Both adults and children often suffer from intestinal infections, which are caused by various pathogens. These include norovirus, which provokes the development of the so-called intestinal flu. Symptoms and treatment of norovirus intestinal infection in children and adults differ little from the treatment of rotovirus infection, but there are some differences.

General characteristics of the virus

Noroviruses, like rotoviruses, are considered the main causative agents of all intestinal infections. Rotavirus and norovirus were not initially distinguished, so patients in all cases were diagnosed with “rotavirus infection”. In 1972, thanks to a series of genetic studies, norovirus was isolated as a separate group. It was found that this pathogen belongs to the family Caliciviridae.

Now known 25 strains of norovirus, each of which represents a danger to human health. Most often, the pathogen, penetrating into the body, provokes the development of acute gastroenteritis, or intestinal flu. This bacillus is very contagious and easily transmitted from person to person.

Intestinal flu is most common during the cold season., although they can be infected in the summer. The incubation period after penetration into the body is from 12 to 48 hours. During this time period, the person does not feel sick, but can infect other people.

Mostly norovirus intestinal infection is mild. This disease is accompanied by unpleasant symptoms that completely disappear in 2-3 days even without the help of a doctor. Drugs are prescribed to speed up the healing process, or if the disease is atypically difficult.

Methods of transmission

Infectious disease begins after the penetration of norovirus into the organism. There are three mechanisms of transmission of this infection:

1. Food - when used poorly washed fruits, vegetables and berries. The most common infection occurs in the summer during the period of mass ripening of fruit and berry products.
2. Water - infection occurs when water enters the body, in which there are pathogens. This is typical for open water bodies where water is not chlorinated. Swimming in the summer in a lake or river, you can catch intestinal flu.
3. Contact-household - bacilli get into the gastrointestinal tract through unwashed dishes, dirty hands or some household items.

A person who has contracted norovirus is considered infectious during incubation periodduring the acute phase, as well as about three days after complete subsiding of all unpleasant symptoms.

After complete recovery, unstable immunity to the disease occurs, which lasts no more than two months. After this period, a person can again get an intestinal infection.

Signs of disease

Norovirus intestinal infection is characterized by the appearance of disorders of the digestive system. The main signs of the disease are:

• persistent nausea and profuse vomiting;
• severe diarrhea with mucus;
• cutting pain in the abdomen;
• unmotivated drowsiness and headache;
• lack of appetite and loss of taste;
• a slight rise in body temperature;
• urging to stool accompanied by pain;
• respiratory symptoms - sore throat, runny nose and lacrimation.

Most often, all these conditions do not require treatment and disappear without a trace in a few days. In especially severe cases, especially in young children, dehydration develops without adequate medical care. At the same time, the water-electrolyte balance is disturbed in the body of a sick person, which can lead to a comatose state or even death.

Young children, the elderly and pregnant women are most affected by this disease.. This disease in such groups of patients is very difficult, in some cases, urgent hospitalization is necessary.

If a child is younger than 3 years old, then you need to urgently call the district pediatrician. Only a physician can make the correct diagnosis and prescribe adequate treatment. Self-treatment of young children is strictly prohibited. This threatens not only the loss of precious time, but also the development of serious complications in a child.

First aid

When the first symptoms of norovirus infection appear, a number of actions can be taken that will slightly alleviate the patient's condition:

• With severe vomiting, you can wash the stomach with a weak solution of potassium permanganate. Due to this, most of the pathogenic microflora and decomposition products will be removed from the body..
• Make a cleansing enema, for which use salted water or a solution of rehydron.
• The patient stubbornly otpaivat to avoid dehydration. For this, a solution of rehydron is suitable, which is often given, but in small portions. Young children drink such a solution with great reluctance or refuse to use at all. In this case, the baby otpaivayut compotes, fruit drinks or tea.

For otpaivaniya adults and children can not use carbonated drinks, kvass and milk. All these products irritate the gastric mucosa even more and contribute to the proliferation of bacteria.

• They give any absorbents, even classic activated carbon will suit, which is pre-crushed into powder and diluted in a small amount of water.
• A person with an intestinal infection is put to bed on his side to avoid choking on vomitus..

The room in which the patient lies, it is necessary to air often. All surfaces are regularly wiped with disinfectant solutions. If the condition has worsened, despite the assistance provided, then an urgent need to call a doctor, especially if we are talking about a child or an old man.

What else to help the patient

With norovirus, it is important to maintain the electrolyte balance in the body and recuperate the patient.. For this, a strong decoction of rice with raisins is suitable. Two tablespoons of pure rice is poured with a liter of water and brought to a boil. Add a tablespoon of washed raisins and simmer for half an hour.

The broth is cooled and given to the patient in half a glass every 20-30 minutes. In such a healing drink many minerals and vitamins, in addition, a decoction of rice has enveloping properties and gently relieves irritation from the stomach.

Principles of treatment of severe cases

If norovirus is severe, the doctor may prescribe a number of drugs to stabilize the patient's condition. In special cases, treatment is carried out in the hospital of the infectious disease ward.. The treatment protocol is as follows:

1. Intravenous injections of saline and glucose are performed to restore the water balance in the body.
2. Showing fortifying vitamins.
3. When indomitable vomiting prescribed antiemetics, for example, cercuated.
4. According to the testimony may be prescribed antibacterial or antimicrobial agents. They are appointed only after obtaining the result of bakposeva feces and emetic masses.
5. Symptomatic treatment is often prescribed to maintain normal liver and heart function.
6. The patient is given a lot to drink. Most often it is pure water without gas, sometimes glucose is added to it.

Medicines to eliminate diarrhea at first do not give. With diarrhea, pathogens and toxins are removed from the body, self-purification occurs. If the gap between the urging to the toilet does not increase and the state does not normalize, then the smect is prescribed. This medicine gently relieves inflammation from the intestinal walls and reduces motility.

Disease prevention

Any disease is always harder and more expensive to treat than to prevent, especially when it comes to severe cases. There are no vaccines for norovirus, but, despite the fact that these bacilli are resistant to many external factors and remain active for a long time, preventive measures are elementary. In order not to get an intestinal infection, you need to follow these rules:

• Wash hands often with soap and water throughout the day. Especially after going to the toilet, walking on the street or playing with pets.
• Buy food only in the places designated for this. Sometimes the ruble saved on vegetables or fruits is worth the health and nerves.
• All vegetable products are well washed with running water, and then poured boiling water. Under the influence of high temperatures, many pathogens die.
• Drink only boiled water or that which is intended for direct consumption..
• If possible, food to be subjected to heat treatment.
• Keep clean and tidy the kitchen. Chopping boards should be separate for different types of products - meat, fish, vegetables, fruits and bread.

A kitchen rag and a sponge is changed every few days. It is important to remember that this is the main hotbed of infection. Microbes from kitchen rags fall on the dishes, and then into the human body.

Any intestinal infection is very unpleasant, but you shouldn't panic. First you need to objectively assess the severity of the patient, give him first aid and, if necessary, call a doctor. When started on time proper treatment  the disease passes without a trace in just a few days.

Since there have been reports that cases of the disease by these types of virus have recently become more frequent, the Mother's Club decided with the help of specialists to figure out how they differ and how you can protect yourself and your child from them.

At first glance, the symptoms, the method of infection, and the course of rotavirus and norovirus are very similar. See for yourself by reading the data in the table.

Nevertheless, these viruses differ somewhat from each other, because the name of them is also different.

would be the same. With the help of interviewed experts, we managed to find out the main differences.

1. Rotavirus - diarrhea and heat, norovirus - vomiting

The symptoms of these viruses, as we have already seen, are similar, but, if there is a difference, this is symptom number one.

“In case of a disease with norovirus, this is vomiting, there may be no high fever at all. With rotavirus, diarrhea almost always appears first, which is accompanied by an elevated body temperature,” says rita Korotinsk, epidemiologist of the Latvian Center of Infectiology.

Yes, instead of diarrhea, there may be vomiting, if it is not there immediately, then it may appear a little later.

2. Rotavirus appears bright, norovirus is hidden

"Rotavirus usually starts very badly: diarrhea, temperature, vomiting. Norovirus is more cunning. Everything starts with vomiting, but there is no temperature and most immediately write it off not as a virus, but as an ordinary food poisoning. You regulate for a while their diet seems to be better, but there is some weakness. It takes several days or even a week and again vomiting. The temperature usually rises by 3-4 or even on the 7th day of the virus ", - explains family doctor, pediatrician Larisa Zakharova.

That is, if the rotavirus manifests itself in all its glory at once, then the norovirus is wavy, incrementally, disguised as a violation of the gastrointestinal tract.

"Therefore, the rotavirus can be ascertained more quickly, whereas the norovirus gives up to two or three exacerbations, everything seems to be fine, 4 days have passed and again vomited 2-3 times," adds L. Zakharova.

3. Norovirus is relevant in winter, rotavirus is always

The people conceived norovirus called "winter vomiting disease" and it is - not just. He really is especially relevant in the winter.

Rotavirus is relevant at any time of the year. Yes, there are certain seasonal outbreaks, but there is always a risk of getting sick.

4. Rotavirus more sick kids, norovirus older children

This is confirmed by the statistics of the Latvian Center of Infectology.

Rotavirus more sick young children up to two years, especially from 6 to 23 months. Whereas older children, including adolescents, suffer from norovirus. This also indicated infectologist of the Children's Hospital Ilze Grope.

Last year, 1,774 diseases of norovirus were recorded, of which children from 0 to 17 years inclusive included 626 people, including 271 children aged 0 to 1 year. Sick children aged 1 to 6 years out of a total of 698.
From which we can conclude that among children, norovirus is particularly susceptible age group from 1 year to 6 years.
Most often, those who go to kindergartenik, to school and attending other educational institutions.

"But this does not mean that a small child cannot get sick with norovirus. In my practice, there were cases when norovirus was diagnosed in a six-month-old baby, and a two-year-old, and a ten-year-old child," he shares his experience. family doctor, pediatrician Lolita Sorge.

Ilze Grope also noted that "representatives of all age groups can get sick in case of contact with a patient."

According to the epidemiologist, last year the norovirus in Latvia was in the top. Now, compared with the data of 2011, the disease is not so relevant, but what it is now is typical, because it's winter, and this is her time.

As my mother's club was told at the Children's Hospital, there is no evidence that the number of patients with norovirus has significantly increased, thereby providing the leeway of information from the Latvian Infectology Center.

5. When rotavirus comes rapid dehydration, norovirus itself releases substances that poison the body

This opinion was shared by Larisa Zakharova. And in fact, and in another case, the body is subject to dehydration, but the reasons are different.

In the case of rotavirus, the body loses fluid through diarrhea and vomiting and it is very important to restore it.

In the case of norovirus, dehydration can occur not only as a result of vomiting, but also from if the virus has remained an unidentified object in the body for too long, hiding under various other diseases, the same poisoning.

6. Rotavirus is harder than norovirus

Not always, but, as practice shows, children with rotavirus are often admitted to hospital than with norovirus.

“Norovirus is a little softer, it is more long-lasting than rotavirus. In the case of rotavirus, the hospitalization rate is higher than in the case of norovirus,” says Lolita Sorge.

The probability of hospitalization uniquely determines the patient's age, emphasizes the infectiologist: "Most often, treatment in a hospital is required in the first year of life. It is known that rotavirus causes such severe gastroenteritis, that in 75% of cases treatment in a hospital is necessary. In turn, the norovirus is easier and according world statistics only 5-10% require hospital treatment. "

7. There is a vaccine against rotavirus, norovirus - no

Rotavirus vaccination is planned to be included in the national vaccination calendar in 2014, so for now it can only be done for money. A total of two doses are provided. They are introduced through the mouth. No shots! Vaccination is recommended up to 6 months.

There is no separate vaccine for norovirus. Perhaps because it affects the child in a more conscious age, when the immunity is no longer so weak and able to fight. In addition, it is not as dangerous as rotavirus, as a result of which dehydration occurs very quickly.

However, it is imperative to observe preventive measures that are the same for almost all infectious diseases that are transmitted by airborne droplets or by dirty hands.

Mother's Club summarized the advice of interviewed specialists, here's what they recommend:

Wash your hands often, especially after going to the toilet, before and after cooking, when changing a diaper, after any contact with a sick infection;
- wash the fruits and vegetables purchased in the store or in the market carefully;
- regularly air the room in which you are located;
- often walk in the fresh air;
- avoid visiting places of large crowds of people (do not take the child to the store, etc.)
- Do not take very young children (a month, two, three) in foreign trips, the immunity is not strong and is subject to various diseases.

If the child is sick:
- do not eat up and do not drink for a child who suffers from an intestinal infection, parents often forget about it and get sick themselves;
- in case of illness, it is necessary to drink, but do not force the child to drink a lot at once - offer him liquid in small portions (2-3 sips, after a few minutes 2-3 sips again, etc.). In addition, it is recommended to drink Regidron.
- food can be taken no earlier than 4 hours after vomiting;
- exclude all dairy products from the diet, including do not cook porridge in milk, etc.
- drink probiotics and antiviral homeopathic remedies

Do not take the child to the kindergarten, if the first signs of the disease appear, go to the family doctor - otherwise the child may infect other children in the group and staff.

PERSONAL EXPERIENCE

Ksenia, Sofia's mom (2.8 years), daughter suffered from both rotavirus and norovirus

We first learned what an intestinal infection is when Sophia was 7 months old.

I confess that we have "enjoyed" these diseases in full. For less than three years, she has already suffered from diarrhea and vomiting four times, she was in the hospital with a temperature of 41 times three times ... And all this was due to roto and norovirus, and during our first hospital stay, both of these viruses were diagnosed in a child.

How do they differ, how to treat and when to urgently run to the hospital? Hmmm ... I can talk about this for a long time and not worse than what is written in medical textbooks.

What is the difference between roto and norovirus?  Norovirus is called “winter vomiting syndrome” or the disease of winter vomiting, and all because it appears most often at this time of year. The most interesting thing is that being in a hospital in Belarus they don’t even know about such a disease. Apparently, since the Soviet times, all intestinal infections were equated with dysentery.

Having stayed with the child in the hospital, I was very surprised by the fact that doctors consider Novorovirus more dangerous than roto infection. If roto symptoms usually appear within 2-3 days: a person can be tormented by terrible bouts of vomiting, diarrhea, the temperature may rise, then the same symptoms of norovirus can last up to two weeks.

Prevention:

Visit public places less

Wash your hands often

Buy a hand sanitizer

How I treat a child:

1. Babies up to 2 years old with diarrhea can be given one packet of Smecta, diluted with a floor with a glass of water. This liquid is drunk throughout the day.
2. At 10 kg of weight is given 1 tablet of activated carbon.
3. The child constantly drinks water (it is best to make a solution of salt water - add a spoonful of salt and a tsp of sugar to 1 liter of warm water)
4. Bacteria can be given: Liveo Baby, Lacto Seven, Linex, etc.
5. A diet with the exception of sweet, dairy, vegetables and fruits ... ideally, a limited menu should be followed for 1-2 weeks depending on the condition of the child.

In the case when the child’s condition worsens and I don’t really want to go to the hospital, I give Nifuroxazide-Richter - an antibiotic suspension, which is taken within five days.

If vomiting does not stop, like diarrhea ... always go to the hospital. There, the doctor prescribes treatment depending on the condition of the child. 3 droppers per day are provided for everyone!

How I treat myself:

1. With diarrhea, Lopiramid was an amazing discovery for me. After two pills, even in the worst case, diarrhea stops. Depending on the manufacturer, this medicine can be used by children from 5 years old, from 12 years old (Grindeks). Be sure to see the instructions.
2. After each emptying of the stomach I accept a bag of Smecta
3. Drink plenty of fluids.
4. Do not eat at all (at least one day)

From the mouth of the nurses:

Immunity to roto and norovirus is valid for six months after suffering the disease. After this time, a person can become infected again.

These diseases are carried not only by contact, but also by airborne droplets. So, especially in the winter months, we are practically defenseless.

In case of diarrhea and vomiting of 10 kilograms of weight, a person should drink 1 liter of water, preferably saline.

The rotovirus vaccine only protects the child from this disease, while the other dozens of intestinal infections can still catch the child ... So the point of vaccination in this case is very doubtful.

Immediately after vomiting, do not let the child drink. Wait five minutes, give a spoonful of water to drink, if after 5-10 minutes vomiting does not recur, continue to give water. It is advisable to do this every 15-20 minutes so that the body is replenished with fluid reserves.

- Be sure to consult your doctor if:
Vomiting and diarrhea in a child does not stop (dehydration in very young can occur in a matter of hours, do not get carried away by self-treatment)
The temperature rises (especially dangerous if the temperature "crosses" for 39 and does not get off)
The child has dried mouth, white tongue
Springwell visibly fell
The child is inactive, looks tired
If during pinching, the skin sticks and does not occupy the original position.

In fact, all of the above indicates that the child is in an extremely serious condition.

Be careful, it is very important to see the edge when you should not skip to the hospital or, conversely, when it is just necessary.

Given the above, I want to emphasize that this is only my experience and in each case I recommend to consult a doctor without delay.  Only a doctor can recommend treatment and medications that are right for you.

It also helps the round-the-clock telephone 66016001, by calling which doctors always give advice. Especially if you do not want to go to the hospital.

Adults and children suffer from intestinal infections. There are viruses that cause diarrhea: norovirus, astrovirus, rotavirus, coronavirus.

Rotavirus and norovirus infections are common.

Recently, rotavirus and norovirus were not separated, they were diagnosed with rotavirus infection. Kinds intestinal diseases  similar, but different symptoms, the course of the disease.

Norovirus infection was detected in the early 70s of the twentieth century in the United States. Infection occurs in public places (kindergartens, educational, entertainment), by contact, in the presence of a virus in the air. All people suffer with norovirus, children, people with reduced immunity suffer more heavily.

50% of infectious diseases in adults and 30% in schoolchildren are caused by noroviruses. Children up to seven years more often suffer from rotavirus.

Norovirus infection is transmitted by the oral-fecal, respiratory routes. The virus is obtained through unwashed vegetables, fruits, boiled water, door handles, and a rim of a toilet bowl.

Norovirus intestinal infection is contagious. The virus is resilient, not afraid of cold, hot temperatures; Killed with detergent disinfectants with chlorine.

The person who has been ill has immunity to infection for up to 7-8 weeks.

Rotavirus infection, intestinal flu - infectioncaused by rotavirus. Infections are sick adults, children. The patient is contagious during the entire period of the disease, about a week. The person who has recovered has immunity to rotavirus.

The cause of infection - the use of unwashed vegetables, fruits, absorption of food with dirty hands.

You can catch the infection through respiratory, coughing, runny nose. Rotaviruses tolerate cold, do not die in chlorinated water.

Determination of the type of virus

Patients do not immediately pay attention to the ailments in the gastrointestinal tract. The faster the diagnosis is made, the faster the recovery.

To determine the difference between norovirus and rotavirus, the manifestations of ailments are described.

Common signs of infection

Signs of rotavirus and norovirus infection:

1. Diarrhea.
2. Pain in the stomach.
3. Vomiting, nausea.

Characteristic signs of infections

Intestinal infections are confused. There are differences in determining the type of virus, prescription drugs.

For intestinal flu or rotavirus is characterized by an acute manifestation of the disease - emetic urge, diarrhea, increased body temperature (more than 38-39 degrees). Infected people develop cold symptoms - sore throat, nasal congestion. Patients complain of weakness, aching joints, loss of appetite.

For norovirus is characterized by sluggish beginning. Appears to feel unwell during the first days after the defeat of the virus. Vomiting, frequent diarrhea, low temperature (37-37.5 degrees), chills, headache begin. Vomiting is observed, the infected writes off on the usual food poisoning.

The infection passes on its own within 1-3 days, in severe cases - up to 7 days.

Necessary measures when infected with viruses

Rotavirus and norovirus infections require a different treatment approach.

With a mild course of norovirus infection, no medication is required. The virus passes by itself, without serious consequences. For patients - abundant use of water at room temperature, to prevent dehydration, rest.

It is advisable to drink the liquid after each attack of diarrhea, follow a diet (chicken broth, fresh compote of dried apples). If the condition has improved, a diet is maintained for a couple of days.

At home - to make a special solution for the normalization of water-salt balance. Take two tablespoons of sugar, one teaspoon of soda, one teaspoon of salt, pour a liter of warm boiled water.

When norovirus infection antidiarrheal medications  prohibited: cause serious consequences.

With frequent vomiting, the doctor prescribes "Promethazin", "Ondansetron", "Prochlorperazin". In case of severe course of the patient, they are hospitalized, they are prescribed droppers with electrolytes: “Trisol”, “Disol”.

For the treatment of rotavirus special medicines  not. Give drugs that reduce the appearance of infection. In the absence of appetite, the patient is given light chicken soup, fruit jelly.

It is forbidden to include in the diet of lactic and lactic products: milk is the optimal medium for the reproduction of bacteria.

With severe vomiting, diarrhea, intoxication is dangerous. Infected people are given a warm liquid, a special solution (a teaspoon of salt is poured with a liter of water).

Food and water are often taken in small portions, so as not to provoke another attack of vomiting. Droppers with electrolytes prescribed for severe cases of dehydration.

The doctor prescribes sorbents for removing toxins from the body: Enterosgel, Smekta, Activated carbon. With rotavirus infection  It is recommended to take medication for diarrhea - Enterofuril is prescribed. To improve digestion, patients are prescribed "Pancreatin", "Mezim".

Intestinal flu is accompanied by increased body temperature. Use of antipyretic drugs - if the patient does not tolerate temperatures up to 38 degrees: high temperature kills the virus.

Use physical methods to reduce body temperature: washing with warm water, airing the room in the absence of the patient.

With improved well-being, the patient is prescribed probiotics that restore the flora of the intestinal mucosa: Atsipol, Probifor, Linex.

If norovirus with severe rotavirus, sign up for an infectious disease specialist. In the absence of complications, contact your local GP, a gastroenterologist.

In the post-infectious period, consult a nutritionist. The doctor will prescribe nutrition to normalize digestion. With treatment, follow the diet.

Disease prevention

In case of infections, it is important to prevent the disease. Vaccination against intestinal infections of norovirus and rotavirus is not derived. It is recommended to comply preventive measures  virus prevention: resilient.

After buying products in the store, on the market, rinse under running water, pour over boiling water. Pay attention to the shelf life of lactic, lactic acid products: spoiled products may contain pathogenic microbes. Use boiled water for food. When you visit the pool, lake, river, do not swallow the water.

If an infected person lives in the apartment, carefully observe hygiene. It is more correct to allocate to the patient a separate room.

Wash the floor and surfaces touched by the patient with chlorine disinfectants daily. Wash clothes and bedding in a typewriter at a temperature of more than 60 degrees.

It is important to seek treatment in medical institutions.

Features of intestinal infections in a child

Parents are experiencing symptoms of intestinal infection in children every day. Kids more often suffer from rotavirus, older children - norovirus. Infection with infections occurs in public places (kindergarten, school, group of additional education) attended by the child.

Control is needed for children of preschool age - they take everything in their mouths.

The task of parents is to instil in children the rules of personal hygiene from an early age to reduce the risk of infection.

Parenting at the first sign of infection

At the first signs of intestinal infections contact a pediatrician. Assign the appropriate treatment.

In case of severe illness, immediately call an ambulance. It is forbidden to give painkillers to the child without a doctor’s appointment: the diagnosis will be erroneous.

In children, the body is intoxicated faster. In case of illness of the child, be near, control well-being.

When signs of illness occur, fluid is supplied to avoid dehydration.

Liquid is offered in small portions (per teaspoon) with an interval of 15-20 minutes. Suitable drugs "Regidron", "Hydrovit", "Hydrovit Forte." Syfeps "Cefekon", "Nurofen" will help to bring down the increased temperature.

Candles are ineffective in the presence of diarrhea. If rotavirus is detected, the pediatrician prescribes the course “Enterofuril” in the form of a suspension.

Sparing diet

Observe the diet: porridge on the water, compotes of dried fruit, crackers. If baby on breastfeedingdo not limit it. Thanks to breast milk, lactic acid bacteria enter the intestines of the child, helping to recover.

Originally, the norovirus was called Norork, Ohio, where in November 1968 an outbreak of acute gastroenteritis was registered among schoolchildren in a primary school. In 1972, as a result of immuno-electronic microscopy of canned feces samples, a virus was discovered, which was called Norwalk virus. The cloning and sequencing of the Norwalk virus genome has shown that these viruses have the same genomic organization as the Caliciviridae viruses. The name Norovirus (genus Norovirus) was approved by the International Committee on Virus Taxonomy in 2002.

Etiology

The genome of norovirus is a single-stranded RNA. The virus contains 5 active proteins, the main structural protein (VP1) within 58 ~ 60 kDa and the minor capsid protein (VP2). When viewed through an electron microscope, viral particles exhibit an amorphous surface structure, the size of viral particles is between 27-38 nm. Noroviruses have 5 genogroups (GI, GII, GIII, GIV and GV). Genogroups I, II, and IV cause disease in humans, and genogroup III in cattle. Genogroup V has recently been found in mice.

Epidemiology

Noroviruses are transmitted by direct contact with the patient or indirectly through infected food, water, household items. A person can release a virus up to 1 month after recovery.
Mechanism of transmission  - fecal-oral, airborne droplets are not excluded. The virus is released from a sick person with a stool or vomit. The main way to transfer  is the food way. Transmission factors most often can be seafood. However, other foods can also be contaminated from the patient while they are cooking and serve as a source of infection. In addition, norovirus can be transmitted through water (ice) and the contact-household method.
  The virus is resistant to environmental factors. Wet cleaning with conventional detergents and alcohol-containing agents does not ensure its destruction, the virus is resistant to drying, freezing, heating to 60 ° C, dies only from chlorine-containing disinfectants.
  Norovirus infection affects all age groups. In the United States, one-third of cases of viral gastroenteritis in children between the ages of 6 and 24 months are noroviruses. The most dangerous norovirus for physically impaired persons, the elderly and young children. Susceptibility to norovirus is ubiquitous.
  Noroviruses often cause outbreaks of gastroenteritis in closed teams and medical institutions.

Clinical picture

The incubation period for norovirus infection is from several hours to 2 days. The disease manifests itself in the form of nausea, vomiting, diarrhea up to 8-10 times a day, pain in the abdomen, sometimes - loss of taste sensitivity, increase in body temperature to 37.5-38 ° C, symptoms of general intoxication, manifested by weakness and pallor skin integument. Vomiting is the leading symptom of norovirus infection. The state of health is normalized within 2-5 days.

Treatment of acute intestinal infections in children

Diet therapy

In recent years, approaches to diet therapy have changed. Nutritional therapy is a constant and important component of diarrhea therapy at all stages of the disease. Fundamentally an important point  in the organization of nutrition of sick children is the refusal to conduct water-tea pauses, because even with severe forms of diarrhea, the digestive function of most of the intestines is proved, and starvation diets help slow down the repair processes, reduce the intestinal tolerance to food, contribute to malnutrition and significantly weaken body defenses. The volume and composition of food depends on the age, body weight of the child, the severity of diarrheal syndrome, the nature of previous diseases. Good nutrition is important for the rapid restoration of bowel function. In the acute period of gastroenteritis, it is recommended to reduce the daily amount of food by 1 / 2-1 / 3, in the acute period of colitis - by 1 / 2-1 / 4. It is possible to increase the multiplicity of feedings up to 8-10 times per day for infants and up to 5-6 times for older children, especially with the urge to vomit. At this time, the most physiological is considered an early, gradual resumption of nutrition. Renewal of the qualitative and quantitative composition of the food characteristic of the child’s age is carried out as soon as possible after the rehydration and the disappearance of the signs of dehydration. It is believed that early resumption of the normal diet together with oral rehydration helps to reduce diarrhea and more rapid bowel repair.
  Feeding with breast milk should be maintained, despite the diarrhea. This is due to the fact that lactose of breast milk is well tolerated by children with diarrhea. In addition, human milk contains epithelial, transformable and insulin-like growth factors. These substances contribute to a more rapid recovery of the intestinal mucosa of children. Also, human milk contains anti-infectious factors such as lactoferrin, lysozyme, lg A, and bifidum factor.
In violation of the absorption of carbohydrates and the development of secondary lactase deficiency on the background of viral, watery diarrhea, anxiety, bloating, regurgitation, splashing foamy stools after each feeding are noted. At the same time, an early introduction into the diet of adapted mixtures that contain lactose of cow's milk, juices can worsen the condition of the child and increase the duration of diarrhea. In addition, cow's milk contains proteins that are allergenic to the baby’s body.
  It is not recommended to use soy-based milk formulas in the acute period of diarrhea. Installed hypersensitivity  the intestinal mucosa of children to soy protein with diarrhea. This increases the risk of developing protein enteropathy.
  An important point that affects the duration of watery diarrhea is the exclusion, if possible, from the diet of disaccharides. In the acute period of viral diarrhea in infants, it is recommended to replace the usual adapted mixtures with low-lactose ones. The duration of a low-lactose diet is individual and depends on the condition of the child. Usually, it is prescribed for the acute period of the disease and is canceled immediately after the start of the formation of a chair.
  In children receiving complementary foods, it is recommended to introduce porridge on the water into the diet, the earlier purpose of meat puree. You can assign a baked apple, dairy products. Recommended introduction to the diet of foods rich in pectin substances (baked apple, bananas, applesauce and carrot puree). The latter is especially indicated in OCI, which are accompanied by colitis syndrome.

Rehydration therapy
Timely and adequate rehydration therapy is the primary and most important element in the treatment of acute intestinal infections, both secretory and invasive. Early use of adequate rehydration therapy is the main condition for the rapid and successful treatment of the disease.
When conducting rehydration therapy, the advantage must be given to oral rehydration. This is a highly effective, simple, affordable and inexpensive method at home. It must be emphasized that oral rehydration is most effective when applied from the first hours of the onset of the disease. Conducting oral rehydration with OCI should be the first therapeutic measure that is carried out at home when the first symptoms of the disease appear. Early administration of oral solutions allows most of the children to be effectively treated at home, to reduce the percentage of patients who are hospitalized, to prevent the development of severe forms of eksikoz. There are no contraindications for oral rehydration. Even repeated vomiting is not an obstacle for oral administration of fluid. In this regard, it is advisable to have drugs for oral rehydration in each family medicine chest next to antipyretic and analgesics. It must be remembered that in solutions that are used for oral rehydration, the glucose concentration should not exceed 2%. If it is greater, then the osmolarity in the intestinal cavity increases, as compared with blood, as a result of which the flow of fluid from the blood into the intestine increases and its loss with diarrhea. With a low glucose concentration (less than 1%), it will not adequately perform the function of co-transport for sodium molecules, as a result of which sufficient absorption of sodium and water from the intestine will not be ensured.
  According to the WHO recommendations, the optimal composition of solutions for oral rehydration are solutions of the following composition:
  sodium 60-75 mmol / l (2.5 g / l);
  potassium - 20 mmol / l (1.5 g / l);
  bicarbonate (sodium citrate) - 10 mmol / l (2.9 g / l);
  glucose - 75 mmol / l (13.5 g / l);
  osmolarity - 245-250 mOsmol / l.

The content of sodium and potassium in solutions for oral rehydration should correspond to their average loss in acute intestinal infections. The concentration of glucose in them should contribute to the resorption of water not only in the intestine, but also in the tubules of the kidneys. Optimal absorption of water from the intestinal cavity is carried out from isotonic and light hypotonic solutions with an osmolarity of 245-250 mosmol / l.
  Due to the high concentration of glucose, high osmolarity in them and inadequate concentration of sodium, the use of fruit juices, sugary carbonated drinks (Coca-Cola, etc.) is not recommended during oral rehydration.
Currently, there are three generations of drugs that are designed for oral rehydration. The first generation is a well-known WHO solution that contains 3.5 g of sodium chloride, 2.5 g of sodium bicarbonate, 1.5 g of potassium chloride, and 20 g of glucose.
  Representatives of the second generation of oral rehydration solutions with their composition are closer to the electrolyte composition of the child's feces. They increase the amount of potassium, reduce the amount of glucose, sodium bicarbonate is replaced by sodium citrate. This gives them an advantage in pediatric use. Both generations of solutions, although effective for rehydration, do not contribute to a decrease in the volume and frequency of feces. In recent years, solutions have been developed for third-generation oral rehydration, in which glucose monohydrate has been replaced by its short-chain polymers. The latter are contained in cereal broths (rice, corn), carrots. The sympathetic effect of solutions of the 3rd generation is higher than that of solutions of the 1st and 2nd generations; in addition, they can be used as a substitute for food mixtures during the first hours of treatment. Such a solution for oral rehydration is effective with OKA and may contribute to the early resumption of nutrition.

Method of oral rehydration
If a child with diarrhea has no signs of dehydration, the main goal of rehydration therapy is to prevent it. To do this, from the first hours of the disease, a child is given to drink an increased amount of liquid: children under 2 years old - 50-100 ml after each stool; children from 2 to 10 years old - 100-200 ml after each stool; Children over 10 years old - as much fluid as they wish to drink. The following fluids are recommended for the prevention of dehydration in children with acute intestinal infections:
  - glucose-saline solutions for oral rehydration;
  - salted broth or salted rice water (recommended 3 g of salt per liter of solution);
  - salted chicken broth (recommended 3 g of salt per liter of solution);
  - weak tea without sugar (green is better);
  - decoction of dried fruit.

Determination of fluid deficiency during dehydration
Fluid deficiency in PCA is calculated by the percentage of weight loss during the illness. If the body weight that was before the disease is unknown, then the measure of dehydration is determined by the following clinical signs.

There is a simpler and more affordable way to determine the severity of dehydration recommended by WHO.

The amount of fluid required for dehydration is calculated, depending on the degree of exsiccium. As a rule, oral rehydration without the use of infusion therapy is sufficient for rehydration of patients with exsiccosis of grade 1–2.
  Oral rehydration is carried out in two stages:
Stage 1:  in the first 4-6 hours is the elimination of water-salt deficiency that occurred during the illness. At this stage of rehydration, you must use special solutions for oral rehydration.

After 4-6 hours after the start of treatment, it is necessary to evaluate the effect of therapy and choose one of the following options:
  1) transition to maintenance therapy (stage 2) with the disappearance or significant reduction of signs of dehydration;
  2) while maintaining signs of dehydration at the same level, the treatment is repeated for the next 4-6 hours in the same regimen;
  3) with increasing severity of dehydration, switch to parenteral rehydration.
Stage 2:supportive rehydration, which is carried out, depending on the current loss of fluid and salts, which continue with vomiting and stool. Approximate solution volume for supporting rehydration is 50-100 ml or 10 ml / kg body weight after each stool. At this stage, glucose-salt solutions alternate with salt-free solutions - fruit and vegetable decoctions without sugar, tea, especially green.
  With vomiting after a 10-minute break, rehydration therapy is resumed. In a hospital, if the child refuses to drink or if vomiting is present, probe rehydration is used.

Parenteral rehydration
For severe dehydration, oral rehydration is combined with parenteral.

A parenteral rehydration therapy program should take into account
1. Determination of the daily needs of the child in fluid and electrolytes.
  2. Determination of the type and degree of dehydration.
  3. Determination of fluid deficiency.
  4. Determination of current fluid loss.

The principle of calculating the volume of infusion therapy for rehydration
Calculation of the daily volume of fluid: the amount of fluid deficiency during the illness, the physiological needs of the child for fluid, the current pathological losses.
  The measure of fluid deficiency is determined by clinical signs or by the percentage of weight loss and is equal to: 1% dehydration = 10 ml / kg, 1 kg loss of body weight = 1 liter.

Physiological needs of the child for fluid
They can be calculated using the Holiday Segar method, which is the most widely used in the world.

An example of the calculation of the physiological fluid demand by the Holiday-Segar method: in a child weighing 28 kg, the daily physiological fluid demand is: (100 ml X 10 kg) + (50 ml X 10 kg) + (20 ml X 8 kg) = 1660 ml / day.
  The calculation of the need for fluid, in terms of the time of administration, is more physiological compared with the daily determination, since it creates conditions for reducing the number of complications during infusion therapy.
  The physiological fluid demand in this way can be calculated as follows:
  Newborns: 1st day of life - 2 ml / kg / hour;
  2nd day of life - 3 ml / kg / hour;
  3rd day of life - 4 ml / kg / hour;
  children: weighing up to 10 kg - 4 ml / kg / hour;
  weighing from 10 to 20 kg - 40 ml / hour + 2 ml for each kg of weight over 10 kg;
  with a weight of more than 20 kg - 60 ml / hour + 1 ml for each kg of weight over 20 kg.

Current pathological losses are determined by weighing dry and used diapers, diapers, determining the amount of vomit, or by means of the following calculations:
  10 ml / kg / day for each degree of body temperature above 37 ° C;
  20 ml / kg / day with vomiting;
  20-40 ml / kg / day with intestinal paresis;
  25-75 ml / kg / day for diarrhea;
  30 ml / kg / day for loss with perspiratsii.

Calculation of the need for salts in exsicosis
Particular attention in the elimination of dehydration should be paid to correcting the deficiency of sodium and potassium, the losses of which are significant. It must be remembered that the baby receives sodium with crystalloid solutions, which are introduced in certain ratios with glucose, depending on the type and degree of dehydration.
  If laboratory control is not carried out, potassium is injected at the rate of physiological need (1-2 mmol / kg / day). The maximum amount of daily potassium should not exceed 3-4 mmol / kg / day. Potassium preparations, mainly potassium chloride, are administered intravenously in 5% glucose solution. Insulin addition is not recommended at this time. The concentration of potassium chloride in the infusate should not exceed 0.3-0.5% (maximum - 6 ml of 7.5% potassium chloride per 100 ml of glucose). Most often, a 7.5% solution of potassium chloride is used (1 ml of 7.5% potassium chloride contains 1 mmol of potassium). Before introducing potassium into the infusate, it is necessary to achieve a satisfactory diuresis, since the presence of anuria or pronounced oliguria is a contraindication for intravenous administration of potassium. The threat to the life of the child occurs when the content of potassium in the blood plasma
  6.5 mmol / l. At its concentration of 7 mmol / l, hemodialysis is necessary.

Electrolyte deficiency recovery
Determination of salt deficiency is based on laboratory data. Given the predominantly isotonic type of dehydration in acute intestinal infections in children, the determination of blood electrolytes for all children with diarrhea is not necessary. It is indicated for severe forms of the disease.
  The definition of Na + and K + is mandatory for exicosis 3 tbsp. and in children with exsiccias
  2 tbsp., In which the severity of the condition does not correspond to the severity of diarrhea, there is an aggravated history, there is no quick effect from the rehydration therapy.
  The deficiency of sodium, potassium or other ions can be calculated using the following formula:
  Ion deficiency in moles = (ION norm - ION of the patient) x M x C, where
  M - body weight of the patient,
  C is the volume ratio of extracellular fluid,
  C-0,5 - in newborns,
  C-0.3 - in children under 1 year old,
  C-0.25 - in children after 1 year,
  C-0,2 - in adults.

Next, it is necessary to determine and take into account the amount of sodium and potassium in solutions that overflow, the volume and ratio of which have already been calculated. After emergency intravenous rehydration, it is necessary to check the level of sodium and potassium in the blood plasma. Considering the importance of magnesium ions for the child’s body, as well as the loss of magnesium in parallel with the loss of potassium, the first stage of rehydration therapy shows the introduction of a 25% solution of magnesium chloride at a dose of 0.5-0.75 mmol / kg body weight (1 ml solution contains 1 mmol of magnesium).
  The calculated volume of fluid must be entered throughout the day. If there is no access to the central vein, the fluid is injected into the peripheral veins, the infusion should be carried out for 4-8 hours, repeating the infusion, if necessary, after 12 hours. Accordingly, this patient receives intravenously that part of the calculated daily volume of fluid, which falls on this period of time (1/6 of the daily volume - for 4 hours, 1/3 - for 8 hours, etc.). The volume that remained is injected through the mouth.
  Control of the correct rehydration therapy is the state of the child, the dynamics of body weight and diuresis.
  When choosing solutions and their ratio for rehydration therapy, it is necessary to consider the type of dehydration. There are 3 types of dehydration: isotonic, hypertonic (water-deficient) and hypotonic (salt-deficient).

Isotonic type.  It develops with the uniform elimination of water and electrolytes from the body of the patient. This kind of exsicosis, most often, occurs in children with acute intestinal infections.
  Considering the features childhoodthat create conditions for the development of hypernatremia, cell edema with inadequate rehydration therapy, in young children, it is necessary to carefully choose the solutions for parenteral rehydration. It is necessary to limit or exclude as much as possible solutions that contain a relatively large amount of sodium (Disol, Trisol, Quartasol, Acesol, Lactasol, Chlosol, etc.).
  The most optimal crystalloid solutions for parenteral rehydration in young children is 5% glucose solution and 0.9% sodium chloride solution, Ringers-lactate solution. Colloidal solutions
  5-10% albumin is advisable to use only in hypovolemic shock or hypoalbuminemia.
  With isotonic rehydration on the first day in conditions of microcirculation preservation, the starting solution is 5% glucose solution with isotonic sodium chloride solution in a 2: 1 ratio. In case of violation of microcirculation, signs of eksikoz 3 tbsp. and shock therapy begins with 5% albumin.
  In parallel, the correction of the content of potassium, magnesium is carried out, according to the physiological need and the calculation of the deficit in the presence of ionogram.
  In severe exsiccosis, the acid-base balance of the blood must be corrected according to certain parameters. For this use
  4-8.5% sodium bicarbonate solution. 8.5% sodium bicarbonate solution is diluted with 5% glucose in a 1: 1 ratio. The dose of bicarbonate, if it is possible to determine the acid-base balance, is calculated by the formula: 4% NaHCO3 ml = BE mmol / lx body weight x 0.5. If it is impossible to determine the parameters of the acid-base balance, sodium bicarbonate is administered only to patients with severe forms of acute intestinal infections with obvious clinical signs of exicosis of grade 3, hypovolemic shock. In such cases, 4% soda solution is administered in a dose of
  4 ml / kg body weight of the child. The calculated amount of bicarbonate is divided by
  3-4 administrations and is administered intravenously with glucose solutions. The introduction of sodium bicarbonate makes up for the lack of alkaline valence, but does not contribute to the removal and neutralization of organic acids. Therefore, in the treatment of acute intestinal infections, the focus should be on the resumption of circulating blood volume and its rheology. In addition, an additional amount of sodium is injected with bicarbonate, which should be taken into account during calculations, especially in comatose states, in order not to deepen the swelling of the brain.
Subsequently, glucose-saline solutions are introduced in a volume that provides the body's physiological fluid need to compensate for dehydration, current pathological losses, and correction of the content of electrolytes in the blood plasma.

Hypertensive type.Sodium content in blood plasma - more than 150 mmol / l. It develops as a result of the predominance of fluid loss over the loss of salts with stools, vomiting, with an excessively rapid introduction of salts against the background of an insufficiently introduced amount of liquid. Clinically, it is manifested by thirst, aphonia, crying without tears. Fabric turgor saved. The skin is dry, warm, in young children a large fontanel does not sink as a result of an increase in the volume of cerebrospinal fluid. In severe cases, an increase in osmotic concentration of cerebrospinal fluid can lead to seizures.
  On the first day, the therapy of hypertonic dehydration begins with the introduction of 2.5% glucose, in combination with an isotonic solution of sodium chloride in a ratio of 2-3: 1.
  When conducting rehydration therapy in patients with hypertonic dehydration, the daily body need for sodium, which is 2-3 mmol / kg body weight, should be taken into account. This need should take into account the sodium content in infusion solutions.
  If during exsicosis the level of sodium in the blood plasma is 140-150 mmol / l, then the amount of sodium decreases 2-fold from physiological needs, and when it increases in the blood plasma more than 150 mmol / l - completely exclude solutions that contain sodium.
  In order to prevent cerebral edema when conducting infusion therapy, constant monitoring of the osmolarity of the blood plasma and the patient's body weight is necessary. Acceptable is the increase in the osmolarity of blood plasma by 1 mosmol / year of life and body weight (up to 8% per day). At this stage, the infusion is carried out at a rate of 15-20 drops per hour, since the rapid introduction of glucose initiates osmotic diuresis and this prevents adequate absorption of fluid in the kidneys.

Hypotonic type.  Sodium content in blood plasma is less than 130 mmol / l. The reason for this is the predominance of salt loss over the liquid, or the excessive introduction of water without an adequate amount of salt. It occurs at intestinal infectionswhich are accompanied by frequent vomiting or during oral rehydration with solutions that contain insufficient amounts of salts.
With this type of exsiccosis, thirst is moderate, patients give preference to brackish solutions. External signs of dehydration are mild: the skin is cold, pale, moist, “marble”, acrocyanosis is expressed. The mucous membranes are moderately dry, the large spring in small children falls, which distinguishes this type of dehydration from hypertonic. Turgor of tissues is reduced, the skin fold is smoothed slowly. Children are sluggish, inhibited, adynamic. In severe cases, seizures are possible (at a sodium level of 120 mmol / l or less), lethargy, and hypothermia.
  The amount of sodium administered per day consists of the daily requirement and its deficit, which is calculated by the formula, but the sodium increase in the blood plasma should not exceed 3-5 mmol / kg / day. Sodium correction is carried out with polyionic solutions, which in their composition approach the extracellular fluid (0.9% sodium chloride solution, Ringer-lactate) mixed with 5% glucose in a 1: 1 ratio. At newborns and children of the first 3 months of life from salt solutions  use only isotonic sodium chloride solution.
  If it is impossible to monitor electrolytes in the serum, glucose-saline solutions are introduced in a 1: 1 ratio.
  In parallel with the correction of sodium in the blood plasma, the correction of the content of potassium and magnesium, which consists of the sum of physiological needs and deficit, which is calculated by the formula, is carried out.
  According to the recommendations of the WHO experts, if it is necessary to conduct fast (bolus administration) infusion therapy in the absence of laboratory control, at the first stage of rehydration the volume of the solution (Ringer-lactate or 0.9% sodium chloride solution) for infusion therapy and the speed of administration are as follows.

Observation of the child during rehydration therapy, if necessary, to conduct rapid rehydration, is as follows:
  The condition of the child is checked every 15-30 minutes until the filling of the pulse on the radial artery is restored. If the condition of the child does not improve, increase the rate of injection of solutions. After each hour, the child’s condition is assessed by checking the skin folds in the abdomen, the level of consciousness, and the ability to drink.

After the entire volume of fluid is injected, the condition is again evaluated:
  - If the signs of severe dehydration persist, then the introduction of solutions follows the same pattern.
- If the condition improves, but there are signs of moderate exsiccosis, proceed to oral administration of glucose-saline solutions. If the baby is breastfed, it is recommended to continue feeding.
  - If there are no signs of dehydration, then breastfed babies increase the length of time they are fed. At the same time, in the presence of diarrhea, for supporting rehydration, children under 2 years old give 50-100 ml, children over 2 years old - 100-200 ml or 10 ml / kg of body weight of the solution for oral rehydration, additionally (to 1/3 of the calculated volume of solution for oral rehydration). Artificially fed babies are treated according to the same scheme, but low-lactose mixtures are used in feeding.
  When conducting parenteral rehydration in children with pneumonia, toxic encephalopathy, the rate of administration of the solutions should not exceed
  15 ml / kg / hour. Under these conditions, the daily weight gain in the first 3 days should not exceed 1-3%.

Antibacterial therapy

Indications for the appointment of antibiotics for OCI
- Severe forms of invasive diarrhea (hemocolitis, neutrophils in coprogram).
  - Children under 3 months.
  - Children with immunodeficiency states, HIV-infected children; children who are on immunosuppressive therapy (chemical, radiation), long-term corticosteroid therapy; children with hemolytic anemia, hemoglobinopathies, asplenia, chronic intestinal diseases, onco-hematological diseases.
  - Hemocolitis, shigellosis, campylobacteriosis, cholera, amebiasis (even if you suspect these diseases).

Indications for parenteral administration of antibiotics
- Impossibility of oral administration (vomiting, lack of consciousness, etc.).
  - Patients with severe and moderate forms of AII and immunodeficiency states.
  - Suspected bacteremia (sepsis), extraintestinal foci of infection.
  - Children under the age of 3 months with high fever.

Adjuvant therapy
World practice and own experience show that the use of adequate rehydration therapy, diet therapy, and, if necessary, antibacterial therapy, almost always provides for recovery of the patient. Along with this, a number of drugs can have a positive effect on the child’s body during the illness, help to reduce the duration of the symptoms of OKA, and alleviate the patient’s condition, although they are not crucial for getting out of the disease. Of these drugs, probiotics are widely used. They contribute to the normalization of the intestinal biocenosis, can act as antagonists of pathogenic bacteria due to their competitive action. With invasive diarrhea, the effectiveness of therapy increases with the simultaneous use of probiotics and antibiotics. With secretory diarrhea, probiotics can act as independent means of treatment. A course of probiotic therapy should be 5-10 days.
  Physiological is the use of probiotics in the period of recovery of the OCI, since intestinal dysbiosis develops during the disease. There are various approaches to the choice of doses of biological products. Most professionals use medication doses. In addition to the dose of the drug, the duration of the therapeutic course, which should be at least 21-30 days, is important.
  Enterosorbents (Enterosgel) can reduce the duration of intoxication with acute intestinal infections and accelerate recovery. The basis for the use of enterosorbents for acute intestinal infections in children is that they are able to fix on the surface of their cells pathogens. Sorbents inhibit the adhesion of microorganisms on the surface of the intestinal mucosa, reduce the translocation of microflora from the intestine during internal environment  organism and, thus, prevent the generalization of the infectious process. Enterosorbents fix rotaviruses that are in the intestinal cavity on their surface.
  In addition to the causative agents of OCI, enterosorbents excrete toxins of microbes and their metabolic products from the body.
Promising in the treatment of acute intestinal infections in children are “white” aluminosilicate sorbents, which in their activity exceed other enterosorbents. Unlike coal sorbents, they do not require the administration of large doses of the drug to achieve the goal, they are far superior in their organoleptic properties. The presence of micropores in coal sorbents interferes with the sorption of high-molecular protein toxins, which are present in microbial pathogens of OKA. Also, carbon sorbents penetrate into the submucosal layer of the intestine and can damage it.
  According to WHO recommendations (2006), zinc preparations are recommended as adjuvant therapy for acute intestinal infections in children. Today in Ukraine, zinc preparations for children are not registered.