1. Rotavirus Crystal Denmon Allen Chiu Anthony Bonilla

2. Background Information Family – Reoviridae Family – Reoviridae Have 10-12 DS RNA segments Have 10-12 DS RNA segments Double icosadehral capsid, 60 nm Double icosadehral capsid, 60 nm Outer capsid + short spikes Outer capsid + short spikes

3. Rotavirus Serotypes 2 Types of Surface Proteins 2 Types of Surface Proteins G (glycoprotein) G (glycoprotein) P (protease- sensitive protein) P (protease- sensitive protein) 11 G serotypes and 12 P types 11 G serotypes and 12 P types

4. Rotavirus Life Cycle

5. How Rotavirus Affects Host Cell Transcription

6. Case Study A 6 month-old child was seen in the emergency in January after two days of persistent watery diarrhea and vomiting accompanied by low grade fever and mild cough. The infant appeared dehydrated and required hospitalization. The patient attended a day-care center. A 6 month-old child was seen in the emergency in January after two days of persistent watery diarrhea and vomiting accompanied by low grade fever and mild cough. The infant appeared dehydrated and required hospitalization. The patient attended a day-care center.

7. Diarrhea Caused by Cellular Apoptosis

8. Symptoms Vomiting Vomiting Watery diarrhea for 3-8 days Watery diarrhea for 3-8 days Fever Fever

9. Similar Viral Agents Traveller’s Diarrhea Traveller’s Diarrhea Get it shortly after you return home or while traveling. More common with young adults age 20-29. Get it shortly after you return home or while traveling. More common with young adults age 20-29. Cholera Cholera Not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill. Symptoms include leg cramps Not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill. Symptoms include leg cramps Salmonella Salmonella Usually from coming in contact with surfaces that had raw meat on them Usually from coming in contact with surfaces that had raw meat on them Campylobacter Campylobacter Associated with handling raw poultry or eating raw or undercooked poultry meat. Diarrhea may be bloody Associated with handling raw poultry or eating raw or undercooked poultry meat. Diarrhea may be bloody

10. Similar Viral Agents Common Cold Common Cold Not just limited to infants. Diahrrea and vomiting are not primary symptoms. Not just limited to infants. Diahrrea and vomiting are not primary symptoms. Shigellosis Shigellosis Diarrhea, often bloody, is the most common sign of shigellosis. Diarrhea, often bloody, is the most common sign of shigellosis. Diptheria Diptheria Toxin usually attacks the tonsils first and causes fever, red sore throat, weakness, and headache. The toxin destroys the normal throat tissue, causing the throat to swell. Toxin usually attacks the tonsils first and causes fever, red sore throat, weakness, and headache. The toxin destroys the normal throat tissue, causing the throat to swell. Norwalkvirus Norwalkvirus General lethargy, weakness, muscle aches, headache, and low-grade fever may occur. General lethargy, weakness, muscle aches, headache, and low-grade fever may occur. Coxsakievirus Coxsakievirus  Hand, foot, and mouth disease, a type of coxsackievirus syndrome, causes painful red blisters in the throat and on the tongue, gums, hard palate, inside of the cheeks, and the palms of hands and soles of the feet.

11. Diagnosis Tests Confirming Rotavirus: Tests Confirming Rotavirus: Rapid Antigen detection of rotavirus in stool. Rapid Antigen detection of rotavirus in stool. Further characterization by: Further characterization by: Enzyme immunoassay or ELISA Enzyme immunoassay or ELISA Reverse transcriptase polymerase chain reaction Reverse transcriptase polymerase chain reaction Polyacrylamide gel electrophoresis (PAGE) Polyacrylamide gel electrophoresis (PAGE) Electron Microscopy (EM) Electron Microscopy (EM) Immunochromatography Immunochromatography

12. Enzyme Immunoassay

13. Transmission Fecal-Oral (primary) Fecal-Oral (primary) Contact with Contaminated surfaces Contact with Contaminated surfaces Food Food Water Water Fomite Fomite (ie. toys, table tops,solid surfaces) (ie. toys, table tops,solid surfaces) Respiratory tract fluids Respiratory tract fluids

14. Epidemiology Incubation time: 2 - 4 days Incubation time: 2 - 4 days Patients show symptoms 3 to 8 days after incubation. Patients show symptoms 3 to 8 days after incubation. Contagious for 2 days before showing symptoms and 2 days after recovery. Contagious for 2 days before showing symptoms and 2 days after recovery.

15. Who’s At Risk?

16. When Are You At Risk? o http://rotavirusinfo.com/hcp/rotavirus_infection.html http://rotavirusinfo.com/hcp/rotavirus_infection.html http://rotavirusinfo.com/hcp/rotavirus_infection.html

17. Treatment Oral Rehydration Therapy (ORT) Oral Rehydration Therapy (ORT) replaces fluids and electrolytes lost via diarrhea and vomiting, is usually given in 2 phases: replaces fluids and electrolytes lost via diarrhea and vomiting, is usually given in 2 phases: Rehydration: to quickly replace water and electrolyte loss. Rehydration: to quickly replace water and electrolyte loss. Maintenance: continued to replace fluid loss and provide adequate caloric intake. Maintenance: continued to replace fluid loss and provide adequate caloric intake.

18. Vaccine and Prevention Live oral vaccine (RotaTeq) for use in children Live oral vaccine (RotaTeq) for use in children (FDA approved February of 2006) (FDA approved February of 2006) Prevention: Prevention: Good Hygiene and Sanitation. Good Hygiene and Sanitation.

19. Questions???

20. References 1. About Rotavirus. Retrieved November 4, 2007 from http://www.cdc.gov/rotavirus/. 1. About Rotavirus. Retrieved November 4, 2007 from http://www.cdc.gov/rotavirus/.http://www.cdc.gov/rotavirus/ 2. Vergara F R, Navarrete MS, Núñez E, Escobar L, Navarro G S, Venegas E G, Schuffeneger P, O'Ryan M. Incidence of Severe Rotavirus Gastroenteritis Among Chilean Children Under Three Years Of Age. Rev Med Chil. 2007 Aug;135(8):975-81. Epub 2007 Oct 25. 2. Vergara F R, Navarrete MS, Núñez E, Escobar L, Navarro G S, Venegas E G, Schuffeneger P, O'Ryan M. Incidence of Severe Rotavirus Gastroenteritis Among Chilean Children Under Three Years Of Age. Rev Med Chil. 2007 Aug;135(8):975-81. Epub 2007 Oct 25. 3. Rotavirus. Retreived November 4, 2007 from http://www.who.int/biologicals/areas/vaccines/rotavirus/en/. 3. Rotavirus. Retreived November 4, 2007 from http://www.who.int/biologicals/areas/vaccines/rotavirus/en/. http://www.who.int/biologicals/areas/vaccines/rotavirus/en/ 4. MMWR. (3/19/99). Vaccine for the Prevention of Rotavirus Gastroenteritis Among Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). Retrieved November 4, 2007 from (http://www.cdc.gov/MMWR/preview/mmwrhtml/00056669.htm. 4. MMWR. (3/19/99). Vaccine for the Prevention of Rotavirus Gastroenteritis Among Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). Retrieved November 4, 2007 from (http://www.cdc.gov/MMWR/preview/mmwrhtml/00056669.htm.http://www.cdc.gov/MMWR/preview/mmwrhtml/00056669.htm 5. Merck & Co. Information about Rotavirus. Retrieved November 5, 2007 from http://rotavirusinfo.com/hcp/information_on_rotavirus.html. 5. Merck & Co. Information about Rotavirus. Retrieved November 5, 2007 from http://rotavirusinfo.com/hcp/information_on_rotavirus.html. http://rotavirusinfo.com/hcp/information_on_rotavirus.html 6. Mayo Clinic Staff (August 25, 2006). Rotavirus: Overview. Retrieved November 5, 2007 from http://www.mayoclinic.com/health/rotavirus/DS00783. 6. Mayo Clinic Staff (August 25, 2006). Rotavirus: Overview. Retrieved November 5, 2007 from http://www.mayoclinic.com/health/rotavirus/DS00783. http://www.mayoclinic.com/health/rotavirus/DS00783 7. Symptomchecker. Retrieved Novevember 7, 2007 from http://symptoms.webmd.com/default.htm. 7. Symptomchecker. Retrieved Novevember 7, 2007 from http://symptoms.webmd.com/default.htm. http://symptoms.webmd.com/default.htm 8. Sandra Martin-Latil, Laurence Mousson, Arnaud Autret, Florence Colbère-Garapin, and Bruno Blondel. Bax Is Activated during Rotavirus-Induced Apoptosis through the Mitochondrial Pathway. October 26 2006. Journal of Virology, May 2007, p. 4457-4464, Vol. 81, No. 9. 8. Sandra Martin-Latil, Laurence Mousson, Arnaud Autret, Florence Colbère-Garapin, and Bruno Blondel. Bax Is Activated during Rotavirus-Induced Apoptosis through the Mitochondrial Pathway. October 26 2006. Journal of Virology, May 2007, p. 4457-4464, Vol. 81, No. 9. 9. Gouvea, V., Glass, R.I., Woods, P., Taniguchi, K., Clark, H.F., Forrester, B., Fang. Z.Y, Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. November 3 1989. Journal of Clinical Microbiology, February 1990, p.267-282. Vol. 28, No.2 9. Gouvea, V., Glass, R.I., Woods, P., Taniguchi, K., Clark, H.F., Forrester, B., Fang. Z.Y, Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. November 3 1989. Journal of Clinical Microbiology, February 1990, p.267-282. Vol. 28, No.2