell nucleus as early as two hours after virus infection, and consists of viral factories thought to be made by two viral nonstructural proteins: NSP5 and NSP2.

The DLPs migrate t o the endoplasmic reticulum where they obtain their third, outer layer (formed by VP7 and VP4). The progeny viruses are released f rom the cell by lysis.

Rotavirus gastroenteritis

usually begins with the symptoms of

• Diarrhoea

• Vomiting

The child may also have

• A fever (high temperature) of

38ºC or above

• Abdominal pain

The symptoms of vomiting usually pass within 1 to 2 days. In most children, vomiting will not last longer than 3 days

The symptoms of diarrhoea usually pass within 5 to 7 days. Most children’s diarrhoea symptoms will not last longer than 2 weeks

Clinical presentation

Complications

Gastroenteritis can cause dehydration:

• This can be more serious than the rotavirus infection itself and can require hospitalisation for intravenous rehydration

• Approximately 12,700 children are estimated to be admitted to hospital each year with rotavirus in England and Wales

Transmission

Rotavirus is highly infectious

• As few as 10-100 virus particles may cause disease

Transmission mainly via the faecal-oral route

• If a child leaves tiny samples of infected faeces on surfaces or utensils e.g. after not washing their hands properly after going to the toilet, they can be picked up by another child

• Small droplets of infected faeces can also be carried in the air, which children can breathe in

Epidemiology of Rota virus in England

Seasonality of Rota virus infection

Recommendation from JCVI for rotavirus vaccine

• The Joint Committee on Vaccination and Immunisation (JCVI) is the UK’s independent panel of immunisation experts

• JCVI recommends that rotavirus vaccination should be given to infants at two and three months of age i.e. two doses

• Rotavirus vaccination should significantly reduce rotavirus gastroenteritis in young children

Why vaccine against Rota virus???

Effectiveness of the vaccine

• Very effective at protecting against the most common strains of rotavirus

• Very effective in protecting against severe rotavirus infection requiring hospitalisation

Use of Rotarix®

• From July 1st 2013, Rotarix® will be used for rotavirus immunisation programme

• Generic name: Rotavirus vaccine, live

• Rotarix® Marketed by GlaxoSmithKline

• Licensed from 6 weeks to 24 weeks

• Oral suspension in a prefilled oral applicator

• Container dimensions 42x24x133mm

Active ingredient

-Human rotavirus RIX4414 strain

-Live attenuated

-Not less than 106.0 CCID50

Excipients

-Sucrose

-Di-sodium Adipate

-Dulbecco’s Modified Eagle Medium

-Sterile water

Rota virus composition

• Prefilled oral applicator

• Oral suspension

• Each dose contains 1.5ml of clear colourless liquid

Rotarix® presentation

Rotarix® must be stored in accordance with manufacturer’s instructions

Cold chain must be maintained

• Store between +2°C and +8°C

• Store in original packaging

• Protect from light

Storage

2 dose schedule

• First dose of 1.5ml at 8 weeks (two months) of age

• Second dose of 1.5ml at least four weeks after the first (i.e. 12 week appointment)

• It is preferable that the full course of two doses is completed before 16 weeks of age. Rotarix® must be given no later than 24 weeks (i.e. 23 weeks and 6 days)

• The first dose must be given before 15 weeks of age. If infant does not have first dose before 15 weeks then do not give Rotarix®

• If the course is interrupted it should be resumed but not repeated, provided that the second dose can be given before 24 weeks

• If infant spits out/regurgitates most of dose, a replacement dose may be given at same visit

Dosage and schedule

DOSAGE

Rotarix is different from the other infant vaccines, as it is a LIVE ORAL vaccine and must not be injected

Rotarix® can be administered at the same time as other childhood vaccines

Administration of Rotarix

NEW DELHI: India will soon have a locally manufactured low cost rotavirus vaccine as part of the government's universal immunization programme (UIP). The vaccine is expected to be available at almost one-fifteenth of the current market price, a senior official, privy to developments, said.

"Bharat Biotech, which has been licensed for manufacturing of this vaccine, has already made 5-6 million doses. However, the requirement is much more to meet the UIP demand. The vaccine is likely to be launched in the market as well as in the UIP in 2015 itself," M K Bhan, founder chairman of the Biotechnology Industry Research Assistance Council and former secretary, department of biotechnology said. Bhan is currently national science professor at Indian Institute of Technology (IIT), Delhi and deeply associated with infant mortality.

According to Bhan, while the locally developed vaccine is almost ready to be launched, the company is waiting for a final approval from the Drugs Controller General of India for the manufacturing plant

REPORT ON VACCINE

RECENT RESEARCH

Recent research was on rotavirus infections and circulating strains in small ruminants. Recent years have seen an intensification of surveillance in humans and live stock animals where vaccines are available led to better understand the epidemiology ,ecology and evolution of RVA strains in other hosts, including lambs,goats and camelids.

on the otherhand there is no comprehensive review articleon exotic rotaviruses in domestic animals and birds.These exotic rota viruses are derived from RVA strains common to other host species ,possibly through interspecies transmission coupled with reassortment events.

• Confirmed anaphylactic reaction to a previous rotavirus vaccine

• Confirmed anaphylactic reaction to component of vaccine

• Previous history intussusception

• Over 24 weeks of age

• Infants presenting for their first dose of Rotarix® over 15 weeks of age

• Severe Combined Immunodeficiency (SCID) disorder

• Malformation of GI tract that could predispose to intussusception.

• Rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltoseinsufficiency.There are very few infants who cannot receive rotavirus vaccine

CONTRAINDICATIONS

PRECAUTIONS

• Potential transmission of live attenuated vaccine from infant

• Vaccination of the infant will offer protection to household contacts from wild-type rotavirus disease and outweigh any risk from transmission of vaccine virus to any immuno-compromised close contacts

Those in close contact with recently vaccinated infants should observe good personal hygiene.

RESOURCES

•Green Book Rotavirus chapter•Journal on virology•WHO •CDC

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