Epidemiology, Clinical Features, and Unusual Complications of Norovirus Infection in Taiwan: What We Know after Rotavirus Vaccines

Abstract

Noroviruses (NoVs) are one of the emerging and rapidly spreading groups of pathogens threatening human health. A reduction in sporadic NoV infections was noted following the start of the COVID-19 pandemic, but the return of NoV gastroenteritis during the COVID-19 pandemic has been noted recently. Research in recent years has shown that different virus strains are associated with different clinical characteristics; moreover, there is a paucity of research into extraintestinal or unusual complications that may be associated with NoV. The genomic diversity of circulating NoVs is also complex and may vary significantly. Therefore, this short narrative review focuses on sharing the Taiwan experience of NoV infection including epidemiology, clinical features, and complications following suboptimal rotavirus immunization in Taiwan (after October 2006). We also highlight the unusual complications associated with NoV infections and the impacts of NoV infection during the COVID-19 pandemic in the literature for possible future research directions. To conclude, further research is needed to quantify the burden of NoV across the spectrum of disease severity in Taiwan. The evidence of the connection between NoV and the unusual complications is still lacking.

Keywords: clinical features; complications; epidemiology; gastroenteritis; norovirus.

Figure 1

The distribution of enteric pathogen detection among hospitalized AGE children under 5 years old after rotavirus vaccine implementation in (a) 2007–2011, the early postvaccine period; (b) 2012–2016, the late postvaccine period. The data were originally from the research by Yu et al. [28].

Figure 2

Complications in different periods of NoV outbreaks in northern Taiwan before and after suboptimal rotavirus vaccine introduction from late 2006 (highlight by arrow). The figure has been modified and originated from the research by Wang et al. [26].