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the stool Treatment is symptomatic, with fluid and electrolyte replacement Local intestinal immunity gives protection against successive infection A previous tetravalent rhesus vaccine was discontinued in 1999 because of a probable association with intussusception Two live oral rotavirus vaccines have emerged that appear to be safe and highly efficacious in providing protection The vaccine currently licensed in the United States is a combination of five bovine-human reassortments Studies are underway to determine their effectiveness in developing nations Noroviruses, such as Norwalk virus, are becoming an increasingly recognized cause of gastroenteritis These viruses are the most common cause of nonbacterial gastroenteritis worldwide and account for up to 60% of disease from enteric pathogens in the United States They are responsible for over 40% of cases of group-related and institutional outbreaks of diarrhea Recurrent gastroenteritis outbreaks with noroviruses have occurred on cruise ships Norwalk virus is also often responsible for military outbreaks Although transmission is usually fecal oral, airborne and waterborne (recently among snowmobilers in Wyoming) transmission is also documented Infections appear to be more common during cold weather intervals RT-PCR of stool samples is used for epidemiologic purposes Treatment is largely symptomatic The presence of antibodies is not associated with protection against reinfection
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Kapikian AZ et al A hexavalent human rotavirus-bovine rotavirus (UK) reassortant vaccine designed for use in developing countries and delivered in a schedule with the potential to eliminate the risk of intussusception J Infect Dis 2005 Sep 1;192 Suppl 1:S22 9 [PMID: 16088801] Ruiz-Palacios GM et al; Human Rotavirus Vaccine Study Group Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis N Engl J Med 2006 Jan 5; 354(1):11 22 [PMID: 16394298] Walter JE et al Astrovirus infection in children Curr Opin Infect Dis 2003 Jun;16(3):247 53 [PMID: 12821816]
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be taken are avoidance of contact with prairie dogs and Gambian giant rats (whose illness is manifested by alopecia, rash, and ocular or nasal discharge), appropriate care and isolation of those who are ill and those exposed within 3 prior weeks to such animals, and veterinary examination and investigation of suspect animals through health departments Primary prevention entails the use of vaccinia immunization, a procedure accompanied by a risk of dissemination in HIVinfected persons The CDC recommends smallpox vaccination to individuals if their exposure to infected animals is sufficient and if the candidate vaccinee has no contraindications (outlined above) In a monkey model, cidofovir has been shown to be more effective in reducing mortality than smallpox vaccination Submission of specimens and case reporting can be conducted using the Association of Public Health Laboratories Web site listed below
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Association of Public Health Laboratories http://wwwaphlorg/ CDC Bioterrorism Public Health Emergency Preparedness and Response Smallpox: Laboratory Testing http://www btcdcgov/agent/smallpox/lab-testing Kretzshmar M et al Frequency of adverse events after vaccination with different vaccinia strains PLoS Med 2006 Aug;3 (8):e272 [PMID: 16933957] Leite JA et al Passatempo virus, a vaccinia virus strain, Brazil Emerg Infect Dis 2005 Dec;11(12):1935 8 [PMID: 16485483] Nalca A et al Reemergence of monkeypox: prevalence, diagnostics, and countermeasures Clin Infect Dis 2005 Dec 15;41 (12):1765 71 [PMID: 16288402] Stittelaar KJ et al Antiviral treatment is more effective than smallpox vaccination upon lethal monkeypox virus infection Nature 2006 Feb 9;439(7077):745 8 [PMID: 16341204] Seward JF et al Development and experience with an algorithm to evaluate suspected smallpox cases in the United States, 2002 2004 Clin Infect Dis 2004 Nov 15;39(10): 1477 83 [PMID: 15546084] Weiss MM et al Rethinking smallpox Clin Infect Dis 2004 Dec 1;39(11):1668 73 [PMID: 15578369]
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Viruses are responsible for at least 30 40% of cases of infectious diarrhea in the United States, and rotaviruses are a leading worldwide cause of dehydrating gastroenteritis in young children The agents that can cause disease include groups A, B, and C rotaviruses; caliciviruses, including noroviruses such as Norwalk virus (which cause epidemics of vomiting and diarrhea in contained environments); astroviruses; enteric adenoviruses; and, less often, toroviruses, coronaviruses, picobirnaviruses, and pestiviruses Rotaviruses (G1 G4 and G9 are the most common serotypes) are a major cause of diarrheal morbidity and mortality worldwide (nearly 600,000 die each year, mainly due to dehydration in developing countries), can also cause infections in adults exposed to infected infants, and are ubiquitous in the environment of an outbreak (Secondary rates are between 16% and 30%) Most rotavirus infections occur in children aged 6 months 2 years, and the incidence peaks during the winter The disease is usually mild, and cases also occur among travelers, in epidemic fashion, and after waterborne exposure The method of choice for diagnosis is PCR of
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