The epidemiology of Norovirus in the Middle East and North Africa (MENA) region: a systematic review
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REVIEW
Open Access
The epidemiology of Norovirus in the Middle East and North Africa (MENA) region: a systematic review Khalil Kreidieh1,2, Rana Charide2, Ghassan Dbaibo3,4 and Nada M. Melhem1,4*
Abstract: Norovirus (NoV) is considered the second leading cause of viral acute gastroenteritis (AGE). To our knowledge, there are no systematic reviews assessing the role of NoV in AGE in the Middle East and North Africa (MENA) region. Consequently, we conducted an extensive systematic literature review on articles studying NoV in the 24 countries of the MENA region during the past 15 years (2000-2015). The methods and reporting were set according to the 2015 PRISMA-P and based on the elements from the international prospective register of systematic reviews (PROSPERO). We retrieved 38 studies meeting our predefined inclusion criteria and were used to extract full data. Studies reporting on NoV were conducted in 15 out of the 24 countries of the region. The reported NoV infection rates in MENA countries ranged between 0.82% and 36.84%. The majority of studies were clinical observational studies assessing NoV rates mainly among children. Participants were recruited from in- and outpatient clinics. NoV infection was reported all year round with with peaks observed mainly during cold months. GII.4 was the predominant genotype detected in stool of participants as reported by 16 out of 25 studies (64%). Overall, there is an increasing recognition of NoV as an important causative agent of AGE across all age groups in the MENA region. Further studies are needed to assess the national and the regional burden of NoV among different age groups, its molecular diversity and seasonal variability. Keywords: Norovirus, Acute gastroenteritis, Middle East and North Africa, Diagnosis, Seasonality
Background Diarrheal disorders still mark the second highest burden among all communicable diseases [1] with an estimated 1.4 million yearly deaths and 89.5 million disabilityadjusted life-years (DALYs) [1, 2]. Recently, noroviruses have been recognized as a leading cause of both sporadic and epidemic acute gastroenteritis (AGE) across all age groups seeking medical care in emergency departments, outpatient clinics and the community [3–6]. Norovirus (NoV), the second leading cause of viral AGE worldwide [7] after rotavirus, is responsible globally for substantial morbidity and mortality rates in both developed and developing countries [8–10]. It is estimated that 212, 000 deaths are caused by NoV yearly worldwide with 99% of these occurring in middle- and high mortality countries [11]. In the USA, NoV contributes to at least * Correspondence: [email protected] 1 Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon 4 Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon Full list of author information is available at the end of the article
20 million illnesses per year leading to 56,000-71,000 hospi
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