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

Margarita Riera-Montes1, Miguel O'Ryan2, Thomas Verstraeten1

  • 1From the P95 Epidemiology and Pharmacovigilance, Leuven, Belgium.

The Pediatric Infectious Disease Journal
|November 15, 2017
PubMed

Insights

Noroviruses (NoV) and rotaviruses (RV) cause severe gastroenteritis in children. This meta-analysis found NoV causes moderate to severe disease similar to RV, with slight differences in hospitalization and rehydration needs.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Public Health

Background:

  • Rotaviruses (RVs) and noroviruses (NoVs) are leading causes of severe acute gastroenteritis in children globally.
  • While RVs are often considered to cause more severe disease, direct comparative analyses are limited.
  • Existing literature lacks systematic reviews comparing the disease severity between NoV and RV infections in pediatric populations.

Purpose of the Study:

  • To systematically compare the disease severity of norovirus (NoV) and rotavirus (RV) infections in children.
  • To provide quantitative data on the clinical outcomes of NoV versus RV gastroenteritis.
  • To inform future public health strategies, including potential norovirus vaccine implementation.

Main Methods:

  • A systematic literature search was conducted on MEDLINE for studies reporting on NoV and RV medically attended disease severity in children.
  • Included studies required testing for both viruses and reporting severity using the Vesikari score or providing clinical severity data.
  • Random effects meta-analysis was used to pool mean severity scores and calculate 95% confidence intervals.

Main Results:

  • The meta-analysis included 14 studies, yielding pooled mean severity scores of 10 (95% CI: 8-12) for NoV outpatients and 11 (95% CI: 8-14) for RV outpatients.
  • Among inpatients, pooled mean severity scores were 11 (95% CI: 9-13) for NoV and 12 (95% CI: 10-14) for RV, with a statistically significant but small difference.
  • Approximately 20% more children with RV infection required rehydration compared to those with NoV infection.

Conclusions:

  • Norovirus (NoV) infection causes moderate to severe gastroenteritis in young children, comparable to rotavirus (RV).
  • The clinical severity and need for rehydration show nuanced differences between NoV and RV infections.
  • Findings support the consideration of norovirus vaccines within national immunization programs for children.
Abstract

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