Acute gastroenteritis outbreaks caused by human astrovirus, 1978-2021: a systematic review

Background: Human astrovirus (HAstV) is one of the main pathogens that causes sporadic cases of acute gastroenteritis, sometimes leading to outbreaks. This study aimed to understand the epidemiological and etiological characteristics of HAstV outbreaks worldwide. Methods: : The literature on HAstV outbreaks published before January 2022 was retrieved from China National Knowledge Infrastructure, WanFang, WeiPu, PubMed, and Web of Science databases and the date, region, population, setting, transmission modes, clinical symptoms, and etiological characteristics of the outbreaks were collected and analyzed. Results: : Twenty-one articles on 21 HAstV outbreaks reported from November 1978 to November 2017 were included. Up to three outbreaks were reported per year, with most having been reported in autumn (8/20, 40.00%). Outbreaks were primarily distributed in the northern hemisphere, with China reporting the most, and mainly occurred in childcare centers/kindergartens (6/21, 28.57%), hospitals (5/21, 23.81%), and schools (4/21, 19.05%). Virus genotypes were identified during 15 outbreaks, and HAstV-1 was the predominant (8/15, 53.33%). Abdominal pain and diarrhea were the most common symptoms. Conclusions: : Although HAstV outbreaks are not frequently reported, it is necessary to consider HAstV of norovirus-negative gastroenteritis outbreaks. In addition, local Centers for Disease Control and Prevention should have the capacity to handle HAstV outbreaks and identify the pathogen. PROSPERO 2022: CRD42022334636