Nguyen Gia Thanh, Phan Kevin, Teng Ian, Pu Jian, Watanabe Toru
The United Graduate School of Agricultural Sciences, Iwate University, Morioka, Japan Department of Environmental and Occupational Health Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue city, Vietnam Faculty of Medicine, University of Sydney Faculty of Medicine, University of New South Wales, Sydney, Australia Department of Food, Life and Environmental Sciences, Yamagata University, Tsuruoka, Yamagata, Japan.
Medicine (Baltimore). 2017 Oct;96(40):e8139. doi: 10.1097/MD.0000000000008139.
While norovirus (NoV) is well known as a leading causal pathogen for acute gastroenteritis in developed countries,structured data on prevalence in developing countries are not available thus far. This review aims to estimate the prevalence of NoV in cases of gastroenteritis in developing countries based on recently published reports.
Relevant studies were identified by searching PubMed and Web of Science for the period January 1, 1990 through March 31, 2016. We included studies performed in developing countries with a study period of at least 12 months and which provided information on polymerase chain reaction (PCR)-confirmed NoV prevalence in patients diagnosed with acute gastroenteritis. A metaanalysis was conducted on NoV prevalence, focused on viral genogroups GI and GII, in cases of acute gastroenteritis.
Using evidence from 178 articles, the estimated NoV prevalence among 148,867 patients with acute gastroenteritis was 17% (95% confidence interval [CI]: 15-18%). The prevalence decreased from 18% (95% CI: 16-20%) for upper middle-income countries to 15% (13-18%) and 6% (3-10%) for lower middle- and low-income countries, respectively. There were no significant differences in NoV prevalence by age group (under 5 years, 5 years and over, and mixed ages) or severity of symptoms as defined by community, outpatient, or inpatient setting. The pooled prevalence of NoV GII (15%, 95% CI: 13-17%) was significantly higher than that of NoV GI (1%, 95% CI: 1-1%) in patients with acute gastroenteritis.
From the evidence considered in this review, the estimated prevalence of NoV in patients with acute gastroenteritis in developing countries was 17%. This estimate can be used to evaluate the burden of NoV-associated acute gastroenteritis in developing countries, which is currently unclear due to poor diagnosis and surveillance systems, and the estimation may enhance the development of human NoV vaccines.
虽然诺如病毒（NoV）是发达国家急性胃肠炎的主要致病病原体，但目前尚无关于发展中国家患病率的结构化数据。本综述旨在根据最近发表的报告估计发展中国家胃肠炎病例中诺如病毒的患病率。
通过检索1990年1月1日至2016年3月31日期间的PubMed和Web of Science确定相关研究。我们纳入了在发展中国家进行的研究，研究期至少为12个月，并提供了经聚合酶链反应（PCR）确认的急性胃肠炎患者中诺如病毒患病率的信息。对急性胃肠炎病例中诺如病毒的患病率进行了荟萃分析，重点关注病毒基因组GI和GII。
根据178篇文章的证据，估计148,867例急性胃肠炎患者中诺如病毒的患病率为17%（95%置信区间[CI]：15-18%）。患病率从上中等收入国家的18%（95%CI：16-20%）分别降至下中等收入和低收入国家的15%（13-18%）和6%（3-10%）。按年龄组（5岁以下、5岁及以上和混合年龄）或社区、门诊或住院环境定义的症状严重程度，诺如病毒患病率无显著差异。急性胃肠炎患者中诺如病毒GII的合并患病率（15%，95%CI：13-17%）显著高于诺如病毒GI（1%，95%CI：1-1%）。
根据本综述中考虑的证据，发展中国家急性胃肠炎患者中诺如病毒的估计患病率为17%。这一估计可用于评估发展中国家诺如病毒相关急性胃肠炎的负担，由于诊断和监测系统不完善，目前该负担尚不清楚，该估计可能会促进人类诺如病毒疫苗的开发。
