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Rotavirus and norovirus prevalence in LMICs remains significant following rotavirus vaccine introductionRotavirus and norovirus remain common causes of childhood diarrhea

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Key Takeaway
Note that rotavirus and norovirus remain significant causes of diarrheal disease in LMICs despite vaccine availability.

This meta-analysis evaluates the prevalence and genotype distribution of norovirus and rotavirus among children under five years of age with diarrheal infection in lower-middle-income countries (LMICs). The analysis included a total sample size of 35,704. The study reports a pooled prevalence of rotavirus at 24% (95% CI: 19.6-28.3%) and a pooled prevalence of norovirus at 13% (95% CI: 11-15%). The combined prevalence of both viruses was 18% (95% CI: 15-21%).

Regarding genotype distribution, the study identified rotavirus G3[P8] at 39% and G1[P8] at 17%. For norovirus, the distribution included GII (76%), GII.4 (53%), and GI (23%). The authors note substantial heterogeneity in the data (I2 = 98.72%, p < 0.001).

Clinically, the findings suggest that norovirus and rotavirus remain significant causes of diarrheal disease in LMICs even after the introduction of rotavirus vaccines. These results underscore the ongoing need for surveillance and the consideration of circulating genotypes when evaluating vaccine formulations. The high heterogeneity of the data may limit the precision of these prevalence estimates.

How this fits prior evidence

This meta-analysis extends the finding that rotavirus vaccination reduces rotavirus prevalence but does not eliminate the broad burden of other viral pathogens. It specifically quantifies the continued prevalence of rotavirus (24%) and norovirus (13%) in LMICs, highlighting that both remain significant contributors to diarrheal disease in children under five.

Diarrheal diseases remain a major health concern for young children in lower-middle-income countries. Even with the introduction of rotavirus vaccines, both rotavirus and norovirus continue to circulate and cause illness in children under the age of five.

Data from over 35,000 cases show that rotavirus has a prevalence of 24 percent, while norovirus shows a prevalence of 13 percent. Together, these two viruses account for 18 percent of cases. Researchers identified specific genetic types, or genotypes, for both viruses. For example, the GII.4 strain of norovirus was found in 53 percent of cases, and the G3[P8] strain of rotavirus was found in 39 percent.

While these findings help experts understand which strains are most common, the data also showed high variation between different regions. This variety makes it harder to draw perfect conclusions, but it highlights why ongoing monitoring is so important. These results help experts decide how to improve vaccine designs to better protect children from these common infections.

What this means for you:
Rotavirus and norovirus remain significant causes of diarrhea in children under five in many parts of the world.

Common questions

How common are these viruses in children?

In the studied group of children under five, rotavirus had a prevalence of 24 percent and norovirus had a prevalence of 13 percent. Combined, these two viruses were found in 18 percent of cases. These numbers show that both viruses remain significant causes of diarrheal disease in lower-middle-income countries.

What specific types of these viruses were found?

The study identified specific genotypes for both viruses. For norovirus, the GII genotype was found in 76 percent of cases, with GII.4 making up 53 percent. For rotavirus, the G3[P8] genotype was found in 39 percent of cases and G1[P8] was found in 17 percent.

What does this mean for vaccine efforts?

Because both viruses still cause significant illness even after rotavirus vaccines were introduced, these findings highlight the need for better monitoring. Understanding which specific genotypes are circulating helps experts consider how to improve the design of vaccines to better protect children.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJan 2026
View Original Abstract ↓
BACKGROUND: Rotavirus and norovirus are the leading viral causes of acute diarrheal disease worldwide. Both viruses encompass multiple genotypes and subgenotypes, and this genetic diversity presents a significant challenge to rotavirus vaccine effectiveness and development. High-quality evidence on the prevalence and circulating genotypes of these enteric viruses among children under five years of age remains limited, particularly following the introduction of rotavirus vaccination in low and middle-income countries (LMICs). Therefore, this systematic review and meta-analysis aimed to synthesizes available evidence on the prevalence and genotype distribution of norovirus and rotavirus in this population. METHODS: A systematic literature search was conducted across five major databases PubMed, Scopus, ScienceDirect, Embase, and Web of Science between February 20 and 28, 2026. Duplicate removal, title and abstract screening, full-text review and data extraction were performed independently by two investigators using the Rayyan web-based platform. STATA version 17 software was used for statistical analysis. A random-effects model was applied to estimate pooled prevalence and effect sizes. Heterogeneity was evaluated using Cochran's Q statistic, the I2 statistic, forest plots, and Galbraith plots. Publication bias was assessed using both graphical (funnel plots) and statistical methods. RESULTS: A total of 35,704 children under five years with diarrheal infection from LMICs were included across eligible studies. The overall pooled prevalence of norovirus and rotavirus combined was 18% (95% CI: 15-21%). Rotavirus had a higher pooled prevalence than norovirus, at 24% (95% CI: 19.6-28.3%) and 13% (95% CI: 11-15%), respectively. Substantial heterogeneity was observed across studies (I2 = 98.72%, p < 0.001). Among norovirus genotypes, GII was predominant (76%), with subgenotype GII.4 accounting for 53% of cases, followed by GI (23%). The most frequently identified rotavirus genotypes were G3[P8] (39%) and G1[P8] (17%). CONCLUSIONS: Norovirus and rotavirus remain significant causes of diarrheal disease among children under five in LMICs, even after the introduction of rotavirus vaccination. Approximately one in five children with diarrheal illness were infected with at least one of these virusesGII, particularly subgenotype GII.4, was the dominant norovirus strain, while G3[P8] and G1[P8] were the most prevalent rotavirus genotypes. These findings underscore the need to strengthen surveillance systems, consider circulating genotypes in vaccine formulation, and continuously monitor genotype shifts within the population.
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