BACKGROUND: Diarrhea remains a major public health problem and characterization of etiology is needed to prioritize interventions. However, most data are from single-site studies of children. We tested samples from participants of any age from 11 geographically diverse hospitals in Bangladesh to describe pathogen-specific burdens of diarrhea. METHODS: We utilized two existing diarrhea surveillance systems: a Nationwide network at 10 sentinel hospitals and at the icddr,b hospital. We tested stools from enrolled participants and non-diarrheal controls for enteropathogens using quantitative PCR and calculated pathogen-specific attributable fractions (AFs) of diarrhea. RESULTS: We analyzed 5516 diarrheal patients and 735 controls. Overall, rotavirus had the highest attributable burden of diarrhea (Nationwide AF 17.7%, 95% confidence interval: 14.3, 20.9; icddr,b AF 39.9%; 38.0, 41.8), followed by adenovirus 40/41 (Nationwide AF 17.9%, CI: 13.9, 21.9; icddr,b AF 16.6%; CI: 14.4, 19.4) and Vibrio cholerae (Nationwide AF 10.2%, CI: 9.1, 11.3; icddr,b AF 13.3%, CI: 11.9, 15.1). Rotavirus was the leading pathogen in children under 5 years of age and was consistent across the sites (coefficient of variation = 56.3%). Adenovirus 40/41 was the second leading pathogen in both children and adults. V. cholerae was the leading pathogen in individuals above 5 years old but was more geographically variable (coefficient of variation = 71.5%). Other attributable pathogens included astrovirus, norovirus, Shigella, Salmonella, ETEC, sapovirus, and typical EPEC. CONCLUSIONS: Rotavirus, adenovirus 40/41, and V. cholerae were the leading etiologies of infectious diarrhea requiring hospitalization in Bangladesh. Other pathogens were important in certain age groups or sites.
BACKGROUND:Diarrhea remains a major public health problem and characterization of etiology is needed to prioritize interventions. However, most data are from single-site studies of children. We tested samples from participants of any age from 11 geographically diverse hospitals in Bangladesh to describe pathogen-specific burdens of diarrhea. METHODS: We utilized two existing diarrhea surveillance systems: a Nationwide network at 10 sentinel hospitals and at the icddr,b hospital. We tested stools from enrolled participants and non-diarrheal controls for enteropathogens using quantitative PCR and calculated pathogen-specific attributable fractions (AFs) of diarrhea. RESULTS: We analyzed 5516 diarrheal patients and 735 controls. Overall, rotavirus had the highest attributable burden of diarrhea (Nationwide AF 17.7%, 95% confidence interval: 14.3, 20.9; icddr,b AF 39.9%; 38.0, 41.8), followed by adenovirus 40/41 (Nationwide AF 17.9%, CI: 13.9, 21.9; icddr,b AF 16.6%; CI: 14.4, 19.4) and Vibrio cholerae (Nationwide AF 10.2%, CI: 9.1, 11.3; icddr,b AF 13.3%, CI: 11.9, 15.1). Rotavirus was the leading pathogen in children under 5 years of age and was consistent across the sites (coefficient of variation = 56.3%). Adenovirus 40/41 was the second leading pathogen in both children and adults. V. cholerae was the leading pathogen in individuals above 5 years old but was more geographically variable (coefficient of variation = 71.5%). Other attributable pathogens included astrovirus, norovirus, Shigella, Salmonella, ETEC, sapovirus, and typical EPEC. CONCLUSIONS: Rotavirus, adenovirus 40/41, and V. cholerae were the leading etiologies of infectious diarrhea requiring hospitalization in Bangladesh. Other pathogens were important in certain age groups or sites.
Authors: Ibrahim Khalil; Richard Walker; Chad K Porter; Farzana Muhib; Roma Chilengi; Alejandro Cravioto; Richard Guerrant; Ann-Mari Svennerholm; Firdausi Qadri; Shahida Baqar; Margaret Kosek; Gagandeep Kang; Claudio Lanata; George Armah; Thomas Wierzba; Mateusz Hasso-Agopsowicz; Birgitte Giersing; A Louis Bourgeois Journal: Vaccine Date: 2021-05-06 Impact factor: 3.641
Authors: Denise T St Jean; Obvious N Chilyabanyama; Samuel Bosomprah; Mah Asombang; Rachel M Velu; Mwelwa Chibuye; Fiona Mureithi; Nsofwa Sukwa; Masuzyo Chirwa; Prudence Mokha; Roma Chilengi; Michelo Simuyandi Journal: PLoS One Date: 2022-08-15 Impact factor: 3.752