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Norovirus Infections and Disease in Lower-Middle- and Low-Income Countries, 1997–2018

Department of Medical Virology, Faculty of Health Sciences, University of Pretoria; Pretoria 0001, South Africa
Viruses 2019, 11(4), 341; https://doi.org/10.3390/v11040341
Received: 21 March 2019 / Revised: 5 April 2019 / Accepted: 8 April 2019 / Published: 10 April 2019
(This article belongs to the Special Issue Noroviruses)
Noroviruses are a major cause of viral gastroenteritis. The burden of the norovirus in low-resource settings is not well-established due to limited data. This study reviews the norovirus prevalence, epidemiology, and genotype diversity in lower-middle-income countries (LMIC) and in low-income countries (LIC). PubMed was searched up to 14 January 2019 for norovirus studies from all LIC and LMIC (World Bank Classification). Studies that tested gastroenteritis cases and/or asymptomatic controls for norovirus by reverse transcription-polymerase chain reaction (RT-PCR) were included. Sixty-four studies, the majority on children <5 years of age, were identified, and 14% (95% confidence interval; CI 14–15, 5158/36,288) of the gastroenteritis patients and 8% (95% CI 7–9, 423/5310) of healthy controls tested positive for norovirus. In LMIC, norovirus was detected in 15% (95% CI 15–16) of cases and 8% (95% CI 8–10) of healthy controls. In LIC, 11% (95% CI 10–12) of symptomatic cases and 9% (95% CI 8–10) of asymptomatic controls were norovirus positive. Norovirus genogroup II predominated overall. GII.4 was the predominant genotype in all settings, followed by GII.3 and GII.6. The most prevalent GI strain was GI.3. Norovirus causes a significant amount of gastroenteritis in low-resource countries, albeit with high levels of asymptomatic infection in LIC and a high prevalence of coinfections. View Full-Text
Keywords: norovirus; lower-middle-income countries; low-income countries; genotype diversity; GII.4; systematic review norovirus; lower-middle-income countries; low-income countries; genotype diversity; GII.4; systematic review
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Mans, J. Norovirus Infections and Disease in Lower-Middle- and Low-Income Countries, 1997–2018. Viruses 2019, 11, 341.

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