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Appendix O
PROSPECTS FOR IMMUNIZING AGAINST ROTAVIRUS

Disease Description

Rotavirus infection causes an acute diarrheal disease. In developed countries it is usually of mild to moderate severity and self-limited within a week (rotavirus illness in technologically less developed countries will be considered separately in the second phase of this study). Typical clinical features have been determined primarily by observing patients affected severely enough to require admission to the hospital; most cases are so mild that medical attention is either not obtained or is handled on an outpatient basis.

In young infants, the illness often begins with vomiting, followed by an explosive, watery diarrhea. Diarrhea usually lasts twice as long as the vomiting, and may be severe enough to result in isotonic dehydration. The stools contain a relatively low concentration of sodium and may be mucoid in 20 to 25 percent of cases, but usually are devoid of blood or pus (Kapikian et al., 1982). Temperature elevations are present in about half of hospitalized patients, and generally are low grade. Concurrent clinical signs of pharyngitis, otitis media, or bronchitis (ronchi or wheezing) may occur in 10 to 25 percent of infants (Gurwith et al., 1981).

Mortality is unusual, but may occur in patients with severe dehydration if adequate fluid replacement is delayed. This situation is more frequent in developing countries. Community studies in developing nations also suggest that both symptomatic and asymptomatic infections result in growth retardation, which may have a significant impact on nutritional status (Mata et al., 1983). Neonatal infection may be frequent in certain hospital nurseries, but is usually either clinically asymptomatic or mild.

The advice and assistance of R.Edelman, W.J.Klish, P.J.Middleton, A.S.Monto, W.Rodriguez, and R.Wyatt in the preparation of this appendix are gratefully acknowledged. The committee assumes full responsibility for any judgments or assumptions.



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