- Design
- Systematic review and meta-analysis of prevalence studies
- Population
- 35,704 children under five with diarrhoea in lower-middle-income countries
- Primary outcome
- Prevalence and genotypes of rotavirus and norovirus
- Effect
- Rotavirus 24% (19.6–28.3%), norovirus 13% (11–15%); I² 98.7%
A systematic review pooled studies of 35,704 children under five with diarrhoea in low- and lower-middle-income countries after the introduction of rotavirus vaccine. It was published on 13 October.
Rotavirus was found in 24% (95% CI 19.6–28.3%) and norovirus in 13% (11–15%), with at least one of the two in about 18%. Among noroviruses, genogroup GII dominated, especially GII.4. Among rotaviruses, G3P[8] (39%) and G1P[8] (17%) were the commonest genotypes.
Heterogeneity between studies was extreme (I² about 99%), so the pooled figures are a rough average across very different settings rather than a single estimate for India. The clinical message is unchanged and simple: viral gastroenteritis in a vaccinated child is still common, rotavirus vaccination remains worth completing, and management rests on oral rehydration and zinc rather than antibiotics.
- Check rotavirus vaccination is complete at every infant visit, since disease is still common after vaccine introduction.
- Manage acute watery diarrhoea in under-fives with oral rehydration solution and zinc.
- Avoid antibiotics for acute watery diarrhoea unless there is blood in the stool or another clear indication.
- Advise handwashing with soap at home, since norovirus spreads easily within families.
Why it matters
Vaccination has not made viral diarrhoea rare, so the basics of rehydration still carry most of the benefit.
Don't overread it
The study cannot measure vaccine effectiveness; it reports what was found in children who were already ill.
The statistics, in plain English
An I² near 99% means almost all the variation between studies reflects real differences in setting, season or testing, not chance. The pooled 24% is therefore an average across very different places, not a figure to apply to one district.
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