Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis.
Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(14)70767-4
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Lopman BA
中科院分区：
文献类型：
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作者：
Ahmed SM;Hall AJ;Robinson AE;Verhoef L;Premkumar P;Parashar UD;Koopmans M;Lopman BA
尽管近几十年来大幅减少，急性肠胃炎仍是全世界所有传染病的第二大负担。诺如病毒是所有年龄组中散在病例和急性胃肠炎暴发的主要原因。我们的目的是评估诺如病毒在全球范围内引起地方性急性胃肠炎的作用。从2008年1月1日至2014年3月8日，我们检索了Embase、Medline和Global Health数据库，查找使用PCR诊断评估诺如病毒在急性胃肠炎患者中的流行程度的研究。我们纳入了在特定集水区（地理区域或人群）连续进行1年或更长时间的研究，纳入了出现急性胃肠炎症状的患者，并对急性胃肠炎患者的所有粪便标本使用基于pcr的诺如病毒诊断。主要结局是诺瓦克病毒在所有肠胃炎病例中的流行。我们通过拟合线性混合效应元回归模型产生了患病率的汇总估计。在纳入的175篇文章中，187336例急性胃肠炎患者诺如病毒的总流行率为18% （95% CI 17-20）。社区（24%,18-30）和门诊（20%,16-24）的急性胃肠炎患者诺如病毒患病率高于住院（17%,15-19,p= 0.066）。低死亡率发展中国家（19%,16-22）和发达国家（20%,17-22）的患病率也高于高死亡率发展中国家（14%,11-16;p= 0.058）。患者年龄和研究是否包括新毒株出现的年数与诺如病毒流行率无关。诺如病毒是一种主要的肠胃炎病原体，与近五分之一的急性肠胃炎病例有关，应考虑采取有针对性的干预措施，如接种疫苗，以减少诺如病毒的负担。世卫组织食源性疾病负担流行病学参考小组（FERG）和代表FERG的荷兰政府。
Despite substantial decreases in recent decades, acute gastroenteritis causes the second greatest burden of all infectious diseases worldwide. Noroviruses are a leading cause of sporadic cases and outbreaks of acute gastroenteritis across all age groups. We aimed to assess the role of norovirus as a cause of endemic acute gastroenteritis worldwide. We searched Embase, Medline, and Global Health databases from Jan 1, 2008, to March 8, 2014, for studies that used PCR diagnostics to assess the prevalence of norovirus in individuals with acute gastroenteritis. We included studies that were done continuously for 1 year or more from a specified catchment area (geographical area or group of people), enrolled patients who presented with symptoms of acute gastroenteritis, and used PCR-based diagnostics for norovirus on all stool specimens from patients with acute gastroenteritis. The primary outcome was prevalence of norovirus among all cases of gastroenteritis. We generated pooled estimates of prevalence by fitting linear mixed-effect meta-regression models. Of 175 articles included, the pooled prevalence of norovirus in 187 336 patients with acute gastroenteritis was 18% (95% CI 17–20). Norovirus prevalence tended to be higher in cases of acute gastroenteritis in community (24%, 18–30) and outpatient (20%, 16–24) settings compared with inpatient (17%, 15–19, p=0·066) settings. Prevalence was also higher in low-mortality developing (19%, 16–22) and developed countries (20%, 17–22) compared with high-mortality developing countries (14%, 11–16; p=0·058). Patient age and whether the study included years of novel strain emergence were not associated with norovirus prevalence. Norovirus is a key gastroenteritis pathogen associated with almost a fifth of all cases of acute gastroenteritis, and targeted intervention to reduce norovirus burden, such as vaccines, should be considered. The Foodborne Disease Burden Epidemiology Reference Group (FERG) of WHO and the Government of the Netherlands on behalf of FERG.