Abstract
Noroviruses are a major cause of viral gastroenteritis. The burden of the norovirus in low-resource settings is not well-established due to limited data. This study reviews the norovirus prevalence, epidemiology, and genotype diversity in lower-middle-income countries (LMIC) and in low-income countries (LIC). PubMed was searched up to 14 January 2019 for norovirus studies from all LIC and LMIC (World Bank Classification). Studies that tested gastroenteritis cases and/or asymptomatic controls for norovirus by reverse transcription-polymerase chain reaction (RT-PCR) were included. Sixty-four studies, the majority on children <5 years of age, were identified, and 14% (95% confidence interval; CI 14–15, 5158/36,288) of the gastroenteritis patients and 8% (95% CI 7–9, 423/5310) of healthy controls tested positive for norovirus. In LMIC, norovirus was detected in 15% (95% CI 15–16) of cases and 8% (95% CI 8–10) of healthy controls. In LIC, 11% (95% CI 10–12) of symptomatic cases and 9% (95% CI 8–10) of asymptomatic controls were norovirus positive. Norovirus genogroup II predominated overall. GII.4 was the predominant genotype in all settings, followed by GII.3 and GII.6. The most prevalent GI strain was GI.3. Norovirus causes a significant amount of gastroenteritis in low-resource countries, albeit with high levels of asymptomatic infection in LIC and a high prevalence of coinfections.
Highlights
Noroviruses are a major cause of sporadic and epidemic gastroenteritis worldwide [1]
This review focused on studies published between 1997 and 2018 on norovirus prevalence, epidemiology, and diversity in low-income countries (LIC) and lower-middle-income countries (LMIC) and includes 64 studies of which 17 (5 LIC and 12 LMIC)
Sixty-four studies were included in the review of the norovirus prevalence
Summary
Noroviruses are a major cause of sporadic and epidemic gastroenteritis worldwide [1]. Noroviruses form a genus of the Caliciviridae family and are divided into at least seven genogroups (GI–GVII) [5]. Of these GI, GII, and GIV infect humans, with GII detected most frequently in clinical surveillance studies throughout the world [6]. Novel variants of GII. emerge periodically, spread rapidly across the globe, and cause pandemics [9]. Other genotypes such as GII. and GII. have emerged and have become predominant in certain regions of the world [10,11]. A comprehensive understanding of the global burden of norovirus illness as well the genotype diversity, dominant strains, and strain replacement patterns is essential for a successful vaccine design [12]
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