Rotavirus
Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. According to WHO estimates in 2013 about 215,000 children aged under 5 years die each year from vaccine-preventable rotavirus infections; the vast majority of these children live in low-income countries (WHO, 2018).
Primary reference(s)
WHO, 2018. Rotavirus. World Health Organization (WHO). Accessed 17 February 2025.
Annotations
Additional scientific description
Rotavirus, a member of the reovirus family, causes watery diarrhoea, vomiting and severe dehydration in young children. Rotavirus is common, accounting for 35-60% of acute severe diarrhoea in children less than 5 years of age in countries without rotavirus vaccine, with the highest attributable percentage in infants. Rotavirus diarrhoea is ubiquitous, and children are infected at an early age. It often causes nosocomial outbreaks in paediatric wards where handwashing and other infection prevention and control measures are lax (WHO, no date a).
Rotavirus is the most common cause of severe diarrhoeal disease in infants and young children globally. It is transmitted through the oral-faecal route, directly from person to person, or indirectly through contaminated objects. People who are infected experience an abrupt onset of fever and vomiting followed by explosive, watery diarrhoea. Rotavirus diarrhoea is profuse, often leading to dehydration which can be severe, requiring hospitalization. The most severe threat posed by diarrhoea is dehydration (WHO no date a). The cornerstones of treatment of severe rotavirus diarrhoea are fluid replacement and zinc supplementation (WHO, no date a).
Vaccines against rotavirus are available, and vaccination is an important measure to reduce severe rotavirus-associated diarrhoea and mortality (WHO, no date a).
Rotavirus causes watery diarrhoea, vomiting and severe dehydration in young children. Rotavirus diarrhoea is ubiquitous and, unlike bacterial diarrhoea, is not more prevalent in settings with poor water, sanitation and hygiene. Rotavirus peaks in cool, dry seasons in temperate climates but exhibits less pronounced seasonality in tropical settings (WHO, no date a).
The clinical spectrum of rotavirus disease is wide, ranging from transient loose stools to severe diarrhoea and vomiting causing dehydration, electrolyte disturbances, shock, and death if rehydration is not provided. In typical cases, following an incubation period of 1-3 days, the onset of disease is abrupt, with fever and vomiting followed by watery diarrhoea. Gastrointestinal symptoms normally resolve within 3-7 days but may last for up to 2-3 weeks (WHO, no date a).
The World Health Organization (WHO) has published guidance on case classification and surveillance standards (WHO, 2018a).
Metrics and numeric limits
Rotavirus has a case-fatality rate (CFR) of approximately 2.5% among children in developing countries who present to health facilities. This CFR is higher in areas without good access to health care. In 2013, rotavirus caused an estimated 215 000 deaths worldwide (WHO, 2018b).
Key relevant UN convention / multilateral treaty
International Health Regulations (2005), 3rd ed. (WHO, 2016).
Drivers
Rotaviruses are shed in very high concentrations and for many days in the stools and vomitus of infected individuals. Transmission occurs primarily by the faecal-oral route, directly from person to person or indirectly via contaminated fomites. The universal occurrence of rotavirus infections shows that clean water supplies and good hygiene are unlikely to have a substantial effect on virus transmission (WHO, no date a).
Rotaviruses are the most common cause of severe diarrhoeal disease in infants and young children worldwide. Studies estimate that approximately 200,000 people die annually from infection. In their systematic review and Bayesian multinomial review, Black et al. (2024) reported that diarrheal diseases leading to the largest estimated global attribution was rotavirus; in LMICs, the proportion of deaths from diarrhoea due to rotavirus in children younger than 5 years appeared lower in 2021 (108 322 [24·4%] of 443 342, 95% uncertainty interval 21·6-29·5) than in 2000 (316 382 [26·5%] of 1 196 134, 25·7-28·5), but the 95% CIs overlapped (Black et al, 2024).
Although the infection rate has decreased with the advent of vaccines, infections are still common throughout the world. Although the viral strains show considerable diversity, 5 serotypes are responsible for the majority of human rotavirus disease. Primarily transmitted by the faecal-oral route, rotaviruses affect the vast majority of children worldwide before the age of 3 years, and in most developing countries before the first birthday (WHO, no date a).
Impacts
Rotavirus has a case-fatality rate of approximately 2.5% among children in low-income countries who present to health facilities. This rate is higher in areas without good access to health care (WHO, no date a). Published in 2003, a peer-review publication reported that each year, rotavirus causes an estimated 111 million episodes of diarrhoea requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000–592,000 deaths (median 440,000 deaths) in children <5 years of age. In other words, by 5 years of age, almost all children will have an episode of rotavirus gastroenteritis, 1 in 5 will require a clinic visit, 1 in 60 will require hospitalization, and approximately 1 in 293 will die. The incidence of rotavirus disease is similar in children in both developed and developing nations. However, children in developing nations die more frequently, possibly because of several factors, including poorer access to hydration therapy and a greater prevalence of malnutrition. An estimated 1,205 children die from rotavirus disease each day, and 82% of these deaths occur in children in the poorest countries (Parashar et al., 2003).
Multi-hazard context
Black et al. (2024) indicate progress in the reduction of deaths from diarrhoea caused by 12 pathogens in children younger than 5 years in the past two decades. However, they recommend that there is a need to increase efforts for prevention, including with rotavirus vaccine, and treatment to eliminate further deaths (Black et al., 2024).
Risk Management
WHO prequalified rotavirus vaccines have been available since 2008 and there are currently four vaccines available. They are all live, oral vaccines. RotaTeq, Rotavac, and ROTASIIL should be administered in a 3-dose schedule, while a 2-dose schedule should be used for Rotarix. A minimum interval of 4 weeks should be maintained between doses (WHO, no date a).
WHO recommends that rotavirus vaccines should be included in all national immunization programmes and considered a priority, particularly in countries with high rotavirus gastroenteritis-associated fatality rates, such as in South and South-eastern Asia and sub-Saharan Africa (WHO, no date a).
In addition, key measures to prevent diarrhoea include the following:
- access to safe drinking water
- use of improved sanitation
- hand washing with soap
- exclusive breastfeeding for the first six months of life
- good personal and food hygiene
- health education about how infections spread (WHO, no date a)
Black et al. (2024) indicate progress in the reduction of deaths from diarrhoea caused by 12 pathogens in children younger than 5 years in the past two decades. However, they recommend that there is a need to increase efforts for prevention, including with rotavirus vaccine, and treatment to eliminate further deaths (Black et al, 2024).
Monitoring
WHO supports countries to conduct all-hazards strategic risk assessment in the contexts of health emergencies and disasters, which results in the development of a country's risk profile. Empowered with the country risk profile, inclusive of a seasonal risk calendar, countries can anticipate potential emergencies before they occur to trigger early alerts and inform early actions (WHO, 2021).
WHO's Early Warning, Alert and Response System (EWARS) has been designed to improve disease outbreak detection in emergency settings, such as in countries in conflict or following a natural disaster. It is a simple and cost-effective way to rapidly set up a disease surveillance system. EWARS is deployed during an emergency as an adjunct to the national disease surveillance system. WHO works with Ministries of Health and health sector partners to train local health workers to use the system. After the emergency, EWARS should re-integrate back into the national system (WHO, no date a).
References
Black, R.E., Perin, J., Yeung, D., Rajeev, T., Miller, J., Elwood, S.E., Platts-Mills, J.A., 2024. Estimated global and regional causes of deaths from diarrhoea in children younger than 5 years during 2000-21: a systematic review and Bayesian multinomial analysis. Lancet Glob Health.;12(6):e919-e928. doi: 10.1016/S2214-109X(24)00078-0. Epub 2024 Apr 20. PMID: 38648812; PMCID: PMC11099298. Accessed 29 May 2025.
Parashar, U.D., Hummelman, E.G., Bresee, J.S., Miller, M.A., Glass, R.I., 2003. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 9(5):565-72. doi: 10.3201/eid0905.020562. PMID: 12737740; PMCID: PMC2972763. Accessed 29 May 2025.
WHO, 2016. International Health Regulations (2005), 3rd ed. World Health Organization (WHO). Accessed 26 May 2025.
WHO, 2018a. Rotavirus. Vaccine-Preventable Diseases: Surveillance Standards. World Health Organization (WHO). Accessed 29 May 2025.
WHO, 2018b. Rotavirus. World Health Organization Western Pacific Regional Office (WHO). Accessed 29 May 2025.
WHO, 2021. Strategic toolkit for assessing risks (STAR): a comprehensive toolkit for all-hazards health emergency risk assessment. World Health Organization (WHO). Accessed 26 May 2025.
WHO, no date a. Rotavirus. World Health Organization (WHO). Accessed 29 May 2025.
WHO, no date b. Early Warning, Alert and Response System (EWARS). World Health Organization (WHO). Accessed 18 April 2025.