Prevalence of rotavirus among older children and adults with diarrhea: A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Older children and adults are susceptible to rotavirus, but the extent to which rotavirus affects this population is not fully understood, hindering accuracy of global rotavirus estimations. OBJECTIVE: To determine what proportion of diarrhea cases are due to rotavirus among persons ≥ 5 years old and to estimate this proportion by age strata. METHODS: We conducted a systematic review and meta-analysis using the PRISMA guidelines. We included studies that reported on conditional rotavirus prevalence (i.e., percent of diarrhea due to rotavirus) in persons ≥ 5 years old who were symptomatic with diarrhea/gastroenteritis and had laboratory confirmation for rotavirus infection. Studies on nosocomial infections and outbreak investigations were excluded. We collected age group-specific conditional rotavirus prevalence and other variables, such as study geography, study setting, and study type. We calculated pooled conditional rotavirus prevalence, corresponding 95% confidence intervals (95% CI), heterogeneity (I2) estimates, and prediction intervals (PI). RESULTS: Sixty-six studies from 32 countries met the inclusion criteria. Conditional rotavirus prevalence ranged from 0% to 30% across the studies. The total pooled prevalence of rotavirus among persons ≥ 5 years old with diarrhea was 7.6% (95% CI 6.2-9.2%, I2 = 99.6%, PI 0-24%). The pooled prevalence of rotavirus among older children and adolescents was 8.7% (95% CI 6.2-11.7%, I2 = 96%, PI0-27%), among younger adults was 5.4% (95% CI 1.4-11.8%, I2 = 96%, PI0-31%), and among older adults was 4.7% (95% CI 2.8-7.0%, I2 = 96%, PI0-16%). Pooled conditional rotavirus prevalences did not differ by other variables. CONCLUSION: In this systematic review and meta-analysis of rotavirus among persons ≥ 5 years old with diarrhea, we found relatively low pooled conditional rotavirus prevalence compared to what is typically reported for children < 5 years; however, results should be interpreted with caution as the wide prediction intervals suggest large heterogeneity.