Rotavirus is the most common cause of sporadic, severe, dehydrating diarrhea in young children worldwide (peak incidence, age 3 to 15 months). Diagnosis is based on clinical suspicion, but polymerase chain reaction testing as part of a multiplex panel for a variety of causes of acute gastroenteritis can be done. Treatment is supportive with oral fluids, but occasionally IV fluids are needed.
Rotavirus incidence has decreased significantly in the United States since the introduction of routine rotavirus immunization, with an approximately 75% reduction in test positivity and a 75 to 90% reduction in hospitalization in children under 3 years of age (1, 2). Rotavirus is highly contagious; most infections occur by the fecal-oral route. Adults may be infected after close contact with an infected infant.
In temperate climates, most infections occur in the winter and spring. In the United States before rotavirus vaccination became available, a wave of rotavirus illness would begin in the Southwest in December and end in the Northeast in April or May. Now, the illness occurs less predictably and can occur year round (3).
Incubation period is 1 to 3 days.
(See also Overview of Gastroenteritis.)
General references
1. Hallowell BD, Parashar UD, Curns A, DeGroote NP, Tate JE. Trends in the Laboratory Detection of Rotavirus Before and After Implementation of Routine Rotavirus Vaccination - United States, 2000-2018. MMWR Morb Mortal Wkly Rep 2019;68(24):539-543. doi:10.15585/mmwr.mm6824a2
2. Staat MA, Payne DC, Halasa N, et al. Continued Evidence of the Impact of Rotavirus Vaccine in Children Less Than 3 Years of Age From the United States New Vaccine Surveillance Network: A Multisite Active Surveillance Program, 2006-2016. Clin Infect Dis 2020;71(9):e421-e429. doi:10.1093/cid/ciaa150
3. Centers for Disease Control and Prevention: Rotavirus: Clinical Overview of Rotavirus. Accessed March 31, 2025.
Symptoms and Signs of Rotavirus Gastroenteritis
Rotavirus gastroenteritis in infants and young children may last 5 to 7 days.
Vomiting occurs in ≥ 80% of patients, and fever > 39° C (> 102.2° F) occurs in up to 60% (1).
Diarrhea is watery and non-bloody.
In adults, the symptoms of rotavirus gastroenteritis are usually mild. In children, the diarrhea is more likely to cause severe dehydration and even death.
Symptoms and signs reference
1. Coffin SE, Elser J, Marchant C, et al. Impact of acute rotavirus gastroenteritis on pediatric outpatient practices in the United States. Pediatr Infect Dis J 2006;25(7):584-589. doi:10.1097/01.inf.0000220251.27595.74
Diagnosis of Rotavirus Gastroenteritis
Sometimes, immune-based assays or polymerase chain reaction (PCR) testing
Diagnostic testing is not routinely done except to diagnose an outbreak; when done, it involves tests to identify rotavirus in the stool. Enzyme-linked immunosorbent assay (ELISA) and latex agglutination are 2 commonly used tests.
Nucleic acid testing (PCR) is very sensitive and is often done in a multiplex PCR panel, including a number of causes of gastroenteritis.
Treatment of Rotavirus Gastroenteritis
Oral or IV fluids
Sometimes antidiarrheal (antimotility) agents and/or antiemetics
Supportive care including rehydration with fluids and electrolytes is the mainstay of treatment and is all that is needed for most adults. Oral glucose-electrolyte solutions, broth, or bouillon may prevent dehydration or treat mild dehydration. Children may become dehydrated more quickly and should be given an appropriate rehydration solution (several are available commercially—see Oral Rehydration), although dilute apple juice or the fluid preferred by the child can be a reasonable option (1). An antiemetic (eg, ondansetron) may be given if vomiting makes oral rehydration difficult.). An antiemetic (eg, ondansetron) may be given if vomiting makes oral rehydration difficult.
Isotonic IV fluids such as Ringer’s lactate and normal saline solution should be given when there is severe dehydration, shock, or altered mental status and ileus or failure of oral rehydration therapy (2). In severe dehydration, IV rehydration should be continued until pulse, perfusion, and mental status normalize.
Antidiarrheal (antimotility) agents should not be given to children < 18 years of age with acute diarrhea (2). Antidiarrheals can be considered in adult patients with watery diarrhea (as shown by heme-negative stool), especially during an outbreak, suggesting a viral cause is likely. However, antidiarrheals may cause deterioration of patients with Clostridioides difficile or E. coli O157:H7 infection and thus should not be given to any patients in whom the cause of diarrhea has not been identified and in whom these disorders may be suspected (ie, based on recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever).
Treatment references
1. Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA 2016;315(18):1966-1974. doi:10.1001/jama.2016.5352
2. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis 2017;65(12):e45-e80. doi:10.1093/cid/cix669
Prevention of Rotavirus Gastroenteritis
Two live-attenuated oral rotavirus vaccines are available that are safe and effective against the majority of strains responsible for disease (1, 2). Rotavirus immunization is part of the recommended infant vaccination schedule.
Prevention references
1. Centers for Disease Control and Prevention: Rotavirus Vaccination: Information for Healthcare Professionals. March 25, 2021. Accessed April 3, 2025.
2. Donato CM, Bines JE. Rotaviruses and Rotavirus Vaccines. Pathogens 2021;10(8):959. doi:10.3390/pathogens10080959
Key Points
Rotavirus gastroenteritis has significantly decreased in countries where the rotavirus vaccine is widely used, but it remains a significant cause of serious and potentially fatal diarrheal disease in children worldwide.
Clinical course may last 5 to 7 days.
Oral rehydration is usually adequate, but antiemetics and sometimes IV fluids may be needed.
Antidiarrheal (antimotility) agents are safe for adults with watery diarrhea but should be avoided in children < 18 years of age and in any patient with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever.
