IN recent weeks there has been an increase in cases of rotaviral gastroenteritis in young children in Jamaica; although alarming, the occurrence is not new to Jamaica and many other countries.
History has illustrated that since the 1970s rotaviral gastroenteritis has been a leading cause of diarrhoeal illnesses amongst young children globally — and in fact in the year 2003 Jamaica experienced 12 deaths of young children attributable to diarrhoea, with eight of the deaths occurring amongst children under three years old. Analysis of samples confirmed that most of the illnesses were linked to rotavirus.
As the name suggests, this type of gastroenteritis is caused by the rotavirus and results in the hospitalisation of approximately 55,000 children each year in the United States and the death of over 600,000 children worldwide. Like most other infectious illnesses, the cases reported are estimated to be a mere 10 per cent of the actual number of the illnesses that exist. Jamaica and other countries that experience similar temperatures and climate often see an increase in the illness during the cooler months of the year, and like many other viruses the rotavirus fares well in the environment and will cause an infection once it enters the body of an individual.
Common signs and symptoms of rotaviral gastroenteritis
The rotavirus causes inflammation of the stomach and intestines; hence most patients will experience diarrhoea, fever, and vomiting. Severe dehydration is also likely to occur in those who are within the susceptible population such as young children, especially those under five years old.
Causes and risk factors
There are five main strains of rotavirus that are responsible for over 90 per cent of rotavirus infections in humans. Importantly, the illness is transmitted via the faecal-oral route, hence the reason most cases occur amongst young children, especially those of day-care age. Globally, outbreaks of this illness have also occurred in the adult population, especially amongst those who are immunocompromised and exist in settings where there are poor hand hygiene and sanitation practices. Secondary transmission or person-to-person spread has always been a major route through which the illness is spread. Close contact of ill individuals therefore stands as a major factor in the contraction and spread of the illness.
In early childhood settings, such as day-care centres, common sources of infection that lead to the spread of this illness are toys and other inanimate objects that are shared. Generally, touching a surface that has been contaminated with the rotavirus and touching the mouth area can result in the infection.
Methods of prevention and control
In order to break the transmission of the illness and curtail its spread, the source of the infection must be targeted. A rotaviral vaccine is available, and when administered to children the chances of a child contracting the illness are greatly reduced. However, other measures of prevention and control are necessary.
Due to the fact that the virus can live for several hours on the hands, and for longer on hard surfaces, proper and frequent hand washing and adhering to good sanitation practices should be exercised as these strategies can reduce the spread of the illnesses by more than fifty per cent.
Hand hygiene policies should therefore be promoted and adhered to in public spaces, especially where populations of young children and other susceptible groups exist. Before eating and after using the restrooms are important intervals to which attention must be paid in relation to the washing of hands with soap (antibacterial liquid soap) and water. People who would have come in contact with ill individuals and their caregivers are encouraged to wash the hands as often as necessary; inclusive of times such as after the changing and handling of soiled diapers.
In early childhood settings, dwellings, and other areas where the susceptible population exist, proper cleaning and disinfection of surfaces such as handrails, sleeping mattress, eating utensils and toys are recommended. When disinfection is being carried out in these areas the following solutions have proven useful in deactivating the virus on surfaces:
• Chlorine bleach solution — half cup of regular household bleach in three quarters of a gallon of water, or the use of a 10 per cent iodine solution. One should take into consideration that whichever solution is used, it should be left on the surface for at least 10 minutes
• 70 per cent isopropyl alcohol left on the surface for 30 seconds
• Feeding bottles, eating utensils and toys should be washed and then sanitised in a solution made from two teaspoons of regular household bleach to one gallon of water. The items should be soaked in the bleach solution for at least two minutes then be allowed to air dry.
Other methods of prevention
• Use only safely treated water for drinking, preparing foods, and other purposes such as hand washing.
• Properly wash and sanitise raw fruits and vegetables before consumption.
• Minimise contact with ill people until at least two days have passed after the last episode of diarrhoea and vomiting.
• After each episode of diarrhoea or vomiting, clean toilet bowls and pipe taps thoroughly with disinfecting solutions.
• Do not share the toys, towels and eating utensils of those who have the infection with other members of the household.
• Ill people should not enter a swimming pool for the first two weeks after their last episode of diarrhoea.
Rotaviral gastroenteritis can be severe and should be treated with great keenness and proficiency. Sick individuals should:
• Seek medical attention early.
• Consume enough fluids to prevent dehydration.
• Use a recommended electrolyte replacement such as Pedialyte.
• Take fever-reducing medication such as acetaminophen. (This should be done according to guidelines given by a medical professional; aspirin is not recommended).
• Follow up with a health-care provider as necessary.
• Eat smaller and more frequently instead of consuming larger meals.
The benefits of prevention
It might seem difficult to always quantify the financial cost associated with the outbreak of this illness, nevertheless, the current outbreak in Jamaica as well the global mortality and morbidity rates associated with this disease concretise the fact that there are benefits to be derived if attention is paid towards efforts and strategies that can prevent this illness, and ultimately protect the vulnerable population.
Vaccination has undoubtedly proven to be the most effective method of preventing the rotaviral infection amongst young children. However, because children are not the only ones affected by this illness the benefits of hand washing coupled with environmental sanitation must be embraced and promoted, not just in the times of an outbreak but instead in a proactive way. More stringent policies that support and mandate adequate installation and proper use of hand washing facilities in educational institutions and in other places where the vulnerable populations exist, and specially designed training in hygiene and sanitation geared towards educating stakeholders such as caregivers will serve well in reducing future incidence of rotaviral or other infections of a similar nature in Jamaica.
Karlene Atkinson is a public health specialist and lecturer at the School of Public Health, University of Technology Jamaica. She can be contacted by email:firstname.lastname@example.org