Burden of acute gastroenteritis caused by norovirus in China: A systematic review

Zhou, Hong-Lu; Zhen, Shan-Shan; Wang, Jinxia; Zhang, Can-Jing; Qiu, Chao; Wang, Songmei; Jiang, Xi; Wang, Xuanyi

doi:10.1016/j.jinf.2017.06.004

Cited by 55 publications

(60 citation statements)

References 37 publications

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“…challenge studies conducted in 1970s (Simmons et al, 2013), if this hypothesis is correct, it would be very difficult to interpret the age distribution observed in this study. The same age distribution has been reported in the previous published meta-analysis (Zhou et al, 2017). In addition, there were a few repeat clinical infections with rotavirus (4 and 1 children in Zhengding and Sanjiang, respectively) and norovirus (2 children in Zhengding).…”

Section: Discussionsupporting

confidence: 82%

“…season" in first site compared to the second, leading to a relative overestimate in Zhengding. Previous studies reported that both rotavirus and norovirus infections in the North showed more strict seasonality compared to the South, which covered more than 90% of laboratory-confirmed cases (Zhou et al, 2017;Fang et al, 2007;Wang et al, 2005b). In addition, the inconsistency in study duration may be responsible for the different proportions of acute gastroenteritis caused by viral pathogens between 2 sites.…”

Section: Discussionmentioning

confidence: 98%

“…In conclusion, with significant improvements of sanitation and nationwide popularization of safe water supplies over the last decades, remarkable achievements have been made in control of bacteria diarrhea in China. Between 2006 and 2017, reported cases of shigellosis, representative of bacterial diarrhea, decreased 74%; however, the absolute number of reported cases of infectious diarrhea attributed predominantly to viral pathogens increased 72% (Zhou et al, 2017; Division of Infectious Disease Chinese Center for Disease Control and Prevention, 2018; Zhang and Zhang, 2017;CDC, 2007). Eventually, infectious diarrhea was listed as the 3rd most common infectious diseases in 2017 according to the annual statistics of China's NIDR (Division of Infectious Disease Chinese Center for Disease Control and Prevention, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Despite significant advances in fighting childhood diarrhea through sanitation improvement, safe water supplies, and vaccine development, diarrheal diseases remained worldwide the fourth cause of death for children <5 years of age in 2016 (United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), 2017). In China, which has benefitted from a booming economy, mortality attributed to infectious diarrhea has declined significantly, but morbidity has remained stable (Zhou et al, 2017). According to the National Notifiable Infectious Disease Reporting system (NIDR), 1,275,290 cases of infectious diarrheawere reported in 2017 (cholera, dysentery, and enteric fever were excluded), resulting in an incidence of 92.2/100,000 person/year (Division of Infectious Disease Chinese Center for Disease Control and Prevention, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Population-based diarrhea surveillance in children under age 5 was conducted in 2 rural counties: Zhengding county of Hebei province (north) and Sanjiang county of Guangxi province (south) in China in 2012 and 2013. To elucidate disease burden and the epidemiology of major viral gastroenteritis for policymaking and vaccine development-e.g., for candidate vaccines against noroviruses (Zhou et al, 2017), we performed a retrospective etiological study using fecal specimens collected in the aforementioned surveys, and analyzed the occurrence and clinical manifestations of noroviruses, sapoviruses, astroviruses, and enteric adenoviruses, compared to rotaviruses.…”

Section: Introductionmentioning

confidence: 99%

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Burden of viral gastroenteritis in children living in rural China: Population-based surveillance

Wang

Zhou

et al. 2020

International Journal of Infectious Diseases

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Background: Despite the considerable disease burden caused by the disease, rotavirus vaccine has not been introduced into routine national immunization schedule, and norovirus vaccines are being developed without a comprehensive understanding of gastroenteritis epidemiology. To bridge this knowledge gap, we investigated the disease burden of viral gastroenteritis in rural China. Methods: Between October 2011 and December 2013, population-based surveillance was conducted in Zhengding and Sanjiang counties in China. Stool samples were collected from children <5 years of age with diarrhea. All specimens were tested for rotaviruses, noroviruses, sapoviruses, enteric adenoviruses, and astroviruses. Results: The most common pathogen causing diarrhea was rotavirus (54.7 vs 45.6 cases/1,000 children/ year in Zhengding and Sanjiang, respectively), followed by norovirus (28.4 vs 19.3 cases/1,000 children/ year in Zhengding and Sanjiang, respectively). The highest incidence of these viruses was observed in children 6-18 months of age. Among the 5 viral pathogens, rotaviruses caused the most severe illness, followed by noroviruses. Conclusion: Rotavirus and norovirus are the 2 most important viral pathogens causing childhood diarrhea in both northern and southern China; they should be the major targets for viral gastroenteritis prevention strategies among children in China.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Burden of viral gastroenteritis in children living in rural China: Population-based surveillance

Wang

Zhou

et al. 2020

International Journal of Infectious Diseases

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Molecular epidemiology of norovirus infections in children with acute gastroenteritis in 2017–2019 in Tianjin, China

Fang

Zhang

Hong

et al. 2021

Journal of Medical Virology

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Norovirus (NoV) is the leading cause of acute gastroenteritis (AGE) worldwide. Globally, the GII.4 Sydney 2012 strain has predominated since 2012, although GII.4 variant strains have caused AGE outbreaks in China. Recent patterns of NoV genotype distributions in 6011 children with AGE in Tianjin, China were investigated. NoV was detected using realtime reverse-transcriptase polymerase chain reaction and sequencing of partial sequences of the viral capsid gene. NoV genotypes were determined, and phylogenetic analysis was conducted. Epidemiological and clinical data were compared between children infected with different NoV genotypes. NoV was detected in 27.6% of the specimens tested. GII.4strains comprised 49.4% infections, followed by GII.3 at 39.9%. Genotypes GII.2, GII.13, GII.17, GII.1, GII.6, and GII.14 were also detected. NoV was detected during most of the year, with a peak season of cases in the winter. Diarrhea, vomiting, fever, abdominal pain, and dehydration were present in patients with NoV infection. The main genotypes were GII.4 and GII.3, with a slight increase in GII.2, beginning in March 2017. Among the GII.4 strains, GII.4 Sydney 2012 was the only epidemic strain in Tianjin. Patients with GII.4 genotypes were more likely to present with diarrhea and vomiting than those with GII.3.Children with GII. Others were prone to suffered from dehydration and abdominal pain than those with GII.3. NoV GII has become the main cause of viral AGE in Tianjin, China.The predominant genotypes of NoV were GII.4 and GII.3. Identification of emerging genotypes is crucial for the prevention and control of NoV-caused AGE.

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Asymptomatic norovirus infection during outbreaks in China: A systematic review and meta‐analysis

Wang,

Ji,

Zhang

et al. 2024

Journal of Medical Virology

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Acute gastroenteritis outbreaks may be caused by the excretion of norovirus (NoV) from asymptomatic individuals. Despite numerous studies involving asymptomatic NoV infection during outbreaks in China, a comprehensive assessment of its role has not been conducted, which is critical for emergency management. Our objective was to assess the prevalence of asymptomatic NoV infection during outbreaks in China. We conducted a comprehensive search of multiple databases, including PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Wanfang, and China Weipu, between January 1, 1997 and June 19, 2023. The retrieved articles and their references underwent screening, which utilized polymerase chain reaction‐based assays for the detection of NoV in asymptomatic individuals during outbreaks that occurred in China. The primary summary data were the prevalence of asymptomatic NoV infection in outbreaks. We generated pooled estimates of asymptomatic prevalence in the population as a whole and in subgroups by using random‐effect models. Of the 97 articles included, the pooled asymptomatic prevalence of NoV among 5117 individuals in outbreaks was 17.6% (95% confidence interval [CI]: 14.1–21.3). The asymptomatic prevalence of NoV GII (17.1%, 95% CI: 12.9–21.5) was similar to that of NoV GI (22.0%, 95% CI: 12.8–32.4). However, the proportion of asymptomatic individuals involved in NoV GII (57.44%) was significantly higher than that of NoV GI (5.12%), and NoV GII (75.26%) was reported much more frequently than NoV GI (14.43%) in the included articles. Meta‐regression analysis of 11 possible influencing factors (geographic region, setting, season, sample type, genotype, transmission route, occupation, age, per capita income, study quality, and cases definition) showed that the source of heterogeneity might be related to the outbreak settings, per capita income, and study quality (p = 0.037, 0.058, and 0.026, respectively). Of particular note was the asymptomatic prevalence peaked in preschoolers (27.8%), afterward, it fell into trough in elementary and junior school children (10.5%), before the second peak located in adults (17.8%), and the elderly (25.2%). Prevalent genotypes reported include GII.4, followed by GII.17, GII.2, GII.3, GII.6, and so forth. The estimated asymptomatic prevalence of NoV during outbreaks in China was as high as 17.6%, with NoV GII dominating. In addition, genetic subtypes of NoV in outbreaks should be detected whenever possible. The role of asymptomatic individuals in NoV outbreaks cannot be ignored. This knowledge will help governments develop public health policies and emergency response strategies for outbreaks, assess the burden, and develop vaccines.

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Burden of acute gastroenteritis caused by norovirus in China: A systematic review

Cited by 55 publications

References 37 publications

Burden of viral gastroenteritis in children living in rural China: Population-based surveillance

Burden of viral gastroenteritis in children living in rural China: Population-based surveillance

Molecular epidemiology of norovirus infections in children with acute gastroenteritis in 2017–2019 in Tianjin, China

Asymptomatic norovirus infection during outbreaks in China: A systematic review and meta‐analysis

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