Wastewater surveillance of rotavirus, norovirus, and hepatitis a virus in the Middle East and North Africa Region: a systematic review

Document Type

Article

Publication Date

12-29-2025

Publication Title

BMC public health

Keywords

Middle East, Africa, Northern, Wastewater, Humans, Rotavirus, Hepatitis A virus, Norovirus, Hepatitis A

Abstract

BACKGROUND: Wastewater surveillance (WWS) is a valuable tool for monitoring circulating and emerging pathogens, and emerging variants, providing an early warning system for potential epidemics. Its use for key viral diarrheal pathogens like Rotavirus (RV), Norovirus (NoV), and Hepatitis A Virus (HAV) remains underexplored in the Middle East and North African (MENA) region. This systematic review aims to advance available data on the use of wastewater to monitor RV, NoV and HAV in countries of the MENA region.

METHODS: A systematic search of six databases (PubMed, Medline, EMBASE, Scopus, Cochrane, and Web of science) was conducted for studies published between 2014 and 2024 in the MENA region following PRISMA guidelines. Eligible studies reported on the use of wastewater to detect RV, NoV, and HAV. Articles on unrelated pathogens, wastewater treatment efficiency, or insufficient sampling data were excluded. Risk of bias assessment was conducted.

RESULTS: We retrieved 11 studies meeting our predefined inclusion criteria and were used to extract full data. These studies were from Egypt, Tunisia, Bahrain, and Jordan. RV was the most studied virus (64%), followed by HAV (45%) and NoV (18%). Most studies (73%) had a moderate risk of bias. All studies sampled wastewater treatment plants. The sampling period, frequency, and sample size varied substantially between studies. Positivity rates for RV, NoV, and HAV showed high variability, ranging between no detection and 100%. The predominantly reported genotypes were GI and P[8] for RV, GI for NoV, and IA for HAV.

CONCLUSION: This review reveals significant gaps in WWS coverage across the MENA region for RV, NoV, and HAV, highlighting the need for investing in and expanding the use of WWS in the region. Effective surveillance of these viruses is pivotal to better understand the burden of these diseases and guide national public health interventions in the MENA region.

Medical Subject Headings

Middle East; Africa, Northern; Wastewater; Humans; Rotavirus; Hepatitis A virus; Norovirus; Hepatitis A

PubMed ID

41462189

ePublication

ePub ahead of print

Volume

26

Issue

1

First Page

398

Last Page

398

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