CDC warns rotavirus at high levels in the U.S., with life-threatening symptoms for kids

It took Ben Lopman’s 18-month-old son just 48 hours to go from energetic toddler to completely listless.

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Lopman’s son, Ruben, suffered from severe dehydration due to rotavirus, one of the most common causes of diarrhea and vomiting in babies and children. He was so ill that he ended up in the hospital, desperately needing intravenous fluids to maintain his strength and fight the infection.

Lopman, an infectious disease epidemiologist now at Emory University, was living in London when his son became ill. It was 2008, five years before the UK approved a vaccine to prevent the highly contagious virus. The boy eventually recovered.

“It was scary,” Lopman said. “It also reminded me how serious this illness can be for any child. »

Rotavirus, a seasonal virus similar to the flu, has been on the rise in the United States since January. With infection rates higher today than this time last year, doctors are again concerned that the decline in vaccinations could lead to more severe illness and a greater increase in coming years.

The virus — which is spread by hands touching an infected surface and then through the mouth — was once a leading cause of serious illness among babies and young children in the United States, responsible for more than 200,000 emergency room visits, up to 70,000 hospitalizations and dozens of deaths each year, according to the National Foundation for Infectious Diseases. This changed dramatically after the first oral vaccine was approved 20 years ago.

Data from WastewaterScan, an academic program at Stanford University in partnership with Emory University, shows the virus has increased since January, with levels continuing to rise in some regions of the United States, including the West and Midwest.

“We’re seeing a lot of rotavirus in wastewater right now, certainly at very high levels, which tells us that there are high levels of rotavirus infections in these communities,” said Dr. Marlene Wolfe, WastewaterScan program director and co-principal investigator.

Decline in vaccination rates

Dr. Stephanie Deleon is watching the rise in Oklahoma City closely.

Deleon is an associate chief medical officer and pediatric hospitalist at Oklahoma Children’s OU Health, where there has been a steady influx of children admitted with rotavirus over the past two months. There’s no sign of it slowing down, she said.

Early symptoms include a fever of around 101 degrees Fahrenheit, as well as vomiting. “Those two disappear pretty quickly, within a day to a day and a half,” she said. But then the diarrhea starts afterwards, often more than 20 episodes a day.

There is no treatment for infection other than supportive care such as fluids, so children and their families must wait for the virus to run its course. Symptoms can last about three to eight days.

Most of the patients she sees at the hospital are either too young to get vaccinated, have not yet received all doses, or are not vaccinated, a growing problem in the United States. According to the latest data from the CDC, nationally, 73.8% of children are vaccinated. This number has been in steady decline over the past eight years.

“Children who are not vaccinated are at absolutely higher risk of severe illness and needing hospitalization,” Deleon said.

“A disease that vomits”

Washing hands and cleaning surfaces can help stop the spread, but the virus is difficult to kill.

“The virus lives on surfaces for a long time,” said Dr. Yvonne Maldonado, Taube Professor of Global Health and Infectious Diseases at Stanford University. “Even if you wash your hands, it is easy for the virus to persist. »

Rotavirus can infect anyone, but it can be particularly rapid and severe in babies and young children, often leading to hospitalization.

“The problem with rotavirus is that it is a vomiting disease,” said Dr. Paul Offit, director of the Vaccine Education Center and professor of pediatrics at Children’s Hospital of Philadelphia. “You vomit and vomit and vomit. It’s very difficult to rehydrate through the mouth someone who is vomiting and that’s why they end up coming to the hospital to receive intravenous fluids.”

Offit said he sees 400 children each year at his hospital suffering from severe dehydration due to the virus. He vividly remembers being a resident in pediatrics and caring for a deceased child.

“This child was perfectly healthy two days earlier,” he said. “It was a healthy 9-month-old little girl. I will never forget that because I was the one who then had to go see this mother in the waiting room to tell her that her child had died.”

He said that memory lived in his head when he later helped develop RotaTeq, one of two vaccines now approved for rotavirus.

The Centers for Disease Control and Prevention estimates that 40,000 to 50,000 hospitalizations among infants and young children are prevented each year by vaccines administered starting at 2 months of age.

Studies have also shown that 9 out of 10 children vaccinated will be protected against serious illness. Seven in 10 people will be protected from infection, CDC says

Despite the data, earlier this year Health and Human Services Secretary Robert F. Kennedy Jr. announced changes to the childhood immunization schedule, including removing the rotavirus vaccine and telling parents they should talk to their doctor before deciding whether to get vaccinated.

“The virus is still circulating,” Offit said. “So the choice not to get vaccinated is a very real choice to experience this infection. » While the schedule changes were put on hold by a federal judge last month, doctors worry that even attempts to change the guidelines have sowed doubt among some new parents, who may now be hesitant to get the rotavirus vaccine.

“They’re young people and they’re getting mixed messages,” Maldonado said. “They don’t know where to turn.”

Although deaths from rotavirus will likely never be common in the United States due to access to health care, the rate of serious complications could increase significantly due to resistance to vaccination, said Dr. Monica Gandhi, an infectious disease specialist at UCSF.

“The fear, the expense, the pain and leaving work, hospitalization is a really big deal,” she said. “When the medical community developed vaccines, it was not because 100% of people died, it was because we didn’t want children to get sick or die. »

Lopman, who was studying rotavirus for the CDC, said he doesn’t think the current increase in cases is related to recent policy changes. But he worries that with vaccination rates dropping, what he experienced with his son could happen to more families.

“This is actually a really extraordinary vaccine,” he said. “It has also been studied extensively in terms of safety and has a very clear and considerable benefit.”