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Pediatric Rotavirus A Infection Among 337,019 Participants Within Asia: A Pan-Asian Systematic Review and
Ali A Rabaan1,2,3, Bello E Kizito4, Abdulsalam Alawfi5
1Molecular and Agnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia, jhah.com.
Insights
Rotavirus A infections are common in Asian children, with about a quarter testing positive. This highlights the critical need for widespread rotavirus A vaccination programs across the region.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health Epidemiology
Background:
- Rotavirus A is a primary cause of severe gastroenteritis in children under five in Asia.
- Existing vaccination programs have not fully curbed the incidence of rotavirus A infections.
- This study addresses the need for updated data on rotavirus A prevalence in Asian pediatric populations.
Purpose of the Study:
- To systematically review and meta-analyze the available evidence on rotavirus A detection rates.
- To determine the pooled proportion of rotavirus A positivity among children tested in Asia.
- To identify factors influencing rotavirus A detection rates across different Asian settings.
Main Methods:
- A systematic review and meta-analysis of 111 studies involving 337,019 children aged five and under.
- Random-effects meta-analysis was employed to calculate pooled rotavirus A positivity.
- Inter-study heterogeneity was quantified using the I-squared statistic.
Main Results:
- The overall pooled proportion of rotavirus A positivity was 24.7% (95% CI: 22.4%-27.1%).
- Significant heterogeneity (I-squared = 99.42%) was observed, indicating variations in diagnostic methods and study populations.
- Higher detection rates were noted in Saudi Arabia (49.3%), Iran (35.2%), Malaysia (33.0%), and India (29.4%).
- ELISA-based diagnostics and cross-sectional study designs were associated with increased detection rates.
Conclusions:
- Nearly a quarter of tested children in Asia are positive for rotavirus A.
- Significant variations in rotavirus A positivity underscore the need for tailored public health interventions.
- The findings emphasize the importance of implementing and expanding routine rotavirus A vaccination programs throughout Asia.
Background:
Rotavirus A remains a leading cause of acute gastroenteritis in children under 5 years of age across Asia, despite expanding vaccination programs. This study systematically synthesizes available evidence on rotavirus A detection among pediatric populations in Asian countries.
Methods:
We conducted a systematic review and meta-analysis of studies reporting laboratory-confirmed rotavirus A infection among children aged ≤ 5 years in Asia. A total of 111 studies comprising 337,019 tested children were included. Random-effects meta-analysis was used to estimate pooled proportions of rotavirus A positivity among tested children. Between-study heterogeneity was assessed using the I 2 statistic.
Results:
The pooled proportion of rotavirus A-positive cases among tested children in Asia was 24.7% (95% CI: 22.4%-27.1%). Substantial heterogeneity was observed across studies (I 2 = 99.42%, p < 0.001), reflecting wide variation in study populations, diagnostic methods, and healthcare settings. Higher test positivity rates were reported in studies from Saudi Arabia (49.3%), Iran (35.2%), Malaysia (33.0%), and India (29.4%), whereas lower proportions were observed in China (13.0%) and Pakistan (18.8%). Diagnostic modality and study design significantly influenced detection rates, with ELISA-based and cross-sectional studies reporting higher positivity.
Conclusion:
Approximately one-quarter of children tested for rotavirus A across Asia were laboratory-positive, although estimates varied markedly across settings and thus stress the need for a routine vaccination program.
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