- 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 to 28.3%); norovirus 13% (11 to 15%)
A meta-analysis pooled studies of 35,704 children under five with diarrhoea in lower-middle-income countries after rotavirus vaccine was introduced. Rotavirus was found in 24% (95% CI 19.6 to 28.3%) and norovirus in 13% (11 to 15%), together about 18%.
Among norovirus, genogroup GII dominated (76%), mostly GII.4. Among rotavirus, G3P[8] (39%) and G1P[8] (17%) were the commonest genotypes. Heterogeneity between studies was very high.
This does not show that vaccines have failed — the review lacks pre-vaccine comparison and cannot separate vaccinated from unvaccinated children. It does show that rotavirus remains a common cause of diarrhoea in children under five in settings like India, and that genotype surveillance matters as vaccines are chosen and updated.
- Check rotavirus vaccination status at every under-five visit and catch up where the schedule allows
- Expect viral causes in most acute watery diarrhoea and avoid routine antibiotics
- Assess dehydration carefully, since rotavirus causes more severe illness than most causes
- Support local surveillance by sending stool samples where outbreaks occur
Why it matters
It is a reminder that vaccination reduces but does not remove rotavirus from the diarrhoea clinic.
Don't overread it
Without comparison by vaccination status, this cannot measure how well rotavirus vaccines work.
The statistics, in plain English
A pooled prevalence of 24% is an average across very different countries and studies (I² near 99%), so local figures may be quite different.
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