EXTENDED EXCRETION OF ROTAVIRUS AFTER SEVERE DIARRHEA IN YOUNG-CHILDREN

Background Rotaviruses are the major cause of severe childhood diarrho ea. Knowledge of the natural history of infection, including duration of intestinal virus shedding, is important in the understanding of tra nsmission, sources of infection, and immune responses. Methods We carr ied out a study of rotavirus excretion in 37 children admitted to hosp ital with severe rotavirus diarrhoea. Sequential faecal specimens were collected from each child during 100 days of surveillance, and screen ed for rotavirus by EIA and by amplification of genome double-stranded RNA by reverse-transcription PCR. IgA coproantibody was estimated by EIA. Findings Duration of rotavirus excretion ranged from 4 to 57 days after onset of diarrhoea. Excretion ceased within 10 days in 16 (43%) children, and within 20 days in 26 (70%) children. Extended excretion was detected for 25-57 days in the remaining 11 (30%) children owing mainly to continued excretion of the primary infecting strain. Extende d excretion was significantly associated with antirotavirus IgA coproa ntibody boosts during 100 days of surveillance (p=0.001, log-rank test ), and with recurrence of mild diarrhoea symptoms during convalescence (p=0.006, Fisher's exact test). Interpretation Severe rotavirus disea se in young children may be followed by extended excretion of rotaviru s. The risk of transmission to others may be greater than previously b elieved. Extended excretion could also explain some cases of the postg astroenteritis syndrome.