Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis.
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 asse...
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doaj-475bbe68e2b14ab2a6611c62d41515692020-11-24T21:52:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032009-06-0146e606010.1371/journal.pone.0006060Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis.Joke BilckePierre Van DammeMarc Van RanstNiel HensMarc AertsPhilippe BeutelsBACKGROUND: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.http://europepmc.org/articles/PMC2699052?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Joke Bilcke Pierre Van Damme Marc Van Ranst Niel Hens Marc Aerts Philippe Beutels |
spellingShingle |
Joke Bilcke Pierre Van Damme Marc Van Ranst Niel Hens Marc Aerts Philippe Beutels Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. PLoS ONE |
author_facet |
Joke Bilcke Pierre Van Damme Marc Van Ranst Niel Hens Marc Aerts Philippe Beutels |
author_sort |
Joke Bilcke |
title |
Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. |
title_short |
Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. |
title_full |
Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. |
title_fullStr |
Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. |
title_full_unstemmed |
Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. |
title_sort |
estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2009-06-01 |
description |
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. |
url |
http://europepmc.org/articles/PMC2699052?pdf=render |
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