Epidemiological characteristics of rotavirus gastroenteritis in China: A systematic review of studies published from 2014 to 2023

Rotavirus gastroenteritis (RVGE) is a major public health concern, particularly amongst children below five-years-old. In China, the disease burden remains high owing to the absence of a comprehensive detection system. This study analyses RVGE incidence, population distribution, and pathogenic genotypes reported in studies published between 2014 and 2023, providing evidence to support vaccine and drug development. A systematic review of studies on RVGE published between 2014 and 2023 was conducted. Articles were screened using a standardized algorithm. A random-effects model was employed to analyze rotavirus positive rates and genotype variation trends. Among 320 studies, the highest rotavirus positive rates in children (≤5 y) were in Jilin (48.59%), Shanxi (40.89%), and Xinjiang (37.65%), while the highest number of infections were in Yunnan (89,128), Jiangsu (82,869), and Guangxi (36,524). Among adults (≥15 y), Shaanxi (27.73%), Inner Mongolia (22.95%), and Heilongjiang (17.82%) had the highest rotavirus positive rates, whereas Shanghai (3,170), Beijing (2,019), and Fujian (1,044) recorded the most infections. The rotavirus positive rates were 26.46% and 32.85% for children visiting the outpatient/emergency department and the inpatient department, respectively. Before 2018, the dominant G genotypes were G9 (children: 42.89%; adults: 56.13%) and G3 (children: 20.17%; adults: 14.71%), whereas the dominant P genotype was P[8] (children: 76.30%; adults: 80.78%). After 2018, G9 (children: 66.73%; adults: 67.43%) and P[8] (children: 88.62%; adults: 88.57%) became predominant in both groups, with an increase in G8 (before: 0.89%; after: 5.08%) among children. RVGE remains a significant burden in China, with evolving distributions. Continuous surveillance is essential to guide vaccine strain selection and development.