[Rotavirus: clinical features and prevention]
OBJECTIVES: This report was prepared with the main objective of making an extensive review of both clinical features and prevention of rotavirus gastroenteritis. In addition, it provides an evaluation about the potential for introduction of the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) in the developing countries. METHODS: The main source of information was the most relevant articles published in both national and international journals, as well as selected official reports from the World Health Organization. With regard to rotavirus vaccines, particular emphasis has been placed on the results available from studies carried out during the past five years. Notice we have stressed the epidemiological features of rotavirus infections in Brazil. RESULTS: As a background for the main subjects of this report - clinical features and prevention - available general information on rotavirus infections are briefly discussed in the Introduction. This includes an overview of the etiological agent, epidemiology, immunity and laboratory diagnosis. A detailed description of the typical symptomatic syndrome is made, as well as of other (unusual) clinical manifestations of rotavirus illness. We also discuss the rotavirus candidate vaccines that have been evaluated to date, highlighting the most significant observations which resulted from field trials with the RRV-TV in several countries. The potential for large-scale use of RRV-TV in developing countries is also discussed, focusing mainly on the epidemiological characteristics of rotavirus disease in these regions. CONCLUSION: Rotaviruses are the leading cause of severe gastroenteritis in infants and young children in both industrialized and lessdeveloped countries; in the latter regions, rotavirus diarrhoeal disease represents a major cause of mortality. There is currently a consensus that attempts at prevention need to be directed toward the development of an effective rotavirus vaccine, for large-scale use, that would primarily protect children (aged 0 to 2 years) against severe rotavirus gastroenteritis. In this regard, results from a recent reevaluation of the Peruvian and Brazilian lower-titer RRV-TV efficacy data are promising. Although the RRV-TV ("Rotashield(R)") (recently licensed for general use in U.S.A.) seems to be currently the most promising rotavirus vaccine, it has been suggested that further trials with this vaccine should be conducted in Africa and Asia (efficacy studies) and Latin America [immunogenicity and effectiveness (efficacy under real conditions in a given setting)]. In addition, it is of paramount importance to establish in these regions a surveillance system to monitor the circulating rotavirus strains.
Oliveira
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Fundação Nacional de Saúde (FNS), Belém, PA, Brazil.
Linhares
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AC