Some diseases are branded as a threat only among children. The rotavirus infection is one of them. With statistics worldwide finding rotavirus responsible for 50% of diarrhoea cases in young children, we somehow underestimate the consequences it might bring to our entire population.
Medical practitioners in Thailand have therefore been in the hot seat recently when rotavirus, a contagious germ, also sent many adults to hospital -- among them actress Nusaba Punnakan who posted on Instagram earlier this month that she was hospitalised due to the virus. Although she has recovered, this still stirred public paranoia and challenged our perceptions that adults are not normally victims.
According to paediatrician Dr Banyat Assavalertpanich, several healthcare providers in Bangkok began noticing last month an increasing number of adult patients infected with rotavirus. While no statistical data is officially released by any authority yet, specialists have discussed among themselves and frowned upon the change in the virus' epidemic pattern.
"Investigation by the Department of Disease Control is now underway to find out why rotavirus is increasingly affecting adults," said Dr Banyat. Figures from the Ministry of Public Health's Department of Disease Control revealed that around a million Thais were found to have suffered severe diarrhoea in 2017. The illness killed four, three of whom were children under five. However, the department did not report the exact number of rotavirus cases.
Rotavirus was discovered in Australia by a group of virologists in 1973. Due to its wheel-like shape when examined under a microscope, the virus was named "rota", which means wheel in Latin, Dr Banyat explained.
In Thailand, the virus became widely recognised especially among gastrointestinal specialists and paediatricians in 2002/3 when a large number of small children in Thailand were diagnosed as being infected.
"Back then, private hospitals in Bangkok had full bed occupancy given the high number of children who were treated and hospitalised due to rotavirus infection. Children were reported to suffer high fever, vomiting, diarrhoea and dehydration," recalled Dr Banyat, citing the 2002/3 statistics stating that an estimated 56,000 children were hospitalised due to the rotavirus each year.
After that epidemic, a vaccine against rotavirus was developed and has since been recommended for small children aged not older than eight months. The World Health Organization (WHO) reiterates that "rotavirus vaccines are an important measure that can be used to reduce severe rotavirus-associated diarrhoea and child mortality".
The spread of the virus in Thailand has been kept in check since, said Dr Banyat.
"The number of rotavirus-infected patients keeps dropping, especially during the past four-to-five years. We, specialists, sort of congratulated the effectiveness of the vaccine."
Mysteriously, beginning last month more adults have been reported to fall victim to rotavirus.
Basically, gastrointestinal infections have many causes -- virus, bacteria and food poisoning. Rotavirus is one of them. Theoretically, it is most common in infants and young children aged six months to five years. It is believed that almost all kids have had at least one rotavirus infection by the time they are five years old.
"The infection can recur as kids grow older but it is likely to be less serious. Especially in adults, the infection would hardly be found given they are immunised after being infected as a child."
The virus grows well in cold weather, which explains the sudden spike in cases in the Kingdom as temperatures plunged in late December. Symptoms can be quite similar to other stomach and intestinal infections. But what's most worrying about rotavirus is that it is transmitted quite easily.
"Rotavirus spreads by the faecal-oral route, which means the virus comes out of the body through the stool and infects the next person via contaminated hands or objects. Also the virus can survive long in the external environment. A mother wipes clean the stool of her rotavirus-infected baby and if she fails to use disinfectants, the virus can survive and get to the next person," explains Dr Banyat.
Data from the US National Foundation for Infectious Diseases shows the virus can survive for several hours on human hands and for days on hard and dry surfaces. Consequently, it can be easily spread in families and especially childcare centres.
Once a person is exposed to rotavirus, the incubation period takes two days before symptoms appear. The infected person can spread the virus via stool two days before symptoms develop. Diarrhoea can last from four to seven days. Even after diarrhoea stops, the virus is likely to stay in their stool for days.
"Children who think they have fully recovered might go back to school but actually they can still be a virus carrier," Dr Banyat says.
There is no specific medication to treat rotavirus infection. When suffering diarrhoea, oral rehydration solutions are most helpful for outpatient cases. Severe dehydration may require hospitalisation for treatment with IV fluids.
"Whatever germ it is, when it comes to diarrhoea, it is crucial for the amount of fluid intake to be as close to the amount of water lost as possible. That would be safe. But in most cases, the problem is patients have insufficient fluid intake. Some do not pay enough attention to the oral rehydration solutions that their doctor prescribes," Dr Banyat says.
"Especially in children who vomit a lot, they cannot drink. In such a case, the infection can turn severe because children cannot stand dehydration as much as adults."
According to the WHO, two oral, live, attenuated rotavirus vaccines, Rotarix and RotaTeq, are available internationally. Both are considered safe and effective in preventing the infection. The WHO even recommends that the rotavirus vaccine for infants be included in all national immunisation programmes.
In Thailand, the rotavirus vaccine is still not covered by national healthcare where all children could receive the shot for free. Given its high price (around a few thousand baht at private hospitals), discussions concerning free coverage have gone on for over a decade.
Setting aside the vaccine, an effective preventive measure against the rotavirus infection is practising good hygiene.
"The virus comes out via the stool and your hands can be contaminated. So make sure to wash your hands thoroughly for at least 30 seconds. And if you are in close contact with rotavirus-infected patients, try not to touch food with your hands even though you wash them thoroughly," Dr Banyat says
"Keep yourself hygienic, clean eating habits are also a prevention. Opt for freshly-cooked food, use a serving spoon for shared dishes and use disposable gloves when cleaning babies. And do not forget to use disinfectants in areas or surfaces contaminated by faeces."
