Epidemiology, genetic diversity and symptom characterization of rotavirus infection in Saudi Arabia, 1985-2024: a meta-analysis.

Introduction: Rotavirus infection has been a major health burden among children under 5 years in Saudi Arabia. There is a lack of meta-analysis on epidemiology and genetic diversity of rotavirus in Saudi Arabia. Methods: We conducted this study to provide a comparative overview of rotavirus infection in Saudi Arabia. We selected published literature between 1985 and 2025. Results: Epidemiological data were retrieved from 18 articles. In Saudi Arabia, the pooled prevalence of RVA among children under 5 years was 34.3% (95% CI: 2% to 81%, I2 = 98.97%). Overall, G1P[8] (52%, 95% CI: 29% to 69%, I2 = 0%) was reported from the highest number of cases, followed by G2P[4] (18%, 95% CI: 9% to 31%, I2 = 36.86%), G9P[8] (14%, 95% CI: 8% to 27%, I2 = 45.37%), G12P[8] (4%, 95% CI: 2% to 11%, I2 = 0%), and G3P[8] (3%, 95% CI: 1% to 11%, I2 = 99%), respectively. Genotype G2P[4] (41%) became the most prevalent, while the frequency of G1P[8] reduced to 38% and G9P[8] to 6% during 2013-2024. The odds of rotavirus infection increased in the winter season (aOD 2.4, 95% CI: 1.52 to 3.57, p-value 0.005). The odds of rotavirus prevalence were significantly lower after vaccination (aOD 0.56, 95% CI: 0.25 to 0.73, p-value 0.001). Discussion: This is one of the first meta-analyses to compare the genotypic data of rotaviruses before and after vaccination in Saudi Arabia. This study will provide an overall insight into prevalence, genetic diversity, and seasonality during pre-vaccination and post-vaccination periods and contribute to policy making.