Talk:Rotavirus/archive2

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Contents 1 Archives 2 GA review 3 Diagnosis 4 Treatment 5 Article structure 6 Lead paragraph 7 Severe diarrhea 8 Images 9 References, discussion of 10 Rotavirus as pathogen involved in 'cruise ship crud'? 11 Rotavirus Vaccine Program 12 Rotavirus and Reovirus 13 Lead 13.1 Fecal-oral cycle 14 Death rates 15 External links 16 iz or is? 17 Scary lead 18 Getting to FAC 19 A review 19.1 Lead at this version 19.2 History at this version 19.3 Comments on this version 19.4 Comments on this version (03/02/2008) 20 Problem with numbers 21 Light and Hodes 22 Signs and symptoms 23 Epidemiology review 24 Review by DO11.10 25 Disease mechanisms 26 Quick review by Fvasconcellos 27 References

[edit] Archives

Out of date discussion has been deleted. User:GrahamColm

Graham, I set up a talk page archive; you should always archive, rather than delete, old talk page entries. SandyGeorgia (Talk) 01:00, 19 November 2007 (UTC)

Someone please point us to an article that shows us all how to archive. Thanks! --Una Smith (talk) 06:01, 30 November 2007 (UTC)

Ah, nevermind, the link Archives is to an article that is about archives. --Una Smith (talk) 06:03, 30 November 2007 (UTC)

[edit] GA review

I found this article to be an excellent article which is close to WP:FA. Some concerns and suggestions:

• the main problem seems to be jargon and terminology, although clearly this has already received substantial attention, and this is not an easy subject.
• the second biggest problem is that free images belong on Wikimedia Commons and should be moved there. This will benefit other language versions of Wikipedia.
• this article is written from a virologist point of view, perhaps more referencing efforts should be made from a clinical perspective (with clinical articles). For example, the diagnosis and treatment section could be expanded, although a link to viral gastroenteritis is probably more appropriate. Are there any statistics on diagnostic accuracy and such, indications for diagnosis, ...? Surely intussusception could be mentioned as a complication not only of vaccines but also of rotavirus itself?
• I would like to some some referencing in the article lead, mostly for the presented numbers on deaths etc.
• the comparison with influenza using tables seems more academic, and could probably be simplified and shortened in a few sentences.

Overall this is really something we can use to show off, nice work! --Steven Fruitsmaak (Reply) 01:45, 27 November 2007 (UTC)

P.S.: Gestational diabetes has replaced this article as a Good article candidate, feel free to review it.

Very nice, Graham ! Now maybe you can badger the Virus and Medicine Project talk pages to get input as to readiness for WP:FAC; I'm not a physician or a biologist, so I can't help, but it's quite a nice article. SandyGeorgia (Talk) 06:15, 29 November 2007 (UTC)

One thing I can think of, be sure to read WP:LEAD and make sure the lead is a summary of the article highlights, covering all important areas, and that nothing is introduced in the lead that isn't covered in the article. SandyGeorgia (Talk) 06:17, 29 November 2007 (UTC)

[edit] Diagnosis

I have done a moderate rewrite of the diagnosis section. It needs more wiki links, and more depth of discussion. Here are some specific points to discuss. Children with suspected rotavirus often are not tested; when is a specific diagnosis helpful? The EIA kits are screening tests, so I would not expect high accuracy; in what sense are these kits very accurate? Eg, what is their documented sensitivity and specificity. Are they less sensitive and/or specific with respect to some strains of the virus? At the end of the section I am left wondering "so what?" Are any of these tests in wide use? Why are they in wide use? How wide? --Una Smith (talk) 05:44, 30 November 2007 (UTC)

"These test kits are very sensitive, specific and...", but what are the actual values? And does "These test kits" refer only to kits using the EIA method? Is electron microscopy really used for routine diagnosis? Or is it a research tool? --66.167.40.113 16:00, 30 November 2007 (UTC)

The actual values are high around 99% for specificity and 97-98% for sensitivity. These are good values for a diagnostic test. Some labs still use the electron microscope because it is a catch-all method in that it allows other viruses such as adenoviruses to be detected.--GrahamColm^Talk 19:45, 30 November 2007 (UTC)

(I took the liberty of changing the format of the above paragraph.) Yes, those numbers are very good. However, dont those numbers apply to use of the test in the context of a specific population with a given distribution of viruses? --Una Smith 22:31, 30 November 2007 (UTC)

It is my understanding that tests specific for rotavirus are used mostly for purposes of public health surveillance; they are not widely used for clinical diagnosis. --Una Smith 16:26, 30 November 2007 (UTC)

No. I perform rotavirus tests on sick children everyday. I did four this morning and the UK rotavirus "season" hasn't started yet. Each year I test around 1,000 kids and my hospital is not very large. And rotavirus test kits are big business. GrahamColm^Talk 19:45, 30 November 2007 (UTC)

Ah, now we're talking. Indeed there are POV issues here; POV always exist, but can be hard to spot. --Una Smith 22:31, 30 November 2007 (UTC)

• Yes. Well spotted. You are right, of course, Una, and I apologise. I have learnt a lesson here. Perhaps I am standing too close to the trees to see the forest. We clearly agree on the importance of RV infections, but need to reach a consensus on the importance of diagnosis. At the risk of a POV, I think specific diagnosis is important in the hospital setting for the reasons I have given but I concede that you are right with regard to moms and dads looking after kids at home. Now the challenge is how to work this into the article. But the article is right about the sensitivity and specificity figures; these kits have been evaluated world-wide.

The section now begins with It is important to diagnose rotavirus infection because other pathogens cause gastroenteritis in children. Unlike shigella and giardia, for example, rotavirus infections do not need treatment with antibiotics and infected children usually make a full recovery after a few days. This is true in a sense but the key is to distinguish between viral and bacterial causes of gastroenteritis. Which virus is of far lower importance. And the usual diagnostic method is merely to wait and see. If the child gets better in a few days, probably the cause was viral. If not, then the cause may be bacterial and a specific diagnosis may be important for selection of an appropriate antibiotic. This is a topic for Gastroenteritis, not this article. --Una Smith 16:26, 30 November 2007 (UTC)

I disagree with you. Norovirus is far more infectious than rotavirus. It is very important to distinguish them. A kid on a hospital ward with rotavirus, if well managed, is unlikely to infect the other kids. A patient with norovirus, unless isolated, will infect all the other patients and the staff. I think we must have different policies in the UK. Kids admitted with diarrhoea are tested for rotavirus as a matter of urgency. Our family doctors also send specimens to hospital labs from children who remain at home. I think we are looking at this from different perspectives. Of the 200 or so kids under five years old admitted to my hospital each year, over half of them have rotavirus infections. If a child has severe diarrhoea, in my experience, parents do not wait and see; they ask for help. GrahamColm^Talk 19:45, 30 November 2007 (UTC)

This is a good explanation about the hospital context that belongs in the article, but not as it stands, which would be original research. Can you locate some references? Standard practice in the US seems far more oriented to keeping infected kids out of hospitals. There are many reasons for this, including economics and policies of the US health insurance system, but also because most of the US has very low population density compared to the UK, so hospitalization of infants and young children has logistic and financial complexities that may not exist in the UK. Common practice here is to keep the child at home regardless of the severity of diarrhea; the decision point is severity of dehydration. Admission to hospital is necessary only if IV or NG rehydration therapy is necessary. Dehydration is managed very proactively with oral rehydration therapy, greatly reducing the likelihood that dehydration will become so severe that admission to hospital is necessary. --Una Smith 22:31, 30 November 2007 (UTC)

• This is a very important and valid critiscism and one that must be addressed in the article. I will have to give this some serious thought. I will get back to you, thanks for making me think more deeply about this. --GrahamColm^Talk 23:31, 30 November 2007 (UTC)

• The importance of rotavirus is fully established and beyond doubt, hence the vaccine project. Please ask yourself why is all this money, (billions) being spent on developing a vaccine? GrahamColm^Talk 19:45, 30 November 2007 (UTC) (attribution added by User:Una Smith)

Politics, policies, and economics of vaccine design and development are far outside the scope of this article. Re this article, I agree with you that rotavirus is an important virus; what I question is the claimed importance of diagnosis of rotavirus. --Una Smith 22:31, 30 November 2007 (UTC)

[edit] Treatment

I also cleaned up the treatment section a bit, but I have to agree with the GA reviewer that maybe the section would be better as a link to a main article viral gastroenteritis, eg "Treatment for acute rotavirus infection is as for any viral gastroenteritis." --Una Smith 16:12, 30 November 2007 (UTC)

According to this Merck Manual, antibiotics are given for some gastroenteritis, depending on the causal agent. --Una Smith (talk) 15:16, 5 January 2008 (UTC)

• Una, sorry I can't get the link to work. Anyhow, my understanding is this: the use of antibiotics for treating GE caused by bacteria is very rare. Only if there is a development of a secondary bacteraemia, (which is very rare), are antibiotics used to treat the bacteraemia. For straight-forward GE, you can't use ciprofloxacin to treat shigelae in children because it is contra-indicated in this age group. Kids don't get C. difficile, so forget metronidazole. Very, very rarely is azithromycin indicated for campylobacter. But, we don't need to say all this in an article about rotavirus. Graham. --GrahamColm^Talk 15:47, 5 January 2008 (UTC)

[edit] Article structure

I suggest adding the short section about rotavirus in animals to the section now titled "Microbiology", and retitle the section "Natural history". Make "Pathogenesis" a subsection of Natural history. Epidemiology follows from Natural history nicely. Note the Epidemiology section now repeats some information in the current Microbiology section, and also contains some information that applies to viral gastroenteritis in general and is in no way specific to rotavirus. If no one gets to this before me, I will try to make all these changes this weekend. --Una Smith (talk) 06:15, 30 November 2007 (UTC)

Hm. The current location of "Diagnosis and treatment" between "Epidemics" and "Vaccines" is slighly awkward. The article would flow better if Vaccines follows directly after Epidemics. --Una Smith (talk) 22:18, 4 December 2007 (UTC)

Perhaps Diagnosis and treatment would be better placed before Epidemiology? What do you think Una? --GrahamColm^Talk 22:28, 4 December 2007 (UTC)

Yes. --Una Smith (talk) 05:11, 5 December 2007 (UTC)

Pathogenesis and Complications are now under Natural history but probably belong in a separate section, together with Diagnosis and treatment. Call that section Infection in humans or something like it, with the usual structure for clinical information. --Una Smith (talk) 17:57, 8 January 2008 (UTC)

[edit] Lead paragraph

• The lead overstates the role of rotavirus in causing viral gastroenteritis. In the article body there is a rather vague mention of rotavirus causing 20%. --Una Smith 16:12, 30 November 2007 (UTC)

Rotavirus causes around 20% of cases of severe diarrhoea. The other 80% of cases are caused by all the other infectious agents including bacteria such as salmonellae, shigellae, vibrios, campylobacters, yersinia, E. coli 0157 and other viruses such as adenovirus types 40 and 41, astroviruses, norovirus and caliciviruses. It is by far the commonest cause of all gastroenteritis in children and the leading cause of viral gastroenteritis. The lead says that rotavirus is the commonest cause of viral gastroenteritis. The body says it causes around 20% of cases of severe diarrhoea. I have tried to make this clearer in the article.--GrahamColm^Talk 18:48, 30 November 2007 (UTC)

• The citation given is from 1995, and there is no mention of the apparently huge reduction since 1995 in childhood morbidity and mortality due to viral gastroenteritis, attributed to better access worldwide to basic rehydration therapies. Anyway, this information is not specific to rotavirus, so does not belong in the lead of this article. --Una Smith 16:12, 30 November 2007 (UTC)

Do you have a reference for this?--GrahamColm^Talk 18:56, 30 November 2007 (UTC)

Oral rehydration therapy has some references. --Una Smith 22:32, 30 November 2007 (UTC)

• "3 to 5% of all hospitalisations of children under age 5 are caused by rotavirus" does not excite me; does it really belong in the first paragraph? --Una Smith (talk) 19:17, 9 December 2007 (UTC)

Doesn't have to be - I'll find a new home for it. --GrahamColm^Talk 19:33, 9 December 2007 (UTC)

That sentence might belong in the lead, but I cannot guess why. There is no context. Is 3-5% large or small? This disease kills so many children in some countries. Is the point that more children should be hospitalized? Or that better treatment is needed so fewer children need to be hospitalized? What do you want to say with or about this fact? --Una Smith (talk) 03:36, 12 December 2007 (UTC)

[edit] Severe diarrhea

• The term severe diarrhea has come up several times now, and I think it needs to be defined. Graham, how do you define it? --Una Smith 22:35, 30 November 2007 (UTC)

Dear Una, there is an accepted severity score scale published by Timo Vesikari in the 1980s. It goes from one to twenty, but, essentially, severe diarrhoea (sorry English spelling), is a diarrhoea that requires controlled oral or IV rehydration therapy. I will let you know the reference in the morning, (it's past my bedtime). Best wishes Graham GrahamColm^Talk 23:39, 30 November 2007 (UTC) p.s. Did I thank you for your help? Well, I do now. G.

You're welcome. --Una Smith 06:02, 1 December 2007 (UTC)

This severity scale appears not to be explained on Wikipedia yet, nor the paper cited. Let's change that. It is important context for Rotavirus and several other articles. --Una Smith (talk) 05:14, 5 December 2007 (UTC)

Is this^[1] the paper? Mention of may belong on Diarrhea. --Una Smith (talk) 05:32, 5 December 2007 (UTC)

• Yes, that's the paper. It's by Tarja Ruuska and Timo Vesikari. I have a copy in front of me if you want full details of the system which was used in all the vaccine trials and most of the rotavirus disease burden studies.--GrahamColm^Talk 06:28, 5 December 2007 (UTC)

• Graham, could you add the severity scale to Diarrhea? This is important context for Rotavirus. --Una Smith (talk) 18:20, 24 December 2007 (UTC)

Yes of course, best place for it, I have made a note.--GrahamColm^Talk 18:44, 24 December 2007 (UTC)

[edit] Images

To answer a comment in an edit summary, not all viruses are encapsulated. Anyway, I added "encapsulated" to the image caption to help searchers find the image and caption. Perhaps the explanation belongs on the image page, not this article. I added "encapsulated" also to emphasize the stage in the lifecycle of this virus. Another pair of images used in this article shows a cell with and without virus, but to most readers the viruses are not apparent. The tell-tale is the wavy cell membrane! Those waves are "budding" viruses that are in the process of acquiring their coats (ie, becoming encapsulated). All of this is telegraphic, tacit knowledge. --Una Smith 20:09, 2 December 2007 (UTC)

• Dear Una, O.K. but I would prefer the description mature virus particles. Rotavirus does not have an envelope. This is my fault, I'm not very good at drawing my diagrams. I will have to tweak my replication diagram to make it clear that RVs are released by cellular lysis and NOT by budding. All viruses are encapsulated, (by defintion] but not all viruses have envelopes. Best wishes to you G. GrahamColm^Talk 20:29, 2 December 2007 (UTC)

Gaak, I mangled capsule with envelope. All viruses are encapsulated during some part of their normal lifecycle. --Una Smith 20:55, 2 December 2007 (UTC)

• This web page has an informative pie chart; something like it would be useful in this article. --Una Smith (talk) 15:18, 24 December 2007 (UTC)

We would have to recreate it from the original data which is probably not in a single review paper. Given the mess Herpes zoster got into wrt the epidemiology figures, I'm reluctant to compile a chart without the help of an epidemiologist. Besides, in doing so we would raise a big question that I don't want to try to answer in this article. It's called the diagnostic gap - all those episodes the GE that can't be explained.^[2]

Re that diagnostic gap, I expect it is due at least in part to the fact that in the US most infectious diarrhea in children is due to rotavirus and other viral agents. When children are hospitalized with severe diarrhea, depending on the source population there may or may not be a high suspicion of a bacterial cause. That leads me to another issue I have with the article. If every child in the world gets exposed to rotavirus, regardless of the safety of the public water supply, what difference does it make (wrt rotavirus!) how safe the water supply may be? Is there a management issue (eg, knowledge of unsafe water supply means greater likelihood of improper restriction of fluid intake means greater dehydration) or an issue of secondary infections (eg, damaged enterocytes means opportunistic infection by bacteria or other pathogens)? --Una Smith (talk) 21:16, 2 January 2008 (UTC)

Hi Una, greater minds than mine have tried to close the diagnostic gap which is beyond the scope of this article I think. WRT your second question, both you answers are true, but again perhaps outside the scope of RV. Graham. --GrahamColm^Talk 07:00, 3 January 2008 (UTC)

[edit] References, discussion of

Graham, thanks for expanding the references from PMID to full format. I gathered them while reading abstracts and did not want to break away from the reading. I have to say, though, tab-delimited references make an article so much easier to edit. I am having a very hard time seeing where the reference ends and the article text resumes. --Una Smith (talk) 03:42, 12 December 2007 (UTC)

Re the child mortality rates, there are numbers per year given in recent abstracts for other countries (gearing up for national vaccine programs), but I would have to look up the birth rate in each one to calculate rates. Is it worth doing, or is the data already present enough? (And what do you think about formatting it as a table?) --Una Smith (talk) 03:42, 12 December 2007 (UTC)

Dear Una, I've been thinking about this on and off all day. Yes, the data might be presented best as a table which we can update easily when all the other rotavirus disease burden studies are published and later use to show the impact of vaccination. I think the data as it stands is enough. If you calculate the rates we might be accused, (albeit wrongly), of contributing original research. Best wishes, Graham. --GrahamColm^Talk 16:41, 12 December 2007 (UTC)

[edit] Rotavirus as pathogen involved in 'cruise ship crud'?

Hearing my mother's tales from her cruise ship adventures, it appears that outbreaks of highly contagious and virulent pathogens causing rapid and widespread onset of diarrhea amongst adult cruise ship passengers are becoming ever more frequent, widespread, and severe. (Cruises are fun?) I think that someone in the know able to address causes of and pathogens involved in these outbreaks could add a lot to this article by addressing this topic, addressing particularly the merits of prophylactic vaccination for cruise ship passengers hoping to avoid 'cruise ship crud'. Darwinianphysicist (talk) 03:59, 20 December 2007 (UTC)

The virus involved is usually norovirus (see this), not rotavirus. Rotavirus affects mostly children (not adults) because it is abundant worldwide, hence most adults have already been exposed to it enough that they are immune. Norovirus affects adults on cruise ships because (1) norovirus is an emerging disease (so almost everyone is susceptible) and (2) cruise ships are crowded and isolation of sick passengers is limited. Norovirus has a brief section on prevention measures. --Una Smith (talk) 04:53, 20 December 2007 (UTC)

[edit] Rotavirus Vaccine Program

I have created this page and moved some of the Vaccine section to it. I have rated the new artcle as Start class. I and, I hope, other editors will expand the new article as the Program develops.--GrahamColm^Talk 16:51, 23 December 2007 (UTC)

[edit] Rotavirus and Reovirus

Please don't confuse these two distinct genera. Both are classified as in the family Reoviridae, but rotavirus is not a kind of reovirus, just as reovirus is not a kind of rotavirus. There are three kinds of reovirus, called 1, 2 and 3.--GrahamColm^Talk 08:52, 24 December 2007 (UTC)

According to the Reoviridae article, it is a reovirus. And the Encyclopedia Brittanica says: Reovirus is any of a group of ribonucleic acid (RNA) viruses constituting the family Reoviridae, so that includes rotavirus. --WS (talk) 13:00, 24 December 2007 (UTC)

According to the (not very good) Reoviridae rotavirus is a member of the reoviridae family not Orthoreovirus genus. As for the Encyclopedia Brittanica entry; it's wrong.

The members of the Reoviridae family are extremely varied in host ranges and have such diverse natural histories that it is compelling to conclude that their structural asset and replication strategy are uniquely successful in evolutionary terms. It follows that their study addresses fundamental aspects of virology, besides the ones which are customary with important pathogens affecting humans, animals and plants. We deal here with the present taxonomy of the family Reoviridae and of its genera, two of which (Orbivirus and Rotavirus) are treated separately in this issue. Along with a cursory presentation of the remaining genera, we give a concise update of recent findings on the genus Orthoreovirus. PMID: 8001342 (my emphasis)--GrahamColm^Talk 13:26, 24 December 2007 (UTC)

There is no genus Reovirus; "reovirus" refers to any virus in the family Reoviridae. But I see the family is a grab bag and in any case for most readers this information won't be meaningful, so I propose omitting the family from the lead. --Una Smith (talk) 15:08, 24 December 2007 (UTC) Let me rephrase that: is there a genus Reovirus? Several taxonomic refs don't include that genus. By "reovirus" I meant Reoviridae. --Una Smith (talk) 15:13, 24 December 2007 (UTC)

There is a genus reovirus, its proper name is Orthoreovirus, but many papers just say reovirus when referring to it. In the Reoviridae family we have the genera; Rotavirus, Coltivirus, Orbivirus, Orthoreovirus, Phytoreovirus, Cypovirus and a couple of others that I can't remember. Do a PubMed search on reovirus and see how many rotavirus papers come up. Not many I think. Please do not introduce this potentially misleading name. If reoviruses were well known, I could understand saying that rotaviruses area a kind of reovirus, but they are not well known. Can we drop this now and concentrate on rotavirus?--GrahamColm^Talk 17:05, 24 December 2007 (UTC)

[edit] Lead

(rewrite lead sentence re role not widely known) Una, that was one of your best edits! (ever)--GrahamColm^Talk 17:43, 24 December 2007 (UTC)

Thanks! The sentence now makes its point better, but still leaves the reader dangling. Waiting for more, KWIM? So either this sentence needs to go somewhere else, or the next paragraph needs to expand on its theme. --Una Smith (talk) 18:16, 24 December 2007 (UTC)

I think I fixed the "dangling reader" problem, by rearranging sentences of the lead first paragraph. I think the lead now develops a strong theme for the entire article. How about removing the following paragraphs, so that the lead paragraph is followed immediately by the story itself: history, natural history, diagnosis and treatment (as one section, all the "clinical" stuff), epidemiology, vaccine. --Una Smith (talk) 21:26, 26 December 2007 (UTC)

Re removal of headings; not a good idea. Firstly, it will make the article difficult to edit; secondly, Una, you know the article very well, so you don't need guiding thru it. Others will need the headings.--GrahamColm^Talk 15:31, 27 December 2007 (UTC)

I wasn't referring to the headings; those are necessary. I was referring to the short lead paragraphs about seasonality or lack thereof, species, and that the virus is highly infectious. Those are relatively minor points. The lead should mention all key points of the article, but not necessarily all points. --Una Smith (talk) 17:45, 27 December 2007 (UTC)

Sorry, I misunderstood. I'm all for short, snappy leads. Go for it, unless I get to it first.--GrahamColm^Talk 18:02, 27 December 2007 (UTC)

• FWIW, the lead on the CDC's Rotavirus home page says:

Rotavirus is the most common cause of severe diarrhea among children, resulting in the hospitalization of approximately 55,000 children each year in the United States and the death of over 600,000 children annually worldwide. The incubation period for rotavirus disease is approximately 2 days. The disease is characterized by vomiting and watery diarrhea for 3 - 8 days, and fever and abdominal pain occur frequently. Immunity after infection is incomplete, but repeat infections tend to be less severe than the original infection.

It has some information not brought out in this article. And I think this article lead now may overstate the immunity following infection. --Una Smith (talk) 18:08, 27 December 2007 (UTC)

Yes, we have overstated it. Old folk occasionally get it again too, when their immunity drops. Immunity is incomplete because of the serotypes. The reinfecting rotavirus is usually of a different serotype. I know the references for this.^[3] I'll sort this out. Well spotted.--GrahamColm^Talk 18:19, 27 December 2007 (UTC)

The lead now says "less susceptible", which is accurate. --Una Smith (talk) 15:31, 29 December 2007 (UTC)

[edit] Fecal-oral cycle

Re this text now in the lead:

"The virus can spread rapidly within families and close communities.[5] Large numbers of rotavirus particles are excreted by infected people, and are spread via the fecal–oral route."

This information is rather academic, because in the lead we already explain that everyone gets it, everywhere. And, by the numbers, clean vs dirty public water supplies are immaterial because even in the US (Americans are notorious throughout Europe for asking to drink tap water) everyone gets it, everywhere. Also, I think it is out of place where it is. The next sentence addresses ORT and vaccines to reduce morbidity and mortality (the previous sentence), not breaking the fecal-oral cycle. So, I suggest either move this information up to before the sentence about global exposure by age 5, or move it out of the lead entirely. --Una Smith (talk) 15:31, 29 December 2007 (UTC)

[edit] Death rates

• Variation in death rates is bothering me now. Is there evidence that the variation is not due to differences in virulence? Does Rotavirus A have geographic variants? --Una Smith (talk) 18:16, 24 December 2007 (UTC)

• Quick answer, no. Long answer, the distribution of G and P types shows georaphical and temporal variation.^[4] All types have turned-up somewhere at some time but there are no differnces in virulence.^[5]

[edit] External links

Could someone fix the external link template at the end of the article? I can't get the ICD 10 code to go to the right WHO webpage :-( --GrahamColm^Talk 15:37, 27 December 2007 (UTC)

Problem fixed. In this case the template needs all 5 arguments, as explained on Template:ICD10. --Una Smith (talk) 19:45, 27 December 2007 (UTC)

• Una, thanks, I'm not very good with these templates.--GrahamColm^Talk 19:53, 27 December 2007 (UTC)

[edit] iz or is?

Both were used, although mainly is (ise, isi and isa). Needs to be consistent. I chose the s in what I copy-edited. I presume it's in BrEng, where there's still a choice, although s is now far more common. Tony (talk) 06:57, 29 December 2007 (UTC)

• Thanks for your help Tony.--GrahamColm^Talk 15:33, 29 December 2007 (UTC)

[edit] Scary lead

I'm changing the first sentence of the lead because it will overly worry parents and others who care for ill children. I'm replacing the word death with gastroenteritis. As it currently stands the Google search brings up a very scary definition.GrahamColm^Talk 10:42, 8 January 2008 (UTC)

Scary definition of death, or of gastroenteritis? --Una Smith (talk) 15:08, 8 January 2008 (UTC)

Scary defination of rotavirus. I don't want mums and dads putting Rotavirus into Google and thinking their kid is going to die. :-( --GrahamColm^Talk 16:12, 8 January 2008 (UTC)

The lead is better now. --Una Smith (talk) 18:40, 8 January 2008 (UTC)

[edit] Getting to FAC

Well, Graham, what more work do you think the article needs before it goes to FAC? --Una Smith (talk) 18:40, 8 January 2008 (UTC)

• Happy New Year dear Una, the article is just waiting for Colin's review, (no hurry Colin!). It's on his to do list and he knows that I am pushing but not rushing. You have been great to work with on this. Let's wait for Colin to do what he does best, give him the time and space and then go for it. I am quietly confident, but the thought of FAC, (after my Virus FAC naїvety/stupidity), makes me come out in an exanthema. Best wishes, Graham. GrahamColm^Talk 21:27, 8 January 2008 (UTC)

• Now that FAC is close, I started reading the article again. The lead is very nice. More later. --Una Smith (talk) 07:10, 2 February 2008 (UTC)

[edit] A review

Graham, I've started reviewing this article and will begin with the lead and follow with other sections when I get a chance. The lead is important as it is the first and possibly only bit the reader will see, and being condensed it contains a lot of information.

• These responses are for my benefit too, so I can keep track of what I have done while it is still fresh in my mind.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

[edit] Lead at this version

• I like the change from "death" to "gastroenteritis" but I'd suggest going one further to "severe diarrhoea". The use of a relatively technical term so early in the lead sentence may be offputting. Note: regardless of what you do, the repeat wikilinking of one of these terms later in the lead is unnecessary.

Please leave it "gastroenteritis"; "severe diarrhoea" is a broader category and Diarrhoea needs even more work than Gastroenteritis does. --Una Smith (talk) 19:56, 12 January 2008 (UTC)

The quality of the linked articles is irrelevant, especially since both are linked within the lead paragraph. I'm not sure I understand the "broader category" comment, but (as I see it) rotavirus causes gastroenteritis which causes diarrhoea. As far as the patient (and reader) is concerned, the end result is the important one. Gastroenteritis is really quite a technical term, that the "general reader" may be unfamiliar with. It is a long polysyllabic word whose meaning can't be guessed. In terms of whether one word is more apt or precise here, the sources should be our guide. To take some of the first sources cited: "Rotavirus is the leading cause of severe diarrhea in infants."; "Rotavirus gastroenteritis is the leading cause of diarrheal disease..."; "Rotavirus is one of the major causes of severe diarrhea..."; "Rotavirus is the single most important cause of severe, dehydrating gastroenteritis"; "rotaviruses are the most commonly identified cause of viral enteritis and diarrhea". The CDC (whose website is aimed at the general reader) say "Rotavirus is the most common cause of severe diarrhea among children". I reckon "severe diarrhoea" has the edge. Colin°^Talk 20:37, 12 January 2008 (UTC)

Oversimplified, rotavirus causes gastroenteritis causes diarrhea causes dehydration causes death. Most cases of diarrhea have nothing to do with rotavirus. Also, most do not lead to dehydration and thus are not life threatening. I want to avoid emphasis on diarrhea because an important part of the mortality story is the very common and very inappropriate practice of "stopping" diarrhea by withholding food and water, hence drastically worsening dehydration. I am sick at heart over the number of times I have had to delete from Gastroenteritis well-meant but potentially lethal advice about the need to "rest the stomach". Although I don't buy the argument that gastroenteritis is "really quite technical", there is a very good synonym: stomach flu. If you don't like that either, then consider linking to the end of the causality chain, Dehydration. Or is that also too technical? --Una Smith (talk) 23:37, 12 January 2008 (UTC)

How is it "oversimplified"? Are all our sources oversimplified too? I fail to see how the difference between mentioning diarrhoea in this sentence or the next will make the slightest difference to whether people treat it inappropriately. Rotavirus causes diarrhoea, that's unavoidable, the rest is totally avoidable if treated with fluids. I don't see what the rest of your argument has to do with this article and Wikipedia is not responsible for medical advice or practice. We're simply writing an encyclopaedia article and must stick to what our sources say rather than use it for advocacy or as a public health information leaflet. Our sources are practically unanimous that the key point of rotavirus is that it is the most important cause of severe diarrhoea in under fives. They don't say it is the leading cause of dehydration. One doesn't go to the doctor with "gastroenteritis". You go because of the diarrhoea. "Stomach flu" is awful baby language. Colin°^Talk 08:30, 13 January 2008 (UTC)

• Changed to severe diarhoea.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• "under the age of five" is no doubt the precise category used for that epidemiological statistic, but "young children" might be an acceptable alternative that reduces the complexity of the sentence? It also avoids the repeat of "the age of five" in the next sentence.

• Done.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• Why does "double-stranded RNA virus" link to Virus classification rather than Double-stranded RNA viruses.

• Done.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• Why does "taxonomic" link to Systematics rather than Taxonomic rank. Also, the following word "family" could link to Family (biology).

• Done.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• Eubulides gave a good rule on herpes zoster that the citations in the lead (where they are required at all) should be repeat citations of those already in the body. The rule on WP:LEAD is that it should be a summary of the article, and not contain unique information of its own. By moving the original full citation to the body and using just a repeat-ref in the lead, one can more easily spot a slip up. There are a number of sources that are only used in the lead here and unfortunately a number of statements that only appear in the lead. I won't spot them all, so I suggest you go through it carefully.

• Almost done, still needs tweaking.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• Gave it another tweak today.--GrahamColm^Talk 16:17, 14 January 2008 (UTC)

• That children are "less susceptible" after an initial infection isn't mentioned in the body.

• In Epidemiology--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• The 30-50% of hospitalised children with diarrhoea stat contradicts the 50% in the body (and uses a different source).

• Uses same source now--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• The "not widely recognised" statement puzzled me a little. Initially, I interpreted this as meaning the role was either only very recently discovered or that there was controversy and few recognised its importance. But instead, the lack of recognition is amongst public healthcare staff rather than specialist consultants or researchers. How about adding "within the public health community", which uses the phrase from the source? Is this generally true, or only so of the developing world?

• Mainly developing countries added, "within the public health community", --GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• The US 2.7 million / 60,000 / 40 stats are sourced to (Fischer et al, 2007). I can only read the abstract but the 40 number looks like you've rounded 37 up (you use 37 later on). The figures appear to be an extrapolation "to the US population" of a large hospital discharge database and the paper is most concerned with children under 5 years old. It isn't clear from the abstract whether this extrapolation is for all <5s in the US or all age groups. I can't confirm the 2.7 million figure since it isn't mentioned in the abstract. I feel that because these stats are based on an extrapolation, we should use the word "approximately" (as the source does), or "estimated", "roughly", etc., and also mention that these figures are for children?

• I've worked on this but I need to double check.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• The 100 million in developing countries isn't mentioned in (Simpson et al, 2007) but the 2 million hospitalisations is. Can you clarify where the 100 million comes from? This source gives 450,000-700,000 deaths which is different to the 500,000 deaths you source to (Stebbins, 2007). I wonder if this latter source has settled on "half-a-million" for convenience rather than clarifing the range of possible values, which the first source does. The first source cites (Parashar et al, 2006) for its figures, which is a source you use later on. Perhaps it would be best to stick to Parashar as the original source, with no rounding? You don't mention global "developing countries" figures in the body text.

• Changed to millions, changed numbers to Parashar paper. Still need to check developing countries in body text.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• The US & the developing world stats form a long sentence, which may be better split in two. There's some repetition of "resulting in", which is a little tedious.

• Changed this, but it's still a little messy.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• BTW, I found it interesting to compare the two sets of stats. The risk of hospitalisation is similar (2%) but the risk of death is almost nil in the US, compared to 0.5% in the developing world. I note that later in the body, you say "These death rates are down from 600,000 and 150, respectively, in 1995". I can understand the 150 >> 37 but I can't see what the 600,000 refers to in the body (probably the 500,000 mentioned in the lead but lost from the body text)? In the body, you attribute the improved survival rate to oral rehydration therapy and cite two sources. I can only read the abstract of (Patel et al, 2007), which doesn't note that fact. I can read (Malek et al, 2006) but it doesn't discuss mortality decline. It looks at hospitalisations, which it notes hasn't reduced despite efforts such as promoting oral rehydration therapy. Be very careful about mixing stats from difference sources. Ideally, the source should give cases/hospitalisations/deaths together rather than you combining them from different sources and certainly it is up to your sources to agree that two sets of stats are worthy of comparison (over time, say) and what the trend is and why.

• This still needs to be addressed.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• I've made some cuts in this section owing to conflicting data in the sources. GrahamColm^Talk 17:57, 13 January 2008 (UTC)

• My understanding from the papers is that in developing countries the goal is to reduce not hospitalizations but deaths. Given the death rates, arguably there should be far more hospitalizations, but that may be impossible. So the focus necessarily is on vaccination and better, earlier management of the sick child to prevent severe dehydration hence the need for hospitalization. Several of the papers cited in "Epidemiology", about epidemiology in advance of vaccination, discuss this, at least to some extent. --Una Smith (talk) 07:01, 2 February 2008 (UTC)

• Thought: how about covering developing coutries first and then giving the US as an example of a developed country. Giving the US first, without context, just looks like the usual Wikipedia bias towards prioritising US facts.

• Switched around.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• The History section isn't mentioned in the lead at all. The (Simpson et al, 2007) source gives 1973 as the date "rotavirus was discovered" but perhaps that's a simplification? How about combining this fact with the lack of recognition fact:

Discovered in 1973, rotavirus is now known to account for 30-50% of infants and children hospitalised with severe diarrhoea; its major role in causing diarrhoea is, as of 2007, still not widely recognised within the public health community.

• Included.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• "Rotavirus can spread rapidly within families and close communities". I can't read the source for this. I note that this isn't covered in the body (either the rapid spread or the groups). I wonder whether the close grouping of people is necessary for its rapid spread or whether this just makes the rapid spread all the more visible (you'll notice if half a hospital ward goes down with it). My point is: do you need continuous close contact or could a chance brief contact (touching a contaminated door handle) be sufficient? If the latter, then only the rapid spread is notable, and could probably be combined into some other sentence in the lead.

• I deleted the sentence. Transmission is worthy of its own Article IMO.--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

• It would be nice to have a citation for the public health campaign focus.

• Reference still needed.--GrahamColm^Talk 16:17, 14 January 2008 (UTC)

• See above re cases/hospitalizations/deaths. --Una Smith (talk) 07:01, 2 February 2008 (UTC)

• The animal aspect is only covered wrt zoonotic transmission. This is also the emphasis in the section later in the body. I can read (Holland, 1990). It speculates that group B rotavirus may be a zoonosis, which may be worth noting in the group B section? Perhaps it is out-of-date? The importance of rotavirus amongst farm animals is probably not given enough coverage in this article. I found one web site stating that calf sours causes more financial loss to cow-calf producers than any other disease-related problem (though rotavirus is just one of many causes). I note you only use the word zoonotic in lead. This is probably too technical a term for the lead, and from what I've read, zoonotic trasmission doesn't seem to be a significant problem so perhaps it is not important enough for the lead. So I'd suggest you rebalance the lead to cover the farm-impact aspect rather than the zoonotic aspect. Again, you've used a source in the lead here but not in the body.

• I think Group B is now thought to be mainly waterbourne. Does Livestock comment need elaboration?--GrahamColm^Talk 14:00, 13 January 2008 (UTC)

That's all for now. More later. Colin°^Talk 17:40, 12 January 2008 (UTC)

• Dear Colin, a million thanks for this, it will keep me busy and away from mischief tommorow. An excellent critique. --GrahamColm^Talk 18:38, 12 January 2008 (UTC) BTW. what's the code for a repeat reference? I am ashamed to say I don't know. Best wishes, Graham.

Wikipedia:Footnotes tells all. For example, <ref name="name" />. Only one ref with that names needs to have the full citation, and it needn't be the first (for example, if it is in the lead). Colin°^Talk 18:49, 12 January 2008 (UTC)

[edit] History at this version

• The history text is a bit passive (was/were) and dry. I've reworked Flewett's rotavirus coining but would like to do more. The discovery of rotavirus isn't explicit in this paragraph and we could add more detail. I like to find out people's names (who they were, where they worked), which adds a bit of life to the history. It gets difficult with modern stuff where big teams are involved. Anyway, the text says:

"In 1973, related viruses were described in children with gastroenteritis, in Australia (Bishop et al, 8th Dec 1973, Lancet)(Bishop et al, 15th November 1973, NEJM letter) and England.(Flewett et al, 29th Dec 1973, Lancet letter)."

A bit of Googling shows that Australia is rather proud of Ruth Bishop from the Royal Children's Hospital in Melbourne. Sometimes Ruth gets all the glory, sometimes it is Ruth and a collegue (Holmes)[1], othertimes it is the team led by Ruth Bishop.[2]. The Thomas Henry Flewett article (which you've also worked on) gives a bit more info. I can't read these journal articles or letters, but think the History section here should highlight that Ruth Bishop and collegues were first (and ignore Flewett's letter). I think you're probably best to phrase this accurately, but I'm thinking of something like "In 1973, Ruth Bishop and collegues from the Royal Children's Hospital in Melbourne, Australia discovered...". Not sure how or if to handle the "duovirus/rotavirus" naming. Possibly saying Flewwett "coined" the name is too strong if it didn't initially achieve universal acceptance. Perhaps "suggested" is better. This allows you to note that Bishop suggested duovirus, and why, and then to conclude that Flewett's name won. Did Bishop come over to Flewett's name, or did she just lose a toss?

• The history ends in the mid-1980s. A brief look at Rotavirus Vaccine Program shows there's some interesting history to the vaccines. I think we should nick most of that article's history as a short new paragraph here. I'd like to know if Rotavirus is part of standard childhood immunisations anywhere, or if just the developing world is being targetted.

• There is a published analysis of the "economic cost" of rotavirus in the US, vs the cost of vaccination, and vaccination (at the projected cost) costs more. Similar analyses have been done in several countries. Is this interesting enough to merit gathering? --Una Smith (talk) 07:09, 2 February 2008 (UTC)

That's all I've had time for today. Colin°^Talk 23:42, 14 January 2008 (UTC)

[edit] Comments on this version

I'm a bit puzzled by the "Natural history" section. I thought the Natural history of disease what what happened during the stages of a disease, gone untreated. But this has sub-sections on types, structure, proteins and replication. These are complex sections, which I'm too tired to analyse just now. Is rotavirus enteritis a clinically distinct disease or does one require a lab test to distinguish this from many other types of diarrhoea? I suspect is isn't clinically distinguishable in the individual, just that statistically, the disease is more likely to have XYZ attributes than the disease caused by another virus or cause. Perhaps the article should say this. This lack of a well-known distinct disease means that a split like we have on polio between the disease and its viral cause isn't practical. So we're trying to describe both the disease and the virus in one article. I think that some of the WP:MEDMOS sections are still valid, however. "Classification" could be used for the seven species. "Signs and symptoms" could be contain much of what is in Pathogenesis (which is a rather technical word) and the rest could go in "Mechanism". "Diagnosis and treatment" could be in separate sections as they are separate paragraphs already. The text in "Complications" could go into "Prognosis". The "Vaccines" section could be labelled "Prevention", which also increases the scope to cover what preventative measures can be taken to minimise transmission (soap and water, bleach, "deep cleansing", isolation, etc). This is a bit of a radical reorg, so you might want to get another opinion. I suggest User:DO11.10 and User:Fvasconcellos. Colin°^Talk 23:21, 15 January 2008 (UTC)

Thinking about this some more, a split into rotavirus enteritis (the disease) and rotavirus (the virus) is worth considering. It might be there isn't enough material or interest for both but it allows the former to develop along MEDMOS lines and the latter to contain much of the technical virus stuff. You'd probably need to put one of the "otheruses" templates at the top of rotavirus to say something like "This article is about the virus, for information on the disease, see rotavirus enteritis." The r.e. article could then have a small "Cause" section that gives an overview of the virus, just like with polio and a link to the virus article itself. The viral article could then give more information on the virus than perhaps you've dared to in a combined article that needs to be accessible. Just another idea for the pot. I strongly suggest bringing in some comments from others (see above, and I'm sure Una is watching :-). Colin°^Talk 07:27, 16 January 2008 (UTC)

Thanks for this Colin, a lot to think about. I'll give it some serious thought and get back to you.--GrahamColm^Talk 18:24, 16 January 2008 (UTC)

Hi Colin, I've thought about this a lot, but having already sent the vaccine section to Rotavirus Vaccine Program, I don't think there enough left for two articles. Rotavirus enteritis isn't considered to be a separate clinical entity as such. I think the best FA model for this article is Influenza and not Polio. I've done some restructuring as you advised. WRT prevention, rotavirus infections are nigh on impossible to prevent, except with vaccines. --GrahamColm^Talk 18:16, 21 January 2008 (UTC)

[edit] Comments on this version (03/02/2008)

• Lead: "subsequent infections are progressively less severe". The word "progressively" has been added. Is this supported by the source (i.e., have people studied several repeated infections in a significantly large group of people and established that it gets weaker each time)?

Removed "progressively", this study has not been done.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Lead: "Rotavirus infects cells that line the small intestine, causing the cells to manufacture its enterotoxin". This was changed from "Rotavirus infects cells that line the small intestine, and produces an enterotoxin." I think this change is splitting hairs. We say "Graham produces excellent virus articles". We don't say "Graham causes his computer to produce excellent virus articles". Does the ability to produce that enterotoxin come from the virus? The later text seems to indicate that NSP4 is the toxin, encoded for by the virus. I think the original text was better. Additionally, the changed text now repeats the word "cells" and adds the word "causing", which is then repeated at the start of the next sentence (and, in fact, generally overused—seven times in the lead alone).

Re-written/reverted.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Microbiology: "Two independently inherited genes determine rotavirus serotypes, and a strain of rotavirus A is classified by its G and P type." These G and P types aren't explained or expanded on. I see from the abstract of the source that "the glycoprotein VP7 defining G types, and the protease-sensitive protein VP4 defining P types. At least 14 G types and more than 20 P types have been distinguished, of which at least 10 G types and at least 11 P types have been found in humans." Perhaps these G/P types can be mentioned after you cover the structural proteins, so we can explain what G and P are. In doing so we need to make it clear that there aren't G-type rotavirus-As that are different from P-type rotavirus-As but that G and P are two separate aspects of the virus that are typed. Hmm. It is hard to explain. Do you think you can then explain this is what leads to combinations like "G1P1A[8], G2P1B[4], G3P1A[8], G4P1A[8]" (don't know what the [8] and [4] are). I assume this nomenclature is like the H5N1 for flu.

This is a difficult one to explain but I have doen my best for know. This might cause problems down the line.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• I think you should move Microbiology to the end.

Done and much better for it. I think this should be standard for Virus articles.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Signs & symptoms: "Large volumes of watery diarrhea occur after the incubation period." They "occur" do they :-) I think we can drop this sentence and modify the next sentence "four to eight days of watery diarrhoea". I'm struggling to come up with a suitable adjective for the "large volume" to insert there. Thesaurus?

Done and how about "profuse"?--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Prognosis: Should this not be a top-level heading? "extraintestinal manifestations, including viremia." this is too technical and erudite. Keep the word "viremia" but try to explain what these "manifestations" might be.

Done.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "Repeated rotavirus infections may increase the risk of coeliac disease in genetically susceptible children." this is subtly different to the abstract of the source. It implies the repeated infections increase the risk. The source merely states that "high frequency of rotavirus infections may increase the risk", the difference is that it is the high frequency that increases the risk, not the infections themselves. The source isn't establishing cause and effect (unless this is burried in the full text), just an association. One possibility is that those who are at increased risk of coeliac disease are also more likely to repeatedly fall prey to rotavirus.

I've dumped this. I never liked it.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Diagnosis: "Reverse transcription-polymerase chain reaction (RT-PCR) is used " is used when? I think you are saying this method is capable of identifying all forms. But who does this and why? If that isn't important, perhaps just change the text to "is capable of detecting...".

Done.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Treatment: "Out of every 40 children diagnosed with acute rotavirus infection, about one child develops dehydration severe enough to necessitate admission to hospital." The source says "1 in 40 children was hospitalized with diarrhea by age 5". I may have missed something but it doesn't give those figures for rotavirus. Indeed it says "Most (68.3%) diarrhea-associated hospitalizations were of unspecified etiology". Even if the source said "1:40 children with rotavirus end up in hospital" that isn't the same as "1:40 children diagnosed with acute rotavirus infection end up in hospital". Because, outside of epidemiological studies, children probably go undiagnosed unless severe enough to see a doctor.

I think this if O.K. now, but please take another look if you have time.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Epidemiology: "10⁸–10¹⁰ infectious particles per ml" I'm not sure what the MOS guidelines on big numbers are, but not everyone can read powers. Can we say "8–10 billion" (it appears the definition of billion is nowadays pretty standard).
  • Oops, I guess you can include me in the "can't read powers". I misread that as 8¹⁰. The lower number is 100 million. So perhaps the sentence below can be "contains anywhere from 100 million to 10 billion infectious..." Colin°^Talk

07:41, 4 February 2008 (UTC)

Ruth Bishops paper say >10¹². That's 10 trillion per gram I think. A figure only Bill Gates and virologists understand perhaps?--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "and infection can also be readily acquired through contaminated, objects, or utensils" this doesn't follow from the faeces statistic, it follows from the contaminated hands bit. Can you glue this onto the correct sentence.

Glued.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "The infective dose is 10–100 infectious viral particles" this would be more effective if it follows the 10 billion per ml statistic. How about:

"Person-to-person spread through contaminated hands is the most important means by which rotaviruses are transmitted, though it can also be readily acquired from contaminated objects, or utensils. The faeces of an infected person contain 8–10 billion infectious viral particles per ml; only 10–100 of these are required to transmit infection to another individual."

Done, but I have put 10 trillion as per ref.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "approximately 22% of childhood hospitalisations for diarrheal disease were caused by rotavirus" This appears to contradict the "accounts for 50% of the cases requiring hospitalisation" earlier.

Removed this. It was over kill anyway.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• The paragraphs and grouping of sentences in the "Rotavirus A" bit seems a little arbitrary. For example, the "almost every child" is grouped with US stats and a unrelated sentence on reinfection and serotypes.

I've had a go at this, might still be a bit messy?--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "thousands of persons". Would "people" be better?

Yes, of course. Shame on me.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Epidemics: "possibly helping the virus escape the prevalent immunity in the population which had no protection." The "which had no protection" is redundant and/or contradicts "prevalent immunity".

Done.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "millions of people" is a different order of magnitude to "thousands of persons" earlier.

Changed to thousands.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "seroepidemiological surveys have indicated" how about "seroepidemiological surveys indicate"?

Yes.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• "Rotavirus C has caused epidemics among school children in Japan." this is more specific (to just school children in Japan) than earlier. There's quite a bit of repetition here. I think it would be best to fold these paragraphs into the relevant parts of the previous section. You may also consider creating subsections for A/B/C rather than just bolding the word -- which would have been OK if it were just a paragraph each.

Done.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Prevention: I read that first paragraph as indicating the vaccine was solely intended for developing countries. If this is not the case, can you elaborate on which countries routinely give this vaccine.

Changing all the time.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• Gastroenteritis isn't needed as a "see also" since it is linked in the text.

Removed link.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• The "Rotavirus Enteritis" box could go up the top, since there is whitespace to the RHS of the contents list.

Moved.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

• There are quite a lot of diagrams and images. At times, I'm not sure the text flows round them so well. Different browsers and screen sizes can affect this (I use Firefox). I'm no expert on page/image layout.

I've checked in IE, Firefox (my fave) and Netscape. O.K. I think.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

Good work, and good luck with FAC. Colin°^Talk 23:05, 3 February 2008 (UTC)

• Thanks Colin, this is great. I'll get to work on this during the week, (on and off). Best wishes, Graham. --GrahamColm^Talk 05:56, 4 February 2008 (UTC)

• Graham, did you spot my mistake with the 8-10 billion? You've incorporated it into the text. Colin°^Talk 14:57, 4 February 2008 (UTC)

• Colin, I think I've addressed all your points, thanks a trillion ;-). I need to take a break and have a fresh look at it agin later to check the flow etc. I plan to ask Eubulides to check the Epidemiogy as you suggested. Thanks again, you're good pal. We'll get there eventually.--GrahamColm^Talk 20:00, 4 February 2008 (UTC)

[edit] Problem with numbers

I am sure of one thing; all epidemiologists estimate!. The primary sources used in the article are difficult because the estimated incidence and prevalence data vary so much. I have a plethora of rotavirus literature but not one decent secondary source for these. Perhaps we should keep the percents and totals to the barest minimum required? --GrahamColm^Talk 15:01, 13 January 2008 (UTC)

[edit] Light and Hodes

I'm so happy that PubMed is now providing us with a citation AND full copy of this important paper. Thanks are due to Colin for checking. I would like to think that it was a result of our efforts here, but I doubt it. My copy of the paper is going brown and brittle. Now I don't have to worry about it anymore.--GrahamColm^Talk 23:18, 14 January 2008 (UTC)

The whole journal issue is available here. I chose the PubMedCentral URL rather than the PDF linked from AJPH since I don't much like the auto download of PDFs. Colin°^Talk 23:27, 14 January 2008 (UTC)

[edit] Signs and symptoms

• The section needs a rewrite; it repeats some information.
• Self-limiting needs a paragraph about the meaning of this term in medicine.
• The section refers in passing to treatment and death, leaving the reader hanging. I suggest move that reference, and all references to self-limiting and full resolution, etc. to the treatment section.

--Una Smith (talk) 07:24, 2 February 2008 (UTC)

[edit] Epidemiology review

Here's a brief review of Rotavirus#Epidemiology. I am commenting on the version of 2008-02-04T22:58:00 UTC. Sorry I don't have time to do something more thorough. Overall there is a lot of good material here but I do have some comments:

• I got greatly confused in reading this section. Is this an article on rotavirus, or an article on rotaviral gastroenteritis, or what? I suspect that this article is on two subjects and should be split: one article on the virus itself, the other on the disease. For now I will assume that this is an article on the disease.
  • Graham, I know you've spent some time thinking about this issue, and there are arguments and precedent for the one-article approach. Let me worry about this for now. I might try some ideas out on my sandbox. You deal with the epidemiology at the moment. Colin°^Talk 09:10, 5 February 2008 (UTC)

• • Colin, thanks.--GrahamColm^Talk 10:19, 5 February 2008 (UTC)

• There's a good deal of material here that really belongs in a Causes section as per WP:MEDMOS, or perhaps in some other section. Epidemiology itself studies frequency and risk, as a tool for planning prevention and management. The causes themselves are more properly part of etiology, a different (albeit related) field. Material that belongs elsewhere includes:
  • "Rotaviruses are transmitted by the fecal-oral route."
  • "The faeces of an infected person can contain more than 10 million million, (10 trillion), infectious particles per gram; only 10–100 of these are required to transmit infection to another person."
  • "Rotaviruses are stable in the environment and have been found in estuary samples at levels as high as 1–5 infectious particles per gallon."
  • "Symptoms usually accompany primary infection, which is followed by protection against subsequent symptomatic infection." (Here the usually part is epidemiology, but the followed by part is not.)
  • "frequent asymptomatic adult infections may be important in maintaining the transmission of infection in the community" (Here the frequent is epidemiology, but the maintaining the transmission part is not.)
  • "Rotavirus A infections occur throughout life, but most recurrent infections are mild or asymptomatic." Some of this belongs here, but the lack of symptoms belongs under a Characteristics or Diagnosis section.

Thanks, I moved most of this to either Symptoms or Transmission ( a new section).--GrahamColm^Talk 20:09, 6 February 2008 (UTC)

• "it can be readily acquired through contaminated objects or utensils" This claim doesn't seem to be sourced. Dennehy 2000 says rotavirus can "possibly" be transmitted by contaminated surfaces; why does the article contain the much stronger claim?

I've added another refernce and re-worded this cliam.--GrahamColm^Talk 20:09, 6 February 2008 (UTC)

• "Person-to-person spread through contaminated hands is the most important means" seems to contradict Dennehy 2000's "Rotavirus is transmitted by fecal-oral contact and possibly by contaminated surfaces and hands and respiratory spread".
• Shouldn't respiratory spread be mentioned? Yes, Added.--GrahamColm^Talk 20:09, 6 February 2008 (UTC)
• There is too much reliance on primary studies here; I'd prefer more references to reliable reviews if possible. See WP:MEDRS for details. I've reduced the 1⁰ sources here.
• Are rotavirus D and up rare? Something should be stated. Yes, It's in the Lead and below in the Microbiology.--GrahamColm^Talk 20:09, 6 February 2008 (UTC)
• The layout is a bit odd. It's better to have illustrations in the section that they illustrate, e.g., the rotavirus C figure should lead off the rotavirus C section. The table should be nect to the discussion of child mortality, not next to episodes in Nicaragua.

Fixed I think--GrahamColm^Talk 20:09, 6 February 2008 (UTC)

• The sentence talking about Colorado logically belongs in the paragraph talking about outbreaks in other areas. Done.--GrahamColm^Talk 20:09, 6 February 2008 (UTC)
• Some sources you might consider for further information about epidemiology (not that I've read them in detail): Santos & Hoshino 2005 (PMID 15484186, already referenced in another section), Gleizes et al. 2006 for hospital-acquired disease (PMID 16397425), Chandran et al. 2006 likewise (PMID 17011311), Turcios et al. 2006 (PMID 16645512, admittedly a primary source), Glass et al. 2006 (PMID 16860702, already referenced in a different section)

Whew! Running out of time. Hope this helps. Didn't really get a chance to check all those references. Eubulides (talk) 23:27, 4 February 2008 (UTC)

• Thanks for this, and the quick response, much appreciated. Graham.--GrahamColm^Talk 10:19, 5 February 2008 (UTC)

Thanks, again for your help with this, Best wishes. Graham.--GrahamColm^Talk 20:09, 6 February 2008 (UTC)

[edit] Review by DO11.10

I haven't extensively read through Colin and Eubulides' recent reviews so I'm sorry if these issues have been addressed prior. Overall the article is well written and fairly comprehensive. In general though, the article feels a bit "choppy" to me. There seem to be a lot of headers which contain little prose. Also the ordering feels a bit off. Here are my thoughts:

• "Microbiology" probably needs to be either the first section or the second section following the "history" section. Much of this section is highly technical and detailed and should probably be spun off into a separate article about the virus itself. This section has a lot of headers and lists without a lot of prose, which would be fine if the section were summarized here and the details spun off into a fuller article (I personally hate to see a level 2 header followed by level 3 header with no intervening text).
• No need for "of infection" in the Signs and symptoms section header.

Done.--GrahamColm^Talk 17:46, 11 February 2008 (UTC)

• Could the "disease mechanisms" section be expanded to explain why inadequate digestion that occurs because of the destruction of gut cells called enterocytes; an activation of the enteric nervous system would cause diarrhea?

Simplified--GrahamColm^Talk 17:46, 11 February 2008 (UTC)

• Under Diagnosis and detection "Several licensed test kits are used available"

Done.--GrahamColm^Talk 17:46, 11 February 2008 (UTC)

• I think I would move the information about the vaccine in the "history" section to the "prevention" section. This information doesn't strike me as particularly historical.
• The information in "Epidemiology" and "transmission" are highly related aspects and could easily be combined into one comprehensive section, called perhaps "Transmission and Epidemiology" or "Causes"

See Eubulides' comments above.--GrahamColm^Talk 17:46, 11 February 2008 (UTC)

• The sub-headers "Rotavirus A", "Rotavirus B", "Rotavirus C" under "Epidemiology" aren't really doing much and could probably be removed.

Done. --GrahamColm^Talk 17:46, 11 February 2008 (UTC)

• Can some of the images be moved to the left?

Done.--GrahamColm^Talk 17:46, 11 February 2008 (UTC)

I'll continue to review the article and post further comments later.--DO11.10 (talk) 22:04, 10 February 2008 (UTC)

Thanks D011, give me time to digest and act on this, (it's past my bedtime). WRT the separate article issue, you are in good company; Colin and Eubulides suggested the same, (Colin will no doubt be wearing a smile [3]. Thanks again. Best wishes Graham. GrahamColm^Talk 22:24, 10 February 2008 (UTC)

[edit] Disease mechanisms

The article is coming along. The section on disease mechanisms needs an added sentence or two. As written now, it mentions malabsorption then milk intolerance, which may leave the reader with the impression that these are synonymous. Diarrhea defines several functional types of diarrhea, including secretory. It is my understanding that rotavirus causes secretory diarrhea. Per Diarrhea, malabsorption is a result, not a mechanism of rotavirus diarrhea. (Although malabsorption may cause secondary diarrhea, presumably of the osmotic type.) --Una Smith (talk) 07:44, 18 February 2008 (UTC)

• Well spotted Una. Yes, this is all true. I'll work this into the section. I think the Mary Estes reference that we already have should cover it. Graham. --GrahamColm^Talk 13:26, 18 February 2008 (UTC)

The latest view is that rotavirus diarhoea has both malabsorption and secretory mechanisms. I think it would be best to leave this section as it is except to add another reference. <ref name="pmid17376232">{{cite journal |author=Lorrot M, Vasseur M |title=How do the rotavirus NSP4 and bacterial enterotoxins lead differently to diarrhea? |journal=Virol. J. |volume=4 |issue= |pages=31 |year=2007 |pmid=17376232 |doi=10.1186/1743-422X-4-31 |url=http://www.virologyj.com/content/4//31 }}</ref> Graham. --GrahamColm^Talk 13:47, 21 February 2008 (UTC)

[edit] Quick review by Fvasconcellos

I realize I'll probably have little to offer besides what has already been noted by Colin, Eubulides, and DO11.10 above, but here goes :)

• I've rearranged and reworded the lead a bit. One sentence still bothers me: "Public health campaigns to combat rotavirus focus on providing oral rehydration therapy and vaccination." This clearly implies that campaigns have a prevention component and a treatment component, so I think this should be stated clearly, along the lines of "focus on vaccinating healthy children and providing ORT for those who become infected" (I'm sure someone else could make this sound better). Fvasconcellos (t·c) 15:02, 8 March 2008 (UTC)

History

• The first sentence of "History" ("In 1943, Jacob Light and Horace Hodes proved that an infectious agent causing scours in cattle was a virus") appears quite misleading to me. From what I gather, the study consisted of samples being taken from (human) babies infected during four diarrhea epidemics in Baltimore and given to calves, and then attempts at "calf-to-calf passage"; later on, they mention wondering whether the same disease occurred naturally in cattle, but a sick calf from a herd "more or less chronically infected with calf scours" was studied and "the cause of his disease" was apparently "not this same agent" (i.e., that found in newborns). Besides, the authors don't seem to call the causative agent a "virus" anywhere in the paper. A major rewrite is in order here.
• "Thomas Henry Flewett suggested the name rotavirus [...] This name was later adopted by the ICTV." When?

More to come later, as I actually read the rest of the article :) Fvasconcellos (t·c) 15:02, 8 March 2008 (UTC)

• Thanks for this, I have edited the article accordingly and very much welcome any further comments. As you can see, I have "gone live" with the FAC. I had to do this today because the next few days will be my only free time for many months, and I know I am going to be under a lot of pressure now. Best wishes. Graham. --GrahamColm^Talk 12:11, 9 March 2008 (UTC)
  • Thank you. Good luck :) Honestly, I would oppose the article if I had to comment at FAC now, but I'm sure it will be in top shape in a couple of days. Fvasconcellos* (t·c) 22:08, 9 March 2008 (UTC)

• "In 1976, related viruses were described in several other species of animals, these viruses causing acute gastroenteritis were recognised as a collective pathogen affecting humans and animals world-wide." I'd change this to the following, if accurate: "In 1976, related viruses were described in several other species of animals. These viruses, all causing acute gastroenteritis, were recognised as a collective pathogen affecting humans and animals worldwide."
• "[...] rotavirus from humans was first grown in cell cultures derived from monkey kidneys, by adding trypsin to the culture medium." Is the trypsin bit relevant to the general reader? If it was a big deal—i.e., what actually made culturing the virus possible—that should be explained.
• "In 2006, two vaccines against rotavirus A infection were shown to be safe and effective in children." Two new vaccines? Also, how would you feel about shifting some of this material to the (now painfully short) "Prevention" section? It could incorporate these few paragraphs on the history of rotavirus vaccination, and the "History" section would focus on discovery and characterization of the virus itself. Fvasconcellos* (t·c) 22:08, 9 March 2008 (UTC)

Thanks, Fvasconcellos, honesty is the very best policy indeed! This is fine criticism, but unfortunately it's past my bedtime and a time when my IQ drops by 50% :-) I will address these v. constructive comments in the morning. Best wishes, Graham. --GrahamColm^Talk 22:38, 9 March 2008 (UTC)

Many thanks again, I have incorporated your comments except the one regarding moving the vaccine history. This was discussed previously, (somewhere above!), and it was decided to leave it in the History. The Prevention section is short because in a previous incarnation it was painfully long. I have started a progeny article on the Rotavirus Vaccine Program which I expect will grow rapidly when the programm gets up to speed. Best wishes. Graham. --GrahamColm^Talk 11:32, 10 March 2008 (UTC)

Thanks. I still think a couple of sections appear too short to stand on their own, but... Fvasconcellos* (t·c) 14:27, 11 March 2008 (UTC)

• In 2006, the results of a preliminary trial of nitazoxanide in rotavirus infection were published (PMID 16829296). I'm not sure if there have been any further developments, or if it's even worth mentioning, but perhaps it is? Fvasconcellos* (t·c) 14:27, 11 March 2008 (UTC)

Thanks, FV. Yes, I know about this, but only two papers and one editorial to date, all by the same group and only one trial on children. I think this is a case for watch this space rather than inclusion. I'll take another look at the small sections and see if I can come up with anything. Best wishes, Graham.--GrahamColm^Talk 14:36, 11 March 2008 (UTC)

[edit] References