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Norovirus and Rotavirus Disease Severity in Children: Systematic Review and Meta-analysis

Riera-Montes, Margarita, MD*; O’Ryan, Miguel, MD; Verstraeten, Thomas, MD*

The Pediatric Infectious Disease Journal: June 2018 - Volume 37 - Issue 6 - p 501–505
doi: 10.1097/INF.0000000000001824
Original Studies

Background: Rotaviruses (RVs) and noroviruses (NoVs) are the most common causes of severe acute gastroenteritis in children. It is generally accepted that RVs cause severe acute gastroenteritis in a higher proportion of cases compared with NoVs. To our knowledge, there are no systematic reviews and meta-analyses comparing the severity of NoV and RV disease.

Methods: We searched MEDLINE for studies reporting data for NoV and RV medically attended disease severity in children. We included studies where all children had been tested for both NoV (reverse transcription polymerase chain reaction) and RV (enzyme-linked immunosorbent assay or reverse transcription polymerase chain reaction) and that reported disease severity using the Vesikari or modified Vesikari score, or provided clinical information on severity. We generated pooled estimates of the mean with 95% confidence intervals using random effects meta-analysis.

Results: We identified 266 publications, of which 31 were retained for qualitative analysis and 26 for quantitative analysis. Fourteen studies provided data on severity score for the meta-analysis. The pooled mean severity scores (95% confidence interval) among outpatients were 10 (8–12) and 11 (8–14) for NoV and RV, respectively. Among inpatients, they were 11 (9–13) for NoV and 12 (10–14) for RV. The difference was statistically significant among inpatients, but relatively small (1 point in a 20-point scale). About 20% more children with RV required rehydration when compared with children with NoV.

Conclusions: NoV causes moderate to severe disease similar to RV in young children. This information should be useful for future evaluations of an eventual introduction of NoV vaccines in national immunization programs.

From the *P95 Epidemiology and Pharmacovigilance, Leuven, Belgium

Programa de Microbiología e inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile.

Accepted for publication September 4, 2017.

M.R.-M. and T.V. have received consulting fees from Takeda related to this work. M.O. has received funding from Takeda for ongoing norovirus epidemiological studies not related to this work and has been a consultant for norovirus vaccine development. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Miguel O’Ryan, MD, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Avda Independencia 1027, Santiago de Chile, Chile. E-mail:

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