Abstract
BACKGROUND: Rotavirus A remains a leading cause of acute gastroenteritis in children under 5 years of age across Asia, despite expanding vaccination programs. This study systematically synthesizes available evidence on rotavirus A detection among pediatric populations in Asian countries. METHODS: We conducted a systematic review and meta-analysis of studies reporting laboratory-confirmed rotavirus A infection among children aged ≤ 5 years in Asia. A total of 111 studies comprising 337,019 tested children were included. Random-effects meta-analysis was used to estimate pooled proportions of rotavirus A positivity among tested children. Between-study heterogeneity was assessed using the I (2) statistic. RESULTS: The pooled proportion of rotavirus A-positive cases among tested children in Asia was 24.7% (95% CI: 22.4%-27.1%). Substantial heterogeneity was observed across studies (I (2) = 99.42%, p < 0.001), reflecting wide variation in study populations, diagnostic methods, and healthcare settings. Higher test positivity rates were reported in studies from Saudi Arabia (49.3%), Iran (35.2%), Malaysia (33.0%), and India (29.4%), whereas lower proportions were observed in China (13.0%) and Pakistan (18.8%). Diagnostic modality and study design significantly influenced detection rates, with ELISA-based and cross-sectional studies reporting higher positivity. CONCLUSION: Approximately one-quarter of children tested for rotavirus A across Asia were laboratory-positive, although estimates varied markedly across settings and thus stress the need for a routine vaccination program.