Wednesday, June 24, 2009

STI: No ordinary diarrhoea

June 25, 2009

No ordinary diarrhoea

Rotavirus can cause severe vomiting and diarrhoea in kids. POON CHIAN HUI finds out how one family coped with the infection

By the age of five, almost every child would have been infected by the rotavirus bug. Yet, there is a vaccine for this common illness which can cause fever, diarrhoea and vomiting.

On June 5, the World Health Organisation recommended that the oral vaccine be included in national immunisation programmes.

In the same week, Singapore's Ministry of Health said the vaccine will not join the list of compulsory childhood vaccines here. It cited the low risk of complications as a reason: No child has died from the virus here.

Should children here be vaccinated?

Professor Phua Kong Boo, a senior consultant at the paediatric department at KK Women's and Children's Hospital (KKH), believes that the vaccine will help to reduce the number of children who suffer from the virus' severe symptoms. In 2007, 650 children were hospitalised at KKH for rotavirus.

The vaccine will also help the parents cope and save on medical bills when their children fall sick.

Ms Shirin Kamarudin, 37, had a harrowing experience two years ago when her three youngest children - now three, five and six years old - caught the virus one after another. Then, she paid more than $8,000 for visits to clinics and hospital stays.

'I was surviving on two to three hours of sleep every day,' said the nurse, who knew about rotavirus but did not get her children vaccinated as she did not expect them to become infected by it. She also has a 14-year-old daughter.

Prof Phua gave another reason for kids to be vaccinated: There is no cure for rotavirus. 'Once a child catches the virus, he must go through the stages of the infection until his immune system overcomes the virus on its own,' he said. 'There is, at present, no medication to eliminate the virus from the body.'

Rotavirus is typically spread by the faecal-oral route, that is, from infected stools to the mouth. Its transmission is often indirect, such as through the consumption of contaminated food or water.

Children, especially those between three months and two years old, can easily catch the infection. It also spreads quickly by person-to-person contact.

Fever usually develops first, with vomiting that lasts up to three days. This is followed by frequent diarrhoea for the next three to nine days.

Prof Phua said the key danger is dehydration due to frequent diarrhoea - up to 20 times daily - and vomiting. Hence, the child must drink enough water to compensate for fluid loss.

Dr Veronica Toh, a consultant neonatologist and paediatrician at Raffles Hospital, advised parents to take their child to a doctor if he is below six years of age and has fever, vomiting and diarrhoea. 'The younger the patient, the worse the illness gets,' she said, adding that dehydration may set in more quickly. In such cases, fluid has to be given intravenously.

Because the virus is very hardy - it can thrive on human hands and on furniture for hours - the best way to reduce the risk of getting infected is through proper handwashing, Dr Toh said. 'Washing your hands before you eat minimises your chances of accidentally coming into contact with rotavirus.'

Two rotavirus vaccines, Rotarix and Rotateq, are available here. They are taken orally in two and three doses respectively. The complete course for each vaccine is about $200.

However, vaccination is not completely foolproof - there is a 10 to 20 per cent chance that one may still get rotavirus, depending on the severity of the infection, said Dr Toh.

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