The epidemiology of Rotavirus and Norovirus in the Middle East and North Africa (MENA) Region : a systematic review -

Abstract

Background: According to the 2010 Global Burden of Disease (GBD) Study, diarrheal disorders still mark the second highest burden among all communicable diseases with an estimated disability-adjusted life years (DALYs) equivalent to 89.5 million. Viral infections are the most common causes of diarrheal diseases with rotavirus (RV) and norovirus (NoV) being the leading agents of acute gastroenteritis (AGE). Little is known about the epidemiology of RV and NoV in the MENA region. The aim of this thesis is to assess the distribution of these two viruses in the 25 countries of MENA using a systematic review approach. Methodology: An extensive systematic literature search was carried out on articles studying RV and NoV in the 25 countries of the MENA region during the past 15 years (2000-2015). The search strategies were developed using the proper Medical Subject Headings (MeSH) terms and keywords related to RV, NoV and the 25 countries. Ten electronic bibliographic databases were used: Medline (OVID), PubMed, EMBASE, COCHRANE, SCOPUS, Web of Science, ProQuest, OpenGrey, IMEMR and AIM. The titles and abstracts of the exported studies were extracted and screened by two independent reviewers for relevance according to the inclusion and exclusion criteria. Full texts of eligible studies were obtained and data was abstracted. Results: The search strategy identified 2,589 and 816 records on RV and NoV, respectively. After removal of duplicates and as per the inclusion and exclusion criteria, 169 unique records for RV and 39 unique records for NoV were included. The 169 studies reported on RV infection rates in 19 countries of the MENA region. As expected, the majority of these studies were among children presenting with AGE. Regionally, G1[P8] was predominantly reported as the causative agent of AGE among children less than 5 years old. Although RV infection spreads all year round in MENA, winter peaks were the most reported. The 39 studies reported on NoV infection rates in 15 countries of the MENA region. NoV is increas