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Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis.
Lancet Infect Dis. 2014 Aug; 14(8):725-730.LI

Abstract

BACKGROUND

Despite substantial decreases in recent decades, acute gastroenteritis causes the second greatest burden of all infectious diseases worldwide. Noroviruses are a leading cause of sporadic cases and outbreaks of acute gastroenteritis across all age groups. We aimed to assess the role of norovirus as a cause of endemic acute gastroenteritis worldwide.

METHODS

We searched Embase, Medline, and Global Health databases from Jan 1, 2008, to March 8, 2014, for studies that used PCR diagnostics to assess the prevalence of norovirus in individuals with acute gastroenteritis. We included studies that were done continuously for 1 year or more from a specified catchment area (geographical area or group of people), enrolled patients who presented with symptoms of acute gastroenteritis, and used PCR-based diagnostics for norovirus on all stool specimens from patients with acute gastroenteritis. The primary outcome was prevalence of norovirus among all cases of gastroenteritis. We generated pooled estimates of prevalence by fitting linear mixed-effect meta-regression models.

FINDINGS

Of 175 articles included, the pooled prevalence of norovirus in 187 336 patients with acute gastroenteritis was 18% (95% CI 17-20). Norovirus prevalence tended to be higher in cases of acute gastroenteritis in community (24%, 18-30) and outpatient (20%, 16-24) settings compared with inpatient (17%, 15-19, p=0·066) settings. Prevalence was also higher in low-mortality developing (19%, 16-22) and developed countries (20%, 17-22) compared with high-mortality developing countries (14%, 11-16; p=0·058). Patient age and whether the study included years of novel strain emergence were not associated with norovirus prevalence.

INTERPRETATION

Norovirus is a key gastroenteritis pathogen associated with almost a fifth of all cases of acute gastroenteritis, and targeted intervention to reduce norovirus burden, such as vaccines, should be considered.

FUNDING

The Foodborne Disease Burden Epidemiology Reference Group (FERG) of WHO and the Government of the Netherlands on behalf of FERG.

Authors+Show Affiliations

Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Rollins School of Public Health, Emory University, Atlanta, GA, USA.National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: blopman@cdc.gov.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

24981041

Citation

Ahmed, Sharia M., et al. "Global Prevalence of Norovirus in Cases of Gastroenteritis: a Systematic Review and Meta-analysis." The Lancet. Infectious Diseases, vol. 14, no. 8, 2014, pp. 725-730.
Ahmed SM, Hall AJ, Robinson AE, et al. Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis. 2014;14(8):725-730.
Ahmed, S. M., Hall, A. J., Robinson, A. E., Verhoef, L., Premkumar, P., Parashar, U. D., Koopmans, M., & Lopman, B. A. (2014). Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. The Lancet. Infectious Diseases, 14(8), 725-730. https://doi.org/10.1016/S1473-3099(14)70767-4
Ahmed SM, et al. Global Prevalence of Norovirus in Cases of Gastroenteritis: a Systematic Review and Meta-analysis. Lancet Infect Dis. 2014;14(8):725-730. PubMed PMID: 24981041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis. AU - Ahmed,Sharia M, AU - Hall,Aron J, AU - Robinson,Anne E, AU - Verhoef,Linda, AU - Premkumar,Prasanna, AU - Parashar,Umesh D, AU - Koopmans,Marion, AU - Lopman,Benjamin A, Y1 - 2014/06/26/ PY - 2014/7/2/entrez PY - 2014/7/2/pubmed PY - 2014/9/16/medline SP - 725 EP - 730 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 14 IS - 8 N2 - BACKGROUND: Despite substantial decreases in recent decades, acute gastroenteritis causes the second greatest burden of all infectious diseases worldwide. Noroviruses are a leading cause of sporadic cases and outbreaks of acute gastroenteritis across all age groups. We aimed to assess the role of norovirus as a cause of endemic acute gastroenteritis worldwide. METHODS: We searched Embase, Medline, and Global Health databases from Jan 1, 2008, to March 8, 2014, for studies that used PCR diagnostics to assess the prevalence of norovirus in individuals with acute gastroenteritis. We included studies that were done continuously for 1 year or more from a specified catchment area (geographical area or group of people), enrolled patients who presented with symptoms of acute gastroenteritis, and used PCR-based diagnostics for norovirus on all stool specimens from patients with acute gastroenteritis. The primary outcome was prevalence of norovirus among all cases of gastroenteritis. We generated pooled estimates of prevalence by fitting linear mixed-effect meta-regression models. FINDINGS: Of 175 articles included, the pooled prevalence of norovirus in 187 336 patients with acute gastroenteritis was 18% (95% CI 17-20). Norovirus prevalence tended to be higher in cases of acute gastroenteritis in community (24%, 18-30) and outpatient (20%, 16-24) settings compared with inpatient (17%, 15-19, p=0·066) settings. Prevalence was also higher in low-mortality developing (19%, 16-22) and developed countries (20%, 17-22) compared with high-mortality developing countries (14%, 11-16; p=0·058). Patient age and whether the study included years of novel strain emergence were not associated with norovirus prevalence. INTERPRETATION: Norovirus is a key gastroenteritis pathogen associated with almost a fifth of all cases of acute gastroenteritis, and targeted intervention to reduce norovirus burden, such as vaccines, should be considered. FUNDING: The Foodborne Disease Burden Epidemiology Reference Group (FERG) of WHO and the Government of the Netherlands on behalf of FERG. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/24981041/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(14)70767-4 DB - PRIME DP - Unbound Medicine ER -