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IJE Advance Access published online on December 4, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn260
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.

Seasonality of rotavirus disease in the tropics: a systematic review and meta-analysis

Karen Levy1,2,*, Alan E Hubbard3 and Joseph NS Eisenberg2

1Department of Environmental Science, Policy and Management, University of California, Berkeley.
2Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109.
3Division of Biostatistics, School of Public Health, University of California, Berkeley, 101 Haviland Hall, MC 7358, Berkeley, CA 94720.

*Corresponding author. Department of Epidemiology, School of Public Health, University of Michigan, 109 Observatory Street, Ann Arbor, MI 48109, USA. E-mail: karenlev{at}umich.edu


  Abstract

Background To date little conclusive evidence exists on the seasonality of rotavirus incidence in the tropics. We present a systematic review and meta-analysis on the seasonal epidemiology of rotavirus in the tropics, including 26 studies reporting continuous monthly rotavirus incidence for which corresponding climatological data was available.

Methods Using linear regression models that account for serial correlation between months, monthly rotavirus incidence was significantly negatively correlated with temperature, rainfall and relative humidity in 65%, 55% and 60% of studies, respectively. We carried out pooled analyses using a generalized estimating equation (GEE) that accounts for correlation from between-study variation and serial correlation between months within a given study.

Results For every 1°C (1.8°F) increase in mean temperature, 1 cm (0.39 in.) increase in mean monthly rainfall, and 1% increase in relative humidity (22%) this analysis showed reductions in rotavirus incidence of 10% (95% CI: 6–13%), 1% (95% CI: 0–1%), and 3% (95% CI:0–5%), respectively.

Conclusions On the basis of the evidence, we conclude that rotavirus responds to changes in climate in the tropics, with the highest number of infections found at the colder and drier times of the year.

Keywords Rotavirus, tropical, seasonality, epidemiology, diarrhoea, gastroenteritis

Accepted 4 November 2008


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