Prevalence and genotype distribution of norovirus and rotavirus among children under five with diarrheal infection in lower-middle-income countries after Rotavirus vaccine introduction: A systematic review and meta-analysis

Firayad Ayele, Tesfaye Assebe, Miheret Mandefro, Desalegn Admassu Ayana and Nega Assefa

PLOS ONE, 2026, vol. 21, issue 10, 1-24

Abstract: Background: Rotavirus and norovirus are the leading viral causes of acute diarrheal disease worldwide. Both viruses encompass multiple genotypes and subgenotypes, and this genetic diversity presents a significant challenge to rotavirus vaccine effectiveness and development. High-quality evidence on the prevalence and circulating genotypes of these enteric viruses among children under five years of age remains limited, particularly following the introduction of rotavirus vaccination in low and middle-income countries (LMICs). Therefore, this systematic review and meta-analysis aimed to synthesizes available evidence on the prevalence and genotype distribution of norovirus and rotavirus in this population. Methods: A systematic literature search was conducted across five major databases PubMed, Scopus, ScienceDirect, Embase, and Web of Science between February 20 and 28, 2026. Duplicate removal, title and abstract screening, full-text review and data extraction were performed independently by two investigators using the Rayyan web-based platform. STATA version 17 software was used for statistical analysis. A random-effects model was applied to estimate pooled prevalence and effect sizes. Heterogeneity was evaluated using Cochran’s Q statistic, the I2 statistic, forest plots, and Galbraith plots. Publication bias was assessed using both graphical (funnel plots) and statistical methods. Results: A total of 35,704 children under five years with diarrheal infection from LMICs were included across eligible studies. The overall pooled prevalence of norovirus and rotavirus combined was 18% (95% CI: 15–21%). Rotavirus had a higher pooled prevalence than norovirus, at 24% (95% CI: 19.6–28.3%) and 13% (95% CI: 11–15%), respectively. Substantial heterogeneity was observed across studies (I2 = 98.72%, p

Date: 2026
References: Add references at CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359886 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 59886&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0359886

DOI: 10.1371/journal.pone.0359886

Access Statistics for this article

More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().