The epidemiology of norovirus and rotavirus in the Middle East and North Africa (MENA) region

Abstract

Purpose: Rotavirus (RV) & Norovirus (NoV) are the first and the second leading causes of severe acute gastroenteritis (AGE) worldwide, respectively. To our knowledge, there are no systematic reviews assessing the role of NoV in AGE in the Middle East and North Africa (MENA) region and the last update on the epidemiology of RV in the MENA region was performed in 2009. Consequently, we conducted an extensive systematic literature review on articles studying RV and NoV in the 24 countries of the MENA region between 2000 and 2015. Methods & Materials: The methods and reporting were set according to the 2015 PRISMA-P and based on the elements from the international prospective register of systematic reviews (PROSPERO). To ensure the comprehensiveness and completeness of the search, six electronic bibliographic databases were used. The Global Health Library (GHL) was used to retrieve studies published on the regional databases. Results: We retrieved 38 and 169 studies for NoV and RV, respectively, meeting our predefined inclusion criteria. Studies on NoV and RV were conducted in 15 and 19 out of the 24 countries of the region, respectively. The reported NoV infection rates ranged between 0.82% and 36.84% while RV rates ranged between 0.6% and 76%. The majority of studies were clinical observational studies assessing RV or NoV rates mainly among children. Participants were recruited from in- and outpatient clinics. These infections were reported all year round with peaks observed mainly during cold months. GII.4 was the predominant genotype detected in stool of participants studies (64%). The predominantly reported RV genotype in the region was G1[P8] followed by G2[P4] and G9[P8]. Conclusion: Overall, there is an increasing recognition of NoV as an important causative agent of AGE across all age groups in the MENA region. Further studies are needed to assess the national and the regional burden of NoV among different age groups, its molecular diversity and seasonal variability. Moreover, our review draws attention to the major gaps existing in the continuous monitoring and surveillance of RV and provides additional support to evaluate the implementation of using rotavirus vaccines in the region.