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Developments in the Treatment of Rotaviral Gastroenteritis

Oral Therapy with Immunoglobulins and Prospects for a Vaccine

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Summary

Rotavirus is the most frequent agent of gastroenteritis in both industrialised and developing countries. It is responsible for a high number of deaths, hospitalisations and nosocomial infections. Besides rehydration, no specific therapy effective against the virus has so far been developed. However, immunotherapy involving oral administration of human serum immunoglobulin meets the criteria for ideal drug therapy for the following reasons: (a) commercially available immunoglobulin preparations have high neutralising antibody titres directed toward rotavirus; (b) the antibodies survive the gastric barrier and remain active throughout the intestine; (c) no adverse effects are associated with oral administration of immunoglobulin.

Preliminary studies have shown the efficacy of a single oral administration of immunoglobulin to children with severe and protracted rotaviral diarrhoea. Subsequently, a double-blind case- and placebo-controlled trial showed that immunotherapy was effective in decreasing the severity of symptoms and the duration of diarrhoea, viral excretion and hospital stay in children admitted with acute rotaviral gastroenteritis. The cost effectiveness of immunotherapy was also clearly proved. This therapy should therefore be considered for children admitted with rotaviral diarrhoea.

Because rotavirus is a large scale worldwide problem, attempts at making an effective vaccine are being pursued. Initial approaches were based on the use of high-passage attenuated rotavirus strains obtained from animals. Genetically engineered strains were also used. However, clinical trials have been only partially successful. The use of new tools available from molecular biology may help to overcome the problem of efficacy and duration of vaccine-induced immunity.

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Correspondence to Dr Alfredo Guarino.

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Guarino, A., Canani, R.B. & Russo, S. Developments in the Treatment of Rotaviral Gastroenteritis. Clin. Immunother. 3, 476–484 (1995). https://doi.org/10.1007/BF03259066

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Keywords

  • Gastroenteritis
  • Bovine Colostrum
  • Rotaviral Gastroenteritis
  • Communicable Disease Report
  • High Neutralise Antibody Titre