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Estimating the Incidence of Symptomatic Rotavirus Infections: A Systematic Review and Meta-Analysis

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  • Joke Bilcke
  • Pierre Van Damme
  • Marc Van Ranst
  • Niel Hens
  • Marc Aerts
  • Philippe Beutels

Abstract

Background: We conducted for the first time a systematic review, including a meta-analysis, of the incidence of symptomatic rotavirus (RV) infections, because (1) it was shown to be an influential factor in estimating the cost-effectiveness of RV vaccination, (2) multiple community-based studies assessed it prospectively, (3) previous studies indicated, inconclusively, it might be similar around the world. Methodology: Pubmed (which includes Medline) was searched for surveys assessing prospectively symptomatic (diarrheal) episodes in a general population and situation, which also reported on the number of the episodes being tested RV+ and on the persons and the time period observed. A bias assessment tool was developed and used according to Cochrane guidelines by 4 researchers with different backgrounds. Heterogeneity was explored graphically and by comparing fits of study-homogenous ‘fixed effects’ and -heterogeneous ‘random effects’ models. Data were synthesized using these models. Sensitivity analysis for uncertainty regarding data abstraction, bias assessment and included studies was performed. Principal Findings: Variability between the incidences obtained from 20 studies is unlikely to be due to study groups living in different environments (tropical versus temperate climate, slums versus middle-class suburban populations), nor due to the year the study was conducted (from 1967 to 2003). A random effects model was used to incorporate unexplained heterogeneity and resulted in a global incidence estimate of 0.31 [0.19; 0.50] symptomatic RV infections per personyear of observation for children below 2 years of age, and of 0.24 [0.17; 0.34] when excluding the extreme high value of 0.84 reported for Mayan Indians in Guatemala. Apart from the inclusion/exclusion of the latter study, results were robust. Conclusions/Significance: Rather than assumptions based on an ad-hoc selection of one or two studies, these pooled estimates (together with the measure for variability between populations) should be used as an input in future cost-effectiveness analyses of RV vaccination.

Suggested Citation

  • Joke Bilcke & Pierre Van Damme & Marc Van Ranst & Niel Hens & Marc Aerts & Philippe Beutels, 2009. "Estimating the Incidence of Symptomatic Rotavirus Infections: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-10, June.
    • Handle: RePEc:plo:pone00:0006060
    DOI: 10.1371/journal.pone.0006060
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    References listed on IDEAS

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    1. Joke Bilcke & Pierre Van Damme & Philippe Beutels, 2009. "Cost-Effectiveness of Rotavirus Vaccination: Exploring Caregiver(s) and ``No Medical Care'' Disease Impact in Belgium," Medical Decision Making, , vol. 29(1), pages 33-50, January.
    2. H. Melliez & D. Levy-Bruhl & P. Y. Boelle & B. Dervaux & S. Baron & Y. Yazdanpanah, 2008. "Cost and cost-effectiveness of childhood vaccination against rotavirus in France," Post-Print hal-00283456, HAL.
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