Burden and typing of rotavirus group A in Latin America and the Caribbean: systematic review and meta-analysis

The study was supported by GlaxoSmithKline.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.INEI-ANLIS Dr. Carlos G. Malbran. Departamento de Virologia. Laboratorio de Gastroenteritis Virales. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clı´nica y Sanitaria. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clínica y Sanitaria. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clínica y Sanitaria. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clínica y Sanitaria. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clínica y Sanitaria. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clínica y Sanitaria. Buenos Aires, Argentina.Institute for Clinical Effectiveness and Health Policy. Instituto de Efectividad Clínica y Sanitaria. Buenos Aires, Argentina.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brazil.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brazil.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brazil.The efficacy of licensed rotavirus vaccines has only been shown against certain rotavirus group A (RV-A) types. It is critical to understand the burden of rotavirus gastroenteritis (RVGE) and its prevalent types to assess the potential impact of these vaccines in Latin America and the Caribbean (LA&C). We performed a systematic review and meta-analyses of all the available evidence reported from 1990 to 2009 on the burden of rotavirus disease and strains circulating in LA&C. Eligible studies--185 country-level reports, 174 951 faecal samples--were selected from MEDLINE, Cochrane Library, EMBASE, LILACS, regional Ministries of Health, PAHO, regional proceedings, doctoral theses, reference lists of included studies and consulting experts. Arc-sine transformations and DerSimonian-Laird random-effects model were used for meta-analyses. The proportion of gastroenteritis cases due to rotavirus was 24.3% (95%CI 22.3-26.4) and the incidence of RVGE was 170 per 1000 children-years (95%CI 130-210). We estimated a global annual mortality for 22 countries of 88.2 (95%CI 79.3-97.1) deaths per 100 000 under 5 years (47 000 deaths).The most common G type detected was G1 (34.2%), followed by G9 (14.6%), and G2 (14.4%). The most common P types detected were P[8] (56.2%), P[4] (22.1%) and P[1] 5.4%, and the most prevalent P-G type associations were P[8]G1 17.9%, P[4]G2 9.1% and P[8]G9 8.8%. In the last 10 years, G9 circulation increased remarkably and G5 almost disappeared. More recently, G12 appeared and P[4]G2 re-emerged. To our knowledge, this is the first meta-analysis of rotavirus infection and burden of disease in LA&C