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WHO It is recommended to get RV vaccine as soon as possible from 6 weeks old
The recent cliff-jumping cooling is really unexpected. Children's immunity is lower than that of adults. In the face of sudden and significant cooling, we should pay special attention to this aggressive disease - autumn diarrhea .
htmlChildren under 55 years old are susceptible to
Autumn diarrhea: It often occurs in autumn and winter, with acute onset and strong contagiousness. It is mainly caused by rotavirus (rotavirus, RV) infection in the children, which is then manifested as diarrhea. RV is also the most common pathogen that causes acute diarrhea in infants and young children.
RV belongs to the genus Rotavirus of Reoviridae family, and is an enveloped double-stranded ribonucleic acid RNA virus. According to the serotype of the inner capsid protein VP6, RV is divided into A~J groups [1].
It is currently known that A, B, C and H groups RV can cause diarrhea in humans. Among them, A group RV is the most common pathogen of acute diarrhea in children under 5 years old [1].
Rotavirus gastroenteritis (RVGE) is the primary cause of severe fatal diarrhea in children of this age. It causes 10 million severe RVGE cases and 118,000 to 183,000 deaths worldwide every year, of which about 41% of the deaths occur in Asia [1].
In my country, 25% to 30% of in acute gastroenteritis (AGE) in children under 55 years old is caused by RV. This virus is the first pathogen that causes AGE hospitalization in children. The incidence of RVGE in children under under 55 years of age reached 54.7/1000 person-years, and the number of deaths was estimated to be about 3,000 cases per year [2].
RV infection source infection is for patients, recovery detoxifiers and asymptomatic infected persons . 2 days before diarrhea occurs, has begun to excrete a large amount of viruses through feces, and can still be detoxified 10 days after symptoms appear. Immunely deficient people have poor RV removal ability, and the detoxification time is correspondingly extended, which can last for more than 30 days [1]. After the body is infected, the RV concentration in the feces and vomit is very high, reaching 1012 virus particles/gram, and 10 virus particles can cause disease [1].
transmission pathway is mainly transmitted through fecal-oral, contact, and can also be transmitted through the respiratory tract. Children under under 55 are susceptible, and children with 6 to 24 months of age are at the peak of the incidence of severe rotavirus gastroenteritis (RVGE).
In summary, children under 5 years old, especially those under under 52 years old should pay attention to the prevention of RV infection.
Vomiting and fever symptoms can last for 1 to 3 days [2]
RVGE incubation period is 1 to 3 days . The onset is acute, and the first symptoms are often manifested as nausea, vomiting , which may be accompanied by fever (mostly medium and low fever). The body temperature of a few children will exceed 39°C.
Then diarrhea occurs, which is watery stool or egg-like stool . The stool is free from mucus and fishy smell. several times to dozens of times a day. Symptoms of vomiting and fever can last for 1 to 3 days.
RVGE disease course is generally 3 to 8 days. If secondary disacidase deficiency (mainly lactase ), the diarrhea time can be prolonged. Chronic RVGE may occur after infection in children with low immune function, and in severe cases, systemic infection may develop.
RVGE complications mainly include dehydration, electrolyte disorders and acidosis, myocarditis , pneumonia, convulsion .
Children with severe vomiting and diarrhea have metabolic acidosis due to dehydration, which leads to electrolyte disorders. Electrolyte disorders and convulsions are at risk of death in the child.
Feed pathogen test can be positive to confirm
Infants and young children have typical clinical manifestations such as fever, vomiting, and watery stool diarrhea in autumn and winter. Combined with stool RV antigen test, , the diagnosis can be confirmed.
treatment is mainly used to correct dehydration and electrolyte disorders
There are currently no effective anti-RV treatment measures. According to different clinical manifestations and laboratory tests, oral rehydration salt or intravenous rehydration will be used to correct dehydration, electrolyte disorders and acid-base imbalance. Other treatment measures include dietary therapy, zinc supplementation treatment and the management of complications [1].
1. General care: digestive tract isolation until diarrhea is relieved, preventing cross-infection [2].
2, oral rehydration salt (ORS) or intravenous rehydration [1]:
(1) Children with diarrhea without symptoms of dehydration, rehydration should mainly prevent dehydration. Oral rehydration salt or drinking water is given; replenishment after each water sample (<6>10 years ）As required for vomiting and diarrhea are stopped;
(2) Mild or moderate dehydration is recommended to use ORS or hypotonic ORS rehydration salt oral rehydration salt dosage: dosage (ml) = weight (kg) × (50 to 75), oral administration is completed in 4 hours. After 4 hours, select the appropriate therapy according to the degree of dehydration;
(3) Children with severe dehydration and moderate to severe diarrhea in newborns are recommended for intravenous rehydration . When severe dehydration or shock requires liquid resuscitation, use a mixed solution of sugar salt containing alkali. Specifically:
in the first stage with 2:1 isotonic liquid intravenously or rapidly injected to rapidly increase blood volume, improve circulation and kidney function, and re-evaluate the dehydration according to pulse, perfusion and mental state after expansion;
if it is still in shock, it can be reused intravenously or injected quickly 1 to 2 times, and then choose an appropriate plan according to the dehydration nature ( isotonic dehydration isotonic dehydration isotonic, and 4:3:2 isotonic dehydration isotonic, and 4:3:2 isotonic dehydration isotonic, and 2/3 isotonic, and
is given oral rehydration.
3. Diet therapy: Resuming diet as soon as possible 4 to 6 hours after rehydration treatment can alleviate changes in gastrointestinal epithelial permeability caused by infection, shorten the course of the disease and improve the nutritional status of the children;
Breast-fed babies should continue to be fed as needed. Infants fed with formula milk should choose lactose-free or low-lactose formula milk for continued feeding while supplementing enough water to meet energy and nutrition;
For older children, there is no restriction on their diet. Including grains, meat, yogurt, fruits and vegetables. The main purpose is to ensure sufficient energy intake.
High-concentration monosaccharide diet is not recommended, including carbonated beverages , jelly, canned juices, desserts and other sugary beverages and high-fat foods.
4. Symptom-based treatment: When there is high fever, try to reduce the temperature physically or use a small dose of antipyretic agent. Appropriate selection of gastrointestinal mucosa protective agents: Montmorillonite powder can shorten the course of diarrhea, reduce defecation, and improve cure rate.
5. Zinc supplement: World Health Organization (WHO) points out that zinc supplements can reduce the duration and severity of diarrhea and reduce the recurrence of diarrhea. In areas with zinc deficiency, children with diarrhea and malnutrition need to supplement zinc. Children under 6 months of age need to supplement zinc with 10mg/d, and 20mg/d of 6 months of age and above, and the course of treatment is 10 to 14 days. 20mg of zinc is equivalent to 100mg zinc sulfate or 140mg zinc gluconate .
RV vaccine is the most effective prevention method
RV vaccine is the most effective prevention method . In addition, , comprehensive prevention of diarrhea, such as breastfeeding, improving the sanitary environment and strengthening case management, are also important measures to prevent RVGE.
WHO recommends that all countries include RV vaccines in the national immunization program, and recommends that be vaccinated with RV vaccine as early as possible from 6 weeks of age to obtain immune protection before natural RV infection.
As of the end of 2021, 118 countries around the world have included rotavirus vaccines in the national immunization program. However, in my country, the rotavirus vaccine is a non-immunization program vaccine and still requires voluntary vaccination at its own expense [3].
Currently, there are two oral vaccines on the market in my country [4], namely the unit-priced Lanzhou lamb rotavirus vaccine (LLR) approved for marketing in mainland my country in 2001, and the pentavalent human-bovine reassortant rotavirus vaccine (RV5) approved for marketing in 2018. See the table below for details.
Table 1: Two types of vaccines (source see watermark, can be enlarged and viewed)
From the table above, we can see that according to the WHO recommendation, children can undergo RV5 vaccination at 6 weeks of age after birth, and take the first dose at 6 to 12 weeks of age.
Here is a further note. Regarding whether RV5 can be vaccinated with other vaccines, such as trivalent live attenuated polio vaccine, cell-free diphtheria and tetanus combined vaccine, inactivated polio vaccine, hepatitis B vaccine, etc., although there are limited clinical research on the concurrent vaccination of RV5 with other live attenuated vaccines except above and inactivated vaccines , the WHO still emphasizes that oral RV vaccines can be vaccinated with other vaccines in the children's immunization program [1].
. According to the vaccine instructions, LLR and other live attenuated vaccines are vaccinated at least 28 days apart.
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References:
[1] Integrated project team of the Yangtze River Delta Immunization Program, Child Infection and Hepatology Group of the Infectious Diseases Branch of the Chinese Medical Association. Expert consensus on the prevention, diagnosis and treatment of rotavirus gastroenteritis in children (2020 edition) [J]. Chinese Journal of Preventive Medicine, 2020, 54(4): 14.
[2] Pediatric Branch of the Chinese Medical Association, China Children's Immunization and Health Alliance, Xu Yi, et al. Diagnosis, treatment and prevention path of rotavirus gastroenteritis in children [J]. Chinese Journal of Practical Pediatrics, 2021, 36(5): 3.
[3] Wang J, Zhang H, Zhang H, et al. Public health impact and cost-effectiveness of rotavirus vaccination in China:Comparison between private market provision and national immunization programs.[J].Hum Vaccin Immunother,1970,:2090162.
[4] Chen Jie, Wang Huaqing, Qian Yuan. Medical and prevention fusion promotes immune prevention of rotavirus gastroenteritis in children [J]. Chinese Journal of Pediatrics, 2020, 58(8):3.
This article was first published: Medical Pediatric Channel
Author: Yuanyi
Review of this article: Xu Lingmin Chief physician of pediatrics, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University
Editor: Wen Jiaxin
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