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.
Pediatr Infect Dis J. 2018 Jun;37(6):501-505. doi: 10.1097/INF.0000000000001824.
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.
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.
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.
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.
轮状病毒（RV）和诺如病毒（NoV）是导致儿童严重急性胃肠炎的最常见原因。一般认为，与 NoV 相比，RV 导致严重急性胃肠炎的比例更高。据我们所知，尚无系统评价和荟萃分析比较 NoV 和 RV 疾病的严重程度。
我们在 MEDLINE 上检索了报告关于轮状病毒（诺如病毒）和 RV （酶联免疫吸附测定或逆转录聚合酶链反应）检测呈阳性的儿童的 NoV 和 RV 发病严重程度数据的研究。我们纳入了所有儿童均接受过诺如病毒（逆转录聚合酶链反应）和 RV（酶联免疫吸附测定或逆转录聚合酶链反应）检测且使用 Vesikari 或改良 Vesikari 评分报告疾病严重程度的研究，或提供了关于严重程度的临床信息。我们使用随机效应荟萃分析生成了均值的合并估计值及其 95%置信区间。
我们共确定了 266 篇出版物，其中 31 篇用于定性分析，26 篇用于定量分析。14 项研究提供了严重程度评分数据用于荟萃分析。门诊患者的平均严重程度评分（95%置信区间）分别为 NoV 组 10（8-12）和 RV 组 11（8-14）。住院患者的平均严重程度评分分别为 NoV 组 11（9-13）和 RV 组 12（10-14）。住院患者之间的差异具有统计学意义，但相对较小（20 分制中相差 1 分）。与 NoV 组相比，RV 组约有 20%的儿童需要补液治疗。
在幼儿中，NoV 引起的疾病严重程度与 RV 相似。这些信息对于未来评估在国家免疫规划中引入 NoV 疫苗的效果将非常有用。
