H: Mark Rise, Host
P: Philippa Forrester
D: Dr Keith Lindley, Consultant Paediatrician, Great Ormond Street

H: I’m Mark Rise, this is the Health Show and today we’re talking about a bug that can affect every child across the nation, so whether you’re a parent or a childcare worker, we’re going to have something of interest for you today. You may never have heard of rotavirus gastroenteritis but it will affect every child under the age of 5 in some cases leading to hospitalisation and in extreme cases it can even be fatal. Well this week is the first childhood gastroenteritis awareness week and joining me in the studio is television personality Philippa Forrester and Dr Keith Lindley, Consultant Paediatrician at Great Ormond Street hospital. Dr Lindley can you first tell us a little bit more about what rotavirus gastroenteritis actually is?

D: I think to take it from the top we have to understand that gastroenteritis is inflammatory condition of the intestine which presents as simple diarrhoea and vomiting so most parents, most families will be very familiar with the symptoms, certainly those who’ve had young children will have seen this affect them. As it turns out most gastroenteritis in childhood is caused by viruses and the commonest virus to cause gastroenteritis is this bug we call rotavirus

H: So it will affect every child, there isn’t a way of getting around it?

D: No, every single child under the age of 5 will have at least one episode of rotavirus gastroenteritis, many will have 3 or 4 episodes before their 5th birthday

H: Well Philippa, considering this is so common, why have we heard so little about it?

P: Well this is the thing, this is why we’re having this awareness campaign. 84% of parents that we surveyed didn’t know what rotavirus gastroenteritis was, including me!

H: And you’ve got 3 children haven’t you?

P: I am one of those parents, yes, and I have 2 sons really, I mean the baby’s only 4 months old at the moment who have had it and I haven’t known what it is and I think a parent whose forewarned is forearmed, you’re much more aware of what to do and how to manage a situation with your child if you know what you’re dealing with, and children can go downhill so quickly, you know an under 2 can become severely dehydrated within 6 hours of starting an episode of sickness and diarrhoea. Now that’s not long at all, if you don’t know what the signs are to look out for, dehydration can be dangerous, that’s when you might be looking at you know taking your child to hospital, so I think that it’s really important to know what you’re dealing with

H: Of course, well if you’ve got any questions that you’d like to ask about the condition rotavirus gastroenteritis please do join us on our live program this afternoon. What you can do is, there should be a little box at the bottom of the screen where you’re watching us right now, just give us your name and your question, it will go through to our moderators and hopefully end up on our screen here in the studio so that I can ask it, and indeed Cerys has done just that, she says “this sounds like ordinary tummy bugs Keith which my kids get from time to time – how can you tell the difference between an upset stomach and the potentially life-threatening condition?”

D: I think you can’t tell the difference because this is very unpredictable. Rotavirus itself has no regard for social class, for culture, for anything, it can produce an illness in anyone and that illness can be either very severe or very mild. What is clear however is that the illness is normally most severe in the younger children, so children between 6 months and 24 months of age are far more likely to have a serious or severe infection than those who are a little bit older

H: So are you saying that older children can get it and adults can get it but we’ve built some kind of immunity by then?

D: That’s right by the age of 5 most children will have seen you know 1,2 or 3 times, they will have a degree of immunity to it, so it’s not uncommon when children have it for their parents also to contract the virus, in fact it’s pretty inevitable, but the parents don’t get a great deal of symptoms because they have some immunity, and they’ll keep that immunity until they’re, you know in their old age

H: I think that it’s worthwhile, being the consultant paediatrician here, tell us what to do I mean, this is a worrying time for any parent if their child contracts it, what are the things that we ought to be doing straight away?

D: Well the key to managing any sort of gastroenteritis is to ensure that the children remain well hydrated

H: And is that just drinking water, I mean what is that?

D: Well what’s being lost in the diarrhoea is water and is salt, and so the best way to replace that is water and salt, but you mustn’t just give water and salt you’ve made up yourself, you give it as a chemically formulated drink called oral rehydration solution, and the chemists have made that very very precisely so it optimises water absorption. So what you shouldn’t do is try and do it yourself, it’s very clearly established that causes harm, but if you pop along to the pharmacist and you ask for the oral rehydration fluid they’ll give it to you, they’ll also talk you through it, they’ll give you some instructions and you use that to rehydrate your child

H: And what happens if your child won’t take that?

P: Bribery and corruption!

H: Kids are unpredictable aren’t they, let’s face it?

D: Don’t flavour it, they have to take it as it is, if you flavour it with a squash you risk actually losing the chemical balance, so that’s a big big big big no

H: And presumably if they really won’t take it you take them to hospital?

D: Well absolutely, what one tends to do is to try about 4 hours worth of it. If they’re dehydrating they do tend to develop thirst as the dehydration starts to really kick in they inevitably get thirsty and they will take it. Little bit and often, little bit and often

H: Little and often, well let me just say Mrs Clements is watching this afternoon, thank you indeed for your question, if you’d like to send a question like she has done all you’ve got to do is just look at the little box at the bottom of the screen, send us your name and your question as well. Mrs Clements has said “is it contagious, if one child gets it, will the rest of them get it?”

D: It’s tremendously contagious, as little as 10 microlitres of poo, I mean you can barely see 10 micro litres it’s so small, there’ll be enough viral particles in there to cause a clinical infection, you need only 10 viral particles so –

H: That’s a terrible thing for someone that runs a nursery for instance

D: Oh absolutely it’s really infectious and it’ll live on the toys, you know what infants are like, you know one licks something and you get poo or saliva here, someone else will pick it up and suck on it, and so it will be everywhere the virus and they will all contract it

H: So is there any useful way of avoiding, I mean apart from washing hands and everything else?

D: Well washing hands doesn’t get the virus off you, unfortunately it’s really very very hardy. Alcohol wipes will inactivate a good deal of the virus and reduce the numbers of viral particles quite dramatically but apart from that, you know hand washing – yes you should wash your hands after you’ve changed someone’s nappy, I’m not saying you shouldn’t and with many bacteria if you use you know disinfectant soaps and what have you, that will help, but with rotavirus unfortunately you will still have it on your hands, you can still pass it round

H: Well I hope that answers Rosie Warrs question because she said “how do you prevent the spread of the thing, is it all about washing hands?” so no there is no way of preventing the spread of it. Philippa that’s bad news for parents isn’t it?

P: Well it’s just one of those things you have to accept you know, you’re a parent, deal with that! You’re a parent you have a lot more washing to do!

H: But there are so many things that parents have to worry about –

P: Of course

H: This is one of those things that if we’re aware of it we can be forewarned is forearmed

P: But this is nothing new, what we’re not doing is starting a panic here, what we’re doing, hopefully is reassuring parents that when they have an episode of sickness and diarrhoea that seems to them to be quite severe, it’s ok, this is probably what it is, it’s been around a long time, there was nothing that you could do to prevent it, it’s not that you know you’ve got low hygiene in your house or that they have in the nursery, it’s just something that you’re going to have to deal with and we’ll support you while you deal with it by giving you extra knowledge

H: Difficult sort of at times for parents to get time off work when their children are ill, but if you’ve got more than one child and one child gets it, you know you’re going to be off work for a few days don’t you?

P: And some nurseries won’t let children back straight away either after they’ve had –

H: Understandably if it’s that contagious

P: Yes absolutely and also you’ll be exhausted. My first son whose now 6 got his first episode at about 18 months which I gather is a quite classic time –

D: Yes

P: Well we were in Manchester in a very nice hotel thank you very much because I was about to present a live show for the BBC for an hour on Sunday morning. That was not great timing, let me tell you!

H: Children aren’t great respecters of time anyway are they to be fair!

P: So you know not only were we staying in a beautiful room in a beautiful hotel, and the staff had to change our bed at least 5 times that night. If I could have stripped the sheets and used the washing machine myself I would much rather than having to keep call them up, I was so embarrassed. But he was suffering, I was worried, you know there was that stress. I was also terrified about the show the next morning, because you can’t just call another presenter at the drop of a hat, you know I had to do that show. Will he be alright, you know I didn’t want to leave him, all of those things were going through my mind. What if we have to call out a doctor in the middle of the night from a hotel room, what do I do? You know so luckily my father-in-law is a GP so I could phone him and say what is going on, how do I manage this, and I got the right advice. Most people don’t have that on tap, that kind of advice, it’s not always there, so I think that’s what’s so important about this campaign, this awareness campaign. As soon as parents realise – ah I’ve heard about this, I know what this is, I know how to treat it, you know some of that panic is taken away. You know we’re not going to stop it, we’re not going to stop rotavirus with these measures and we’re not going to stop the wider implications which are you know huge percent of time off work

H: Keith the interesting thing about this is this is a virus that’s been around, presumably for hundreds of years, why is it now that not only are we giving it more publicity but it’s actually been given a name – why are we treating it like this now?

D: Yes I mean we’ve had the name for the virus for 25 years or thereabouts, it was the early 70s it was identified in stool as a viral particle and presumably it had been round for many years before that. What is absolutely fascinating is that our standards of hygiene have improved, throughout the west and indeed in the undeveloped world the rate at which the virus strikes has remained very constant, so it’s something which has no respect for standards of sanitisation or standards of hygiene, it’s always been there as far as we know

H: Miss Smith wants to know if there’s no cure at the moment is there going to be one, are they working on it?

D: Yes, part of the reason for talking about this now, albeit 25 years after the virus was described, is that there have been quite exciting developments in developing vaccines which can prevent this

H: Yes but children have a lot of vaccinations don’t they?

D: Yes children do have a lot of vaccinations but you know what we’re giving here is something which is inevitable, every child by the age of 5 is going to be exposed to this virus, so why not make their first exposure a bug which won’t cause terrible diarrhoea, which won’t dehydrate them, which won’t send them to hospital – remember 1 in 40 children under the age of 5 is going to be hospitalised with this. Why not give them an attenuated virus which we know is safe and which we know can reduce the incidence of severe gastroenteritis caused by Rotavirus by about 95%?

H: We’ve got a question in from Mrs Thomas from Edinburgh who wants to know “my kids get enough vaccines as it is – do they really need another one?”

D: Well as I said this is something they’re going to be exposed to, all we’re doing is exposing them to a virus which isn’t going to cause clinical illness. So we’re doing exactly what nature’s going to do but we’re going to do it a little bit earlier and we’re going to do it in a safer manner. You have to remember this is a virus which is given by mouth, and so it doesn’t really get into the body, and it will be one of thousands if not millions of proteins which go through our gut every day which our immune system samples, so we’re just – if you like - allowing the immune system to sample a benign version of the Rotavirus before a pathogenic version comes and causes a clinical illness

H: Would that mean that the vaccine when it is finally developed would be oral or would that be another injection that children would have to have, or is it too early to tell?

D: No the vaccine is developed and the vaccine is actually licensed in Europe but it’s not actually widely available yet because it’s not part of the immunisation schedule

H: So the idea is if we can get it on the immunisation schedule then it would be another idea for parents to think about right at the beginning?

D: I think it’s a very good candidate to go on the schedule

H: How do we get vaccines on the schedule, do we know this?

P: I think you can ask for it – can you ask for it privately?

D: I think that there are 2 vaccines, I think that one of them can be got privately at the moment and I think the other one is coming shortly

H: So this is about parental pressure as well so it’s more parents knowing about it, more parents asking about it in the same way as lots of other vaccines have become available that way I guess?

D: Yes but I don’t feel we want a two tier health system here you know, if it’s good for children to have then ideally in our society they should all have it, and I would support that

H: Indeed. Fay wants to ask and this is one that you might deal with Philippa “if I’m breast-feeding and my child develops this, can I continue breast-feeding, would that in some way prevent the spread of it?”

P: Well I’m breast-feeding at the moment, I have a 4 month old, and when I walked in and said that I was breast-feeding this morning you said “oh well that’s one of the best ways to prevent it”

H: Oh so that’s a good thing?

P: Because breast-feeding boosts your child’s immune system and I will be passing on my immunity to my son. Equally if he is experiencing an episode of sickness and diarrhoea then I need to keep breast-feeding to keep his hydration up and on demand, you know I know some people think that maybe you should be a bit regimented between feeds but when they’re sick and they need as much fluid as possible then feed on demand, and yes absolutely keep feeding, it’s the best thing you can do

H: Ok well that’s really good advice. If you’ve got any questions please do keep them coming, you will see a little box at the bottom of the screen where you’re watching us right now, just pop your name in there and any question that you’ve got and send it through to us, it will pop up on our screen here in the studio. We’re about halfway through the program, we’ve had quite a lot of questions in about nurseries, working at nurseries, children going to nurseries, so I’d like to deal with some of those. Somebody has sent us a question saying “I run a small nursery and haven’t been made aware of this particular illness by the county council or whoever’s job it is to warn me. Where do I go for more information?”

P: Whose job is it? That’s an interesting one, I don’t know – I think it’s all of our, as parents or whatever it is we do it’s down to us and we are responsible to get information, so us – and we have a website

H: Excellent

P: www.rotavirus.org.uk

H: And the great thing is we’ve got a link to that at the bottom of our screen right now

P: Ok

H: So you can actually go directly to it. That’s not fully up and running yet is it though?

P: No we’re going as quickly as we can because we’re aware that parents want the information –

H: Of course

P: But there will be a free downloadable parent information leaflet, so shortly up and running will be you can put your details and request the leaflet and then we’ll give it to you as soon as we can

H: Excellent. We’ll give you that link at the end of the show as well, so www.rotovirus.org

P: .UK

H: .UK, that’s the one you need to remember. Excellent. Danielle wants to know “does my child’s nursery have an obligation to inform parents if somebody else’s child is diagnosed with it, as we’ve heard it’s so contagious –

D: I don’t think the nursery are going to know to be honest because most cases of this the general practitioner won’t know, he’ll know how to treat it and it will be treated, all the nursery will know is that a child has a diarrhoea and vomiting illness

H: And suddenly there are no children there the next day!

P: Or teachers!

H: That’s an interesting point though, after one child gets it how quickly can you expect another child to catch it, is it that fast, is it next day or –

D: No it’s well we believe it’s about 3 or 4 days it takes to get from one to the other but you have to remember that children are very infectious in the vomiting phase which is before the diarrhoea starts, so often you know one vomit and then the diarrhoea starts and then it will be the vomiting phase that they’re infectious

H: And how long does this illness last, is it are we talking a 24 hour bug, a 5 day bug – what?

D: Well it’s very very variable you know, some breast-fed babies who are very lucky will have a 12 hour illness and then get better, those admitted to hospital the average time they’re in hospital in the UK is about 4 days and the occasional child will go on to have a much longer illness and then what we call a post-rotavirus syndrome where the diarrhoea can continue in a slightly different form, even for months

H: You talked about hospitalisation and I mentioned right at the beginning that this is an illness that can be fatal, it’s not actually the illness that is fatal, presumably it’s the dehydration?

D: Yes I mean you know it can be severe and we’re in January, February, March are the peak months for the epidemic form of this, and during these months we would expect in the UK about 250 children a day to be admitted to hospital with this

H: Wow, I mean that’s a lot, that’s a tremendous drain on the health service anyway isn’t it?

D: Well I remember as a junior doctor walking in August on the ward thinking why are there all these empty beds and nurses not doing anything and then when January came I realised it’s because they had to be there waiting, the January peaks of Rotavirus and actually another virus, called bronchialitis virus, RSV virus, they both hit together in January and really stress the healthcare system

H: So it’s no surprise that we’re talking about it and the awareness week is specifically in January because that’s one of the worst times?

D: That’s done on purpose really

H: That’s interesting because if more parents know about it you’re going to be bothering your GP less because you know what to do about it. Let’s just go back, in case you missed the beginning of the show let’s go back, this is a virus that will affect all children under the age of 5 at some point, tell us what we can do about it once your child has got it, Keith what can we actually do?

D: You can do nothing to change the natural history of the infection, what you have to do is prevent the complications of dehydration and so primarily that is achieved with these oral rehydration solutions

H: So that’s the correct procedure, because Elspeth has emailed and said “what’s the correct procedure, what should I be doing?”

D: Yes well if in doubt, if you’re worried, seek medical advice, I guess that’s the first thing to say. If your child has had a lot of vomiting and diarrhoea but still looks like their normal bouncy self and is happy, then you get the oral rehydration solution – I would give them probably of the order of about 50mls per kilogram of body weight, so that’s about 300mls for your average 6 month old

P: But the chemist will help you with that if you need

D: Yes the chemist will help you, and if you do that over 3 or 4 hours

H: So how does it come, does it come in a sachet that you make up, something like that –

D: It comes in a sachet which you add water to. Follow the instructions on that precisely, don’t adulterate it, don’t make it up too strong –

H: So you’re using a measuring jug and –

D: You don’t make it strong, you don’t dilute it you don’t flavour it – it’s precisely formulated, it’s extremely important that, and you just give it and you know if your child is perking up when it’s rehydrated after 4 hours, fine, if you’re not making any progress at that point it’s time to seek help from some professionals, be it a GP, be it NHS Direct or what have you

H: So speed is of the essence, when your child has this, you need to get them hydrated again and fast

D: Well it’s variable but in its most severe form a baby can become severely dehydrated in 4-6 hours

H: Philippa you were talking about when your first child had it you didn’t know what to do, fortunately your father-in-law was a GP, was it a question that you noticed a rapid downhill of your first child, that it got a lot worse?

P: Absolutely, oh from fine bouncing healthy boy asking to go to the toy shop which he’d just seen to do you know, I’m doing a little bit of whining now and being a bit clingy, oh I’ve been sick, oh I’ve got diarrhoea, and then we were away – it was very fast that they go downhill and talking as a parent particularly I’d like to talk about getting the fluid in, because it’s all very well us sitting here saying “yes you need to rehydrate your child –“

H: Children aren’t that easy are they let’s face it

P: It’s so not that easy especially with a toddler, and you can’t even reason with a toddler when they’re poorly

H: Not when they’re poorly, no

P: They won’t even watch telly let alone drink this stuff which they don’t necessarily like the taste of some of them, sometimes they do if you’re lucky, but you know they might be asking for another drink and you need to persuade them that no, this is what they’re having to drink, and I have sat there in one of these episodes before now with a 5ml syringe filling it up and drip drip dripping gently just into his mouth, so he has to swallow it because it’s just going into his cheek there, so it’s just going in just so slowly, it’s painful, but I know fluid is getting in there. And if they drink it too fast they’re probably going to just be sick again so it’s little and often, little and often and if you have to resort to “I will buy you the toy of your dreams –“

H: Oh the old bribery trick, yes

P: Well who cares?

H: Exactly. But the way you describe it coming on really quite quickly it’s something that anybody that looks after your child on a kind of even semi-permanent basis, child minder or whatever, they all need to know about this as well

D: Absolutely

P: You should make everyone aware, from grandma through, you know because the likelihood is that grandma’s seen it but she’s not known what it is either

H: But that means that some grandparents will turn round to us, quite rightly so and say “I dealt with it when I was a mum, I didn’t need to know more about it, you know –

P: And what we need to give them is fizzy drinks! Flat, fizzy drinks, that’s what we hear a lot, and on no account take that advice, just say you know I have this issue as much as any other parent, you know I have people who have been there before me and things have changed slightly, and you just have to say look they’ve done a lot of work on this lately, and this is what’s now recommended, and I have to go with that, and any mum, anyone whose been a mum will understand why you have to go with the advice

H: Of course. Mary has sent us in a question, thank you very much indeed Mary, we’ve got about another 10 minutes of the program so there’s still time for you to get your questions in – Mary wants to know “am I – “ this is another nursery question and this turns it on its head actually “am I obliged to inform my nursery if my child has had this, they usually ban kids for days after and I can’t afford to give up the extra time off work if my child isn’t actually sick – surely it’s not a problem once they’ve got better?”

P: Well how long are they contagious, that’s the key isn’t it?

D: Yes well they’re not normally terribly contagious after they developed the diarrhoea maybe 24 / 48 hours or so the virus is coming out in large amounts, but that too does vary and does depend on the amount of immunity you’ve got, and children with impaired immunity can actually excrete the virus for many weeks, so any figure we come up with has to be a ball park figure rather than an absolute value

H: But what you were saying is it is much more contagious in the early stages?

D: Yes absolutely, most nurseries, any child who vomits, most nurseries will not want them in that nursery for at least 24 or 48 hours after

P: However you will also have a child whose just been through a heck of a lot with a small body and will probably want mummy or daddy or someone close nearby and be feeling still a bit clingy and still a bit weak and pathetic and actually won’t be up to going to nursery mentally as well as physically I would say, so sometimes you’ve just got to, as a working mum, you’ve got to say “dad” or “grandma” or someone that’s known

H: Well this is what we were saying earlier though Philippa isn’t it, if you’ve got more than one child, you know you’re going to have to have some time off work because it will spread between your children

P: Yes you’ve just got to be practical about it and actually if you’re an employer you’ve got to hear what we’re saying too and be practical about it, you might lose, you know this is why the vaccine would be such a great idea, you might lose some of your work force to this, and if you do well that’s just life and there’s nothing anyone can do about it –

H: Absolutely

P: You know with the best will in the world

D: We’ve done some sums on this and the economic cost in the UK is probably about £40 million a year in lost productivity, through parents being absent

H: Wow! And that is the kind of figure that employers –

D: Huge

H: Start taking notice of, so I guess when the website is fully up and running print out the information sheet, take it to your employer as well saying you know everyone with kids is going to have this at some time

P: Yes

H: There’s an education week coming up as well I believe? Who wants to talk about that? What else is going on?

P: Well I mean the awareness week is the first gastroenteritis awareness week that we’ve ever had and that’s for the reasons that we’ve been talking about, there’s some very exciting developments

H: So chances are you’ll read it in your newspapers, you’ll hear it in your local radio stations as well –

P: Absolutely

H: So this message will actually be spread far and wide

P: Yes, our mission is exactly that, to arm parents with information so that as soon as they’re witnessing what they think is rotavirus they know how to deal with it and therefore are more confident and therefore are less likely to have their children hospitalised

H: And I guess in any situation when your child is vomiting or has bad diarrhoea the rehydration is important either way, whether you know it’s rotavirus or not

D: No absolutely it’s the same with everyone

H: Avril Harper wants to know “is it possible to educate nursery staff to differentiate between serious illnesses like this and the odd upset tummy?” She’s saying “I’m forever having my child sent home for the slightest of upsets”

D: It’s not possible –

H: Yes it sounds like it –

D: It’s such a variable thing,

H: But that makes it difficult for parents doesn’t it, I mean I’m trying to give some sort of light at the end of the tunnel –

P: Yes and no, I think what the great thing really is, whether it’s rotavirus or another form of gastroenteritis, you deal with it in the same way, you just have to watch out for dehydration, that’s the most important thing, you know and lots of love and cuddles at the same time. But then it becomes, you know I can understand why a nursery would want to send a child home who was poorly, you can’t stay at nursery, they’re just not well enough, so it’s an insurance policy I suppose that you know the slightest –

D: Well maybe they can’t look after them, they take a lot of looking after don’t they, you know, you’ve done it

P: Absolutely

H: Instant diagnosis question here, Mrs Birch has sent us a question, thank you for it, “my son’s had a tummy bug for a couple of days now, he’s got diarrhoea, occasional vomiting and a slight temperature, should I take him to the GP or does this sound like classic rotavirus gastroenteritis?”

D: It would do but I mean I can’t tell you more than that, if he’s well hydrated, he’s this far into the illness, he’s probably going to be ok, one just carries on

P: At what point do you go there?

H: Yes exactly when do you take them to the GP?

D: Well the early stage of this is the most dehydrating phase, it’s right at the very start, and if you get through that by and large you’re ok, unless the diarrhoea goes on and on and on and you know if they’re still having diarrhoea after two weeks, then probably this is a complication of rotavirus or it’s not the rotavirus

H: So there may be an underlying cause that would need to be checked out?

D: If there’s blood in the stool and stuff it’s probably not the rotavirus it’s something else, go see the GP

P: Might it be a good idea to call the surgery and say “should I bring him in?” because the other thing is you don’t want to take him out to the surgery

H: Well indeed

D: Absolutely, I’m sure I mean someone at the surgery, a nurse or someone, or even NHS Direct for that would be happy to offer you some guidance

H: Megan’s sent us a question saying “can you be specific about the symptoms please” I think she may have missed the beginning of the program, can you go back over the actual symptoms of rotavirus gastroenteritis which as we’ve said pretty much every child under the age of 5 will experience at some point

D: Typically it starts with a vomit, typically with a low-grade fever

H: Isolated I mean will your child, I mean Phillipa you were saying that your son got a little bit whiny, a little bit moany just before that happened, so you would expect a kind of downhill from bouncing, happy toddler?

D: Yes sometimes they go a little bit whiny, go a little bit pale before they puke because that’s what happens, and then the watery diarrhoea will normally start not too long after the first vomit. The vomiting is normally gone within 12-24 hours and the diarrhoea can last for a variable period of time from 12 hours to a week

P: And we’re talking about 20 episodes of vomiting or diarrhoea within a 24 hour period so it can –

H: And that’s a lot isn’t it?

P: It’s a lot, it’s fairly dramatic you know, you’re not going to miss it

H: We’re nearing the end of the program and I do want to give some light at the end of the tunnel, the vaccine has been developed, it is available, one of them is available privately now but it’s all about trying to fit this virus into the child vaccination schedule so that all parents will be able to benefit from those

D: I think to be fair about the vaccines they are both very good, they have both had the largest pre-clinical trials of any vaccination ever used on this planet, over 60,000 children were given the vaccine in the safety trials, and in fact the science behind it has one many awards as being one of the best conducted trials ever, so they’re safe, they work

H: And it’s watch this space for when it’s generally available

D: And they’re licensed in the EU –

H: Fantastic

D: And that’s the other good news about this

H: So there is some good news at the end of all that –

D: There is –

H: That is absolutely brilliant. As I say it is the first awareness week that you’re doing, Phillipa can you give us that website again because I’m sure lots of people will want to go and check it out

P: I will and I just want to say one thing as well as well – rehydration, rehydration, rehydration! www.rotavirus.org.uk

H: And that’s rotavirus spelt ROTAVIRUS. I hope that’s given you some food for thought and if your child does experience it you are a little bit more forewarned and forearmed. From us here, Phillipa and Keith thank you very much, I hope you’ll join us again soon. Bye bye.