03 November, 2010

Rotavirus infection

Seperti yang dirancang dalam entry ini kali ni Mama buat entry tentang pengalaman anak-anak dijangkiti Rotavirus. Untuk rujukan teori Mama quote dari medicinenet (jawapan italic) . Selain itu disertakan juga pengalaman dari Mama sendiri (jawapan biru).

What is rotavirus ?
Rotavirus is a virus that infects the bowels. It is the most common cause of severe diarrhea among infants and children throughout the world and causes the death of about 600,000 children worldwide annually. The name rotavirus comes from the characteristic wheel-like appearance of the virus when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel").

Almost all children have become infected with rotavirus by their third birthday. Repeat infections with different viral strains are possible, and most children have several episodes of rotavirus infection in the first years of life. After several infections with different strains of the virus, children acquire immunity to rotavirus. Children between the ages of 6 and 24 months are at greatest risk for developing severe disease from rotavirus infection. Adults sometimes become infected, but the resulting illness is usually mild.

What are rotavirus symptoms?
The time period from initial infection to symptoms (incubation period) for rotavirus disease is around two days. Symptoms of the disease include fever, vomiting, and watery diarrhea. Abdominal pain may also occur, and infected children may have profuse watery diarrhea up to several times per day. Symptoms generally persist for three to nine days.

Dini mula muntah pada pagi Rabu (27/10). Just muntah sahaja tanpa tanda-tanda lain. Cikgu nurseri inform dia muntah kira-kira 3 kali before Mama sampai ke nurseri pada jam 2.30 petang. Mama sangat risau sebab takut-takut dia muntah sebab kesan daripada jatuh atau terhantuk benda keras yang mungkin kami tak sedar. Kesian sangat dekat princess seorang ni sebab dia memang berselera makan. Lepas muntah je dia akan mintak nak makan balik . Tak lama lepas tu muntah balik. Mama bawa dia ke KJMC tapi bahagian outpatient je sebab klinik Dr Syed (Paed) bermula pukul 7 malam. Sepanjang jalan almost 3 times dia muntah lagi. Since dia dah muntah banyak kali Dr bagi Primperan ubat tahan muntah masuk ikut rectal. Untuk bawak balik Dr prescribed ubat tahan muntah (Novimin), paracetamol dan Oral Rehydration Salt (ORS) . Episod watery diarrhea bermula pada malam tersebut. Suhu badan pun mula naik sedikit. Tengah tidur dia melepas. Memang watery habis. Mami Poko pun tak mampu nak serap. Bocor habis cadar (Thank you to my matress protector). Boleh dengar perut dia berbunyi-bunyi. Alhamdulillah dia tak meragam. Mujur Dini masih breastfeeding. Asyik melekap ajela (kalau tak sakit pun malam memang asyik melekap je). Dini masih muntah-muntah the next day dan lebih kerap cirit. Tapi masih aktif. Hari Jumaat (hari ke-3) baru dah tak muntah tetapi masih cirit-cirit sekali sekala.

How is rotavirus spread?
Rotavirus infection is highly contagious. The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of another child. This is known as a fecal-oral route of transmission. Children can transmit the virus when they forget to wash their hands before eating or after using the toilet. Touching a surface that has been contaminated with rotavirus and then touching the mouth area can result in infection.

There also have been cases of low levels of rotavirus in respiratory-tract secretions and other body fluids. Because the virus is stable (remains infective) in the environment, transmission can occur through ingestion of contaminated water or food and contact with contaminated surfaces. Rotavirus can survive for days on hard and dry surfaces, and it can live for hours on human hands.

Puas Mama fikir dari mana Dini dapat infection. Rasanya bukan dari nurseri sebab tak de budak lain yang kena. Kalau ikut incubation period (2 days) most probably she got the infection on Sunday. Hari Ahad tu memang kami ada keluar ke Giant beli groceries. Lepas tu kids main2 di tempat permainan kat sana dan we had our lunch there. Tempat-tempat public macam tu memang senang terdedah pada jangkitan. Before makan memang WAJIB basuh tangan dengan sabun tapi si Dini ni pulak kadang-kadang suka gigit sana sini. Ntah-ntah dia gigit/jilat mana-mana bahagian kat playground tu masa asyik bermain. (Macam-macam spekulasi Mama) . Rotavirus ni highly contagious. Sebab tu jika anak kena infection diapers kena dispose elok-elok. Cuci tangan bersih2. Dalam ambil semua langkah-langkah tu Aqil pun boleh kena jugak. Dia mula muntah hari Sabtu (Rasanya berjangkit dari Dini). Huhuhu penat sungguh rasanya sebab dari Selasa sampai Jumaat I was alone ( Mr Hubby ada conference 5 hari di Bali). Kalau nak betul-betul separate dua-dua budak ni memang tak mungkinla. Pasrah je bila Aqil mula muntah-muntah tu. Thank you to my parents and sister yang datang jauh-jauh dari Taiping Jumaat petang tu. Akhirnya ku ada dahan untuk berpaut sementara menunggu Mr Hubby pulang 

 How is rotavirus diagnosed?

The diagnosis may be made by rapid detection of rotavirus in stool specimens. Strains of rotavirus may be further characterized by special testing with enzyme immunoassay or polymerase chain reaction, but such testing is not commonly available or necessary.

Untuk kes Mama ni Dr tak ambil stool specimens pun. tengok dari symptoms je they all dah cakap ROTAVIRUS punya kerja. Sebab lain mungkin sebab takde darah dalam stool. Kalau bacteria infection (E.coli) biasanya akan ada darah dalam stool. Mama jumpa Dr dua kali. Pertama MO outpatient KJMC bila Dini mula muntah. Kedua paed Dr Syed di KJMC bila Aqil pulak mula muntah dan demam (masa ni Mr Hubby pun dah balik Malaysia).

How is rotavirus treated?

There is no specific treatment for rotavirus. For people with healthy immune systems, rotavirus infection of the bowel (gastroenteritis) is a self-limited illness, lasting for only a few days. The treatment consists of increased fluid intake (oral rehydration) to prevent dehydration. About one in 40 children with rotavirus infection of the bowel requires hospitalization for intravenous fluid.

Viral infection Dr jarang prescribe antibiotik (unless di rasakan perlu to avoid secondary infection by bacteria). Treatment lebih kepada symptoms and prevent dehydration cause it is not the virus that is life threatening. It is the dehydration that comes with it! Antara ubat yang kami dapat ialah Novimin (tahan muntah), Smecta (keraskan najis), colicky (angin dan sakit perut), probiotik, paracetamol dan ORS (prevent dehydration).  Memang kena close monitoring.  Untuk Dini takde masalah nak minum ORS. Bagi apa semua dia minum. Sambil tidur pun kadang-kadang Mama guna syringe bagi ORS. Lebih baik bagi dalam jumlah sedikit tapi kerap. Aqil pulak...adoiiiii...susah betul. Pujuk baik-baik tak nak. Sekali terpaksa la paksa naik suara. Minum dalam sedu sedan. Baru 2-3 sips muntah sebab dia tak boleh terima rasa ORS tu (Mama rasa sedap je masin masin manis).  Akhirnya tak nak paksa lagi. Bagi dia minum susu dan air masak je banyak-banyak. Probiotik tu Mama masukkan dalam susu.  Ada orang kata kalau budak-budak diarrhea kena stop bagi susu or change to soybased milk. Tapi in my case Dr Syed kata ok je continue dengan susu biasa (Aqil minum Mamil Gold selang seli dengan Dugro). Dini pulak  tak de masalah. Susu Mama adalah yang terbaik. Kalau tengok anak-anak yang terkena jangkitan lemah sebab tak mahu minum kena bawak ke hospital untuk masuk air (IV) to avoid severe dehydration . Alhamdulillah kami tak sampai tahap itu.

How can rotavirus infection be prevented?

Because the virus is so prevalent, it is very difficult or even impossible to prevent rotavirus infection. Even places with excellent standards of hygiene and sanitation can become contaminated. Vaccination is the most effective preventive measure.

Our paed ada cadangkan rotavirus vaccines sebelum ini. Tapi masa tu rasa macam tak penting (ketuk kepala sendiri). Kami fokus hanya pada imunisasi biasa (seperti dalam jadual). Untuk tambahan  ambil pneumococcal vaccines (that cost 1K plus for complete package for both of them). InsyaAllah kalau rezeki dapat anak lagi perlu pertimbangkan Rotavirus vaccine ni.



Catatan Mama : Alhamdulillah sepanjang recovery  both my kids masih ada selera untuk makan. Rasanya menu paling sesuai ialah bubur nasi dan sup ayam (bertambah-tambah Dini makan). Tapi Aqil request nak KARI AYAM (penangan Mama suka makan tosai sepanjang pregnantkan Aqil). Buatlah jugak kari ayam (kurangkan rempah) makan dengan nasi lembut. Yang penting dia nak makan. Pagi tadi stool Dini dah macam biasa. Maknanya lebih kurang 8 hari jugak nak betul-betul hilang symptom. Cuma Aqil masih watery sikit. Tapi dua-dua sudah ceria dan cergas macam biasa.

 

Ini gambar kontroversi. Kalau MMS kat Mr Hubby or my mum and dad (opah dan atuk) sure they all tak boleh tidur malam tu. Nampak Dini macam lemah je. Actually she's sleepy (pukul 2 pagi) tapi Mama bagi minum ORS guna syringe. Dia pulak baik je menurut perintah sedut slow-slow


 
Air garam yang Aqil sangat anti. Nampak Mama gunting je peket ni dia dah meraung-raung



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