Rotavirus is a virus that causes gastroenteritis in infants and young children. It is estimated that nearly all children will be infected with rotavirus by age 5. Rotavirus causes about half of all cases of gastroenteritis in children under 5. India will soon have a locally manufactured low-cost rotavirus vaccine as part of its universal immunization program. The vaccine from Bharat Biotech is expected to be available at almost one-fifteenth the current market price and could be launched in 2015. Recent research has studied rotavirus infections and strains in small ruminants and the potential for interspecies transmission.

2. Contents
 What is rota virus?
 Complications
 Epidemiology
 Seasonality
 Diagnosis
 Therapy
 Why vaccine against rota virus?
 Rotarix

3. What is Rota virus????
 Rotavirus is a virus that causes
gastroenteritis, in particular in
infants and young children .
 Estimated that all children will
become infected with rotavirus at
least once by the time they are 5 years
old .
 Estimated that rotavirus causes
around half of all gastroenteritis in
children aged under 5 years

4.  Incubation period
The incubation period is approximately 2 days ,
 Infectious period
Shedding of the virus in faeces may begin before the onset of
major symptoms and may continue for several days after
symptoms have resolved ,
 Rotavirus is found in the stool of infected. Rotavirus is
easily spread by hand-to-mouth contact with stool from an
infected person.
 Most children with rotavirus diarrhea recover on their
own. Some children become very ill with severe vomiting,
diarrhea, and life-threatening loss of fluids that requires
hospitalization.

5. Structure
The genome of rotavirus
consists of 11 unique double
helix molecules of RNA which are
18,555 nucleotides in total.
Each helix, or segment, is
a gene, numbered 1 to 11 by
decreasing size. Each gene codes
for one protein, except genes 9,
which codes for two.[78] The RNA
is surrounded by a three-
layered icosahedral protein capsi
d. Viral particles are up to
76.5 nm in diameter[79][80] and
are not enveloped.

6. Common Replication process
Enter cells by receptor mediated
endocytosis and form a vesicle known
as an endosome. Proteins in the third
layer (VP7 and the VP4 spike) disrupt
the membrane of the endosome,
creating a difference in
the calcium concentration.
This causes the breakdown of
VP7trimers into single protein
subunits, leaving the VP2 and VP6
protein coats around the viral dsRNA,
forming a double-layered particle
(DLP).

7. Eleven dsRNA strands remain within the protection of the two
protein shells And the viral RNA-dependent RNA polymerase creates
mRNA transcripts of the double-stranded viral genome. By remaining in
the core, the viral RNA evades innate host immune responses called RNA
interference that are triggered by the presence of double-stranded RNA.
During the infection, rotavirus produces mRNA for both protein
biosynthesis and gene replication. Most of the rotavirus proteins
accumulate in viroplasm, where the RNA is replicated and the DLPs are
assembled. Viroplasm is formed around the cell nucleus as early as two
hours after virus infection, and consists of viral factories thought to be
made by two viral nonstructural proteins: NSP5 and NSP2.
The DLPs migrate t o the endoplasmic reticulum where they obtain their
third, outer layer (formed by VP7 and VP4). The progeny viruses are
released f rom the cell by lysis.

8.  Rotavirus gastroenteritis
usually begins with the symptoms of
• Diarrhoea
• Vomiting
 The child may also have
• A fever (high temperature) of
38ºC or above
• Abdominal pain
 The symptoms of vomiting usually pass within 1 to 2 days.
In most children, vomiting will not last longer than 3 days
 The symptoms of diarrhoea usually pass within 5 to 7 days.
Most children’s diarrhoea symptoms will not last longer
than 2 weeks
Clinical presentation

9. Complications
 Gastroenteritis can cause dehydration:
• This can be more serious than the rotavirus infection itself
and can require hospitalisation for intravenous rehydration
• Approximately 12,700 children are estimated to be
admitted to hospital each year with rotavirus in England
and Wales

10. Transmission
 Rotavirus is highly infectious
• As few as 10-100 virus particles may cause disease
Transmission mainly via the faecal-oral route
• If a child leaves tiny samples of infected faeces on surfaces
or utensils e.g. after not washing their hands properly after
going to the toilet, they can be picked up by another child
• Small droplets of infected faeces can also be carried in the
air, which children can breathe in

12. Epidemiology of Rota virus in England

13. Seasonality of Rota virus infection

14.  Recommendation from JCVI for rotavirus vaccine
• The Joint Committee on Vaccination and Immunisation
(JCVI) is the UK’s independent panel of immunisation
experts
• JCVI recommends that rotavirus vaccination should be given
to infants at two and three months of age i.e. two doses
• Rotavirus vaccination should significantly reduce rotavirus
gastroenteritis in young children
Why vaccine against Rota virus???

15.  Effectiveness of the vaccine
• Very effective at protecting against the most common
strains of rotavirus
• Very effective in protecting against severe rotavirus
infection requiring hospitalisation

16. Use of Rotarix®

17. • From July 1st 2013, Rotarix® will be used for rotavirus
immunisation programme
• Generic name: Rotavirus vaccine, live
• Rotarix® Marketed by GlaxoSmithKline
• Licensed from 6 weeks to 24 weeks
• Oral suspension in a prefilled oral applicator
• Container dimensions 42x24x133mm

18.  Active ingredient
 -Human rotavirus RIX4414 strain
 -Live attenuated
 -Not less than 106.0 CCID50
 Excipients
 -Sucrose
 -Di-sodium Adipate
 -Dulbecco’s Modified Eagle Medium
 -Sterile water
Rota virus composition

19. • Prefilled oral applicator
• Oral suspension
• Each dose contains 1.5ml of clear colourless liquid
Rotarix® presentation

20.  Rotarix® must be stored in accordance with
manufacturer’s instructions
 Cold chain must be maintained
• Store between +2°C and +8°C
• Store in original packaging
• Protect from light
Storage

21.  2 dose schedule
• First dose of 1.5ml at 8 weeks (two months) of age
 • Second dose of 1.5ml at least four weeks after the first (i.e.
12 week appointment)
• It is preferable that the full course of two doses is completed
before 16 weeks of age. Rotarix® must be given no later than
24 weeks (i.e. 23 weeks and 6 days)
 • The first dose must be given before 15 weeks of age. If infant
does not have first dose before 15 weeks then do not give
Rotarix®
 • If the course is interrupted it should be resumed but not
repeated, provided that the second dose can be given before 24
weeks
 • If infant spits out/regurgitates most of dose, a replacement
dose may be given at same visit
Dosage and schedule

22. DOSAGE

23.  Rotarix is different from the other infant vaccines, as it is a
LIVE ORAL vaccine and must not be injected

 Rotarix® can be administered at the same time as other
childhood vaccines
Administration of Rotarix

24. NEW DELHI: India will soon have a locally manufactured low cost
rotavirus vaccine as part of the government's universal immunization
programme (UIP). The vaccine is expected to be available at almost one-
fifteenth of the current market price, a senior official, privy to
developments, said.
"Bharat Biotech, which has been licensed for manufacturing of this
vaccine, has already made 5-6 million doses. However, the requirement is
much more to meet the UIP demand. The vaccine is likely to be launched
in the market as well as in the UIP in 2015 itself," M K Bhan, founder
chairman of the Biotechnology Industry Research Assistance Council and
former secretary, department of biotechnology said. Bhan is currently
national science professor at Indian Institute of Technology (IIT), Delhi
and deeply associated with infant mortality.
According to Bhan, while the locally developed vaccine is almost ready to
be launched, the company is waiting for a final approval from the Drugs
Controller General of India for the manufacturing plant
REPORT ON VACCINE

25. RECENT RESEARCH
 Recent research was on rotavirus infections and
circulating strains in small ruminants.
 Recent years have seen an intensification of surveillance
in humans and live stock animals where vaccines are
available led to better understand the epidemiology ,ecology
and evolution of RVA strains in other hosts, including
lambs,goats and camelids.
on the otherhand there is no comprehensive review
articleon exotic rotaviruses in domestic animals and birds.
These exotic rota viruses are derived from RVA strains
common to other host species ,possibly through interspecies
transmission coupled with reassortment events.

26. • Confirmed anaphylactic reaction to a previous rotavirus
vaccine
• Confirmed anaphylactic reaction to component of
vaccine
• Previous history intussusception
• Over 24 weeks of age
• Infants presenting for their first dose of Rotarix® over
15 weeks of age
• Severe Combined Immunodeficiency (SCID) disorder
• Malformation of GI tract that could predispose to
intussusception.
• Rare hereditary problems of fructose intolerance,
glucose-galactose malabsorption or sucrose-isomaltose
insufficiency.There are very few infants who cannot
receive rotavirus vaccine
CONTRAINDICATIONS

27. PRECAUTIONS
• Potential transmission of live attenuated vaccine from
infant
• Vaccination of the infant will offer protection to household
contacts from wild-type rotavirus disease and outweigh
any risk from transmission of vaccine virus to any
immuno-compromised close contacts
 Those in close contact with recently vaccinated infants
should observe good personal hygiene.

28. RESOURCES
•Green Book Rotavirus chapter
•Journal on virology
•WHO
•CDC

29. THANK U