Prevalence and genotype distribution of norovirus and rotavirus among children under five with diarrheal infection in lower-middle-income countries after Rotavirus vaccine introduction: A systematic review and meta-analysis.
Firayad Ayele, Tesfaye Assebe, Miheret Mandefro et al.
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In 30 seconds
This systematic review and meta-analysis assessed norovirus and rotavirus prevalence and genotype distribution among children under five with diarrheal infection in low- and middle-income countries after rotavirus vaccine introduction. Across 35,704 children, the pooled prevalence of the two viruses combined was 18% (95% CI: 15-21%). Rotavirus prevalence was 24% (95% CI: 19.6-28.3%), compared with 13% (95% CI: 11-15%) for norovirus. Norovirus GII predominated, particularly GII.4; G3[P8] and G1[P8] were the most frequently identified rotavirus genotypes.
Key findings
- Combined pooled prevalence of norovirus and rotavirus was 18% (95% CI: 15-21%) among children with diarrheal infection.
- Rotavirus prevalence was 24% (95% CI: 19.6-28.3%), versus 13% (95% CI: 11-15%) for norovirus.
- Norovirus GII accounted for 76% of genotypes; GII.4 represented 53% of cases, followed by GI at 23%.
- The most frequently identified rotavirus genotypes were G3[P8] (39%) and G1[P8] (17%).
Why it matters
The findings indicate that both viruses remain relevant causes of diarrheal illness in young children in LMICs after rotavirus vaccine introduction. The reported genotype distribution provides context for surveillance and for assessing whether circulating strains change over time, while the substantial between-study heterogeneity cautions against assuming these pooled estimates apply uniformly across settings.
What to keep in mind
Substantial heterogeneity was observed across studies (I2 = 98.72%, p < 0.001), limiting the uniformity of pooled estimates across settings.