Is Human Bocavirus Infection Associated with Gastroenteritis in Children? An Updated Systematic Review and Meta-analysis

BackgroundHuman bocavirus (HBoV) figures as an increased risk factor of respiratory and gastrointestinal tract infections among children. A great deal of data is available to support the pathogenic role of HBoV in acute respiratory diseases. However, the association between HBoV infection and gastroenteritis remains controversial due to the ambiguous results. The present work aims to clarify the role of HBoV as a cause of gastroenteritis in children. Methodology/Principal findingsA systematic search of the literature was carried out from 1 January 2016 to 29 August 2021 in Embase, PubMed, Scopus, Web of Science, and the Chinese bibliographic database of biomedicine (CBM). Data from included studies were analyzed by use of a random-effects model. The pooled estimates of HBoV prevalence among all cases of gastroenteritis were generated and stratified by potential confounders. The pooled odds ratio (OR) and 95% confidence interval (CI) were computed for HBoV infection in relation to the risk of gastroenteritis. The overall prevalence of HBoV in children with gastroenteritis (9.1%, 95% CI: 6.7-11.8%) was considerably higher than that detected in children without gastroenteritis (4.0%, 95% CI: 1.1-8.5%). HBoV prevalence tended to be higher in cases of gastroenteritis under five years of age (12.1%, 95% CI: 6.8-18.7%). The highest frequency of HBoV was found in Egypt (57.8%, 95% CI: 47.7-67.6%). The predominant genotypes of HBoV circulating in children with gastroenteritis were genotype 1 (HBoV1, 3.8%, 95% CI: 2.7-5.2%) and genotype 2 (HBoV2, 2.4%, 95% CI: 1.3-3.7%). HBoV infection was significantly associated with an increased risk of gastroenteritis in children (OR 1.620, 95% CI: 1.023-2.566). ConclusionThe HBoV prevalence in pediatric cases of gastroenteritis is higher than that in children without gastroenteritis, demonstrating an increasing global burden of gastroenteritis in children caused by HBoV infection. Targeted intervention to reduce the HBoV burden should be established. Author summaryIn addition to the known gastroenteritis-associated pathogens (rotavirus and norovirus et al.), several novel viruses that might be caused agents of diarrhea have been gradually determined, such as HBoV. The impact of HBoV infection on the development of childhood gastroenteritis remains ambiguous and in need of verifications. This work clarifies the association between HBoV infection and the risk of gastroenteritis in children based on the review literature. The estimated HBoV prevalence in all cases of gastroenteritis was categorized into different subgroups following the potential confounders, including age, gender, country, and HBoV genotypes. The main finding of this work was the significant association between HBoV infection and the development of childhood gastroenteritis. Our systematic review highlighted that HBoV infection contributes to the increased global burden of gastroenteritis in children.