Rotavirus infection

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Rotavirus infections are a leading cause of severe, dehydrating gastroenteritis in children <5 years of age. Despite the global introduction of vaccinations for rotavirus over a decade ago, rotavirus infections still result in >200,000 deaths annually, mostly in low-income countries. Rotavirus primarily infects enterocytes and induces diarrhoea through the destruction of absorptive enterocytes (leading to malabsorption), intestinal secretion stimulated by rotavirus non-structural protein 4 and activation of the enteric nervous system. In addition, rotavirus infections can lead to antigenaemia (which is associated with more severe manifestations of acute gastroenteritis) and viraemia, and rotavirus can replicate in systemic sites, although this is limited. Reinfections with rotavirus are common throughout life, although the disease severity is reduced with repeat infections. The immune correlates of protection against rotavirus reinfection and recovery from infection are poorly understood, although rotavirus-specific immunoglobulin A has a role in both aspects. The management of rotavirus infection focuses on the prevention and treatment of dehydration, although the use of antiviral and anti-emetic drugs can be indicated in some cases.

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Figure 1: Rotavirus structure.
Figure 2: Rotavirus-associated mortality in children <5 years of age in 2013.
Figure 3: The number of rotavirus-positive tests in the United States before and after vaccine introduction.
Figure 4: The rotavirus replication cycle.
Figure 5: Duodenum histology of mice with rotavirus infection.
Figure 6: Schematic model of rotavirus-induced diarrhoea and vomiting.
Figure 7: Rotavirus-mediated inhibition of interferon induction and amplification.


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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention (CDC).

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Introduction (S.E.C. and S.R.); Epidemiology (J.E.T. and U.D.P.); Mechanisms/pathophysiology (L.S. and M.H.); Diagnosis, screening and prevention (M.A.F. and H.B.G.); Management (M.O.); Quality of life (G.K.); Outlook (U.D. and M.K.E.); Overview of Primer (S.E.C., S.R. and M.K.E.).

Correspondence to Mary K. Estes.

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Crawford, S., Ramani, S., Tate, J. et al. Rotavirus infection. Nat Rev Dis Primers 3, 17083 (2017) doi:10.1038/nrdp.2017.83

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