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. 2015 Dec 3;10(12):e0142927.
doi: 10.1371/journal.pone.0142927. eCollection 2015.

Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food

Sara M Pires  1 , Christa L Fischer-Walker  2 , Claudio F Lanata  3   4 , Brecht Devleesschauwer  5 , Aron J Hall  6 , Martyn D Kirk  7 , Ana S R Duarte  1 , Robert E Black  2 , Frederick J Angulo  6
Affiliations

Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food

Sara M Pires et al. PLoS One. .

Abstract

Background: Diarrhoeal diseases are major contributors to the global burden of disease, particularly in children. However, comprehensive estimates of the incidence and mortality due to specific aetiologies of diarrhoeal diseases are not available. The objective of this study is to provide estimates of the global and regional incidence and mortality of diarrhoeal diseases caused by nine pathogens that are commonly transmitted through foods.

Methods and findings: We abstracted data from systematic reviews and, depending on the overall mortality rates of the country, applied either a national incidence estimate approach or a modified Child Health Epidemiology Reference Group (CHERG) approach to estimate the aetiology-specific incidence and mortality of diarrhoeal diseases, by age and region. The nine diarrhoeal diseases assessed caused an estimated 1.8 billion (95% uncertainty interval [UI] 1.1-3.3 billion) cases and 599,000 (95% UI 472,000-802,000) deaths worldwide in 2010. The largest number of cases were caused by norovirus (677 million; 95% UI 468-1,153 million), enterotoxigenic Escherichia coli (ETEC) (233 million; 95% UI 154-380 million), Shigella spp. (188 million; 95% UI 94-379 million) and Giardia lamblia (179 million; 95% UI 125-263); the largest number of deaths were caused by norovirus (213,515; 95% UI 171,783-266,561), enteropathogenic E. coli (121,455; 95% UI 103,657-143,348), ETEC (73,041; 95% UI 55,474-96,984) and Shigella (64,993; 95% UI 48,966-92,357). There were marked regional differences in incidence and mortality for these nine diseases. Nearly 40% of cases and 43% of deaths caused by these nine diarrhoeal diseases occurred in children under five years of age.

Conclusions: Diarrhoeal diseases caused by these nine pathogens are responsible for a large disease burden, particularly in children. These aetiology-specific burden estimates can inform efforts to reduce diarrhoeal diseases caused by these nine pathogens commonly transmitted through foods.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overview of data utilized to estimate the aetiology-proportions of diarrhoeal cases in children <5 years of age (outpatients and community studies).
Studies conducted in EURO Region countries and other low-mortality countries (sub-region A) were removed from the original data set. *SR: systematic review. SR Lanata 2013 [5]; Update SR: see S2 Appendix; Norovirus SR [14].
Fig 2
Fig 2. Overview of data utilized to estimate the aetiology-proportions of diarrhoeal deaths in children <5 years of age (inpatient studies).
Studies conducted in EURO Region countries and other low-mortality countries (sub-region A) were removed from the original data set. *SR: systematic review. SR Lanata 2013 [5]; Update SR: see S2 Appendix; Norovirus SR [14].
Fig 3
Fig 3. Overview of data utilized to estimate the aetiology-proportions of diarrhoeal cases and deaths in persons >5 years of age (inpatients, outpatients and community studies).
Studies conducted in EURO Region countries and other low-mortality countries (sub-region A) were removed from the original data set. *NG: information on type of patients included in the study not given; SR: systematic review; SR Fisher-Walker 2010 [6]; Update SR: see S2 Appendix; Norovirus SR [14].
Fig 4
Fig 4. Relative contribution of nine diarrhoeal agents and of unknown aetiology for diarrhoeal cases in children <5 and the population ≥5 years of age.
Estimates exclude the proportion of the incidence envelope attributable to “other pathogens”, because these were not considered in Approach 1 (applied to 60 countries within EURO, AMRO sub-region A, and WPRO sub-region A).
Fig 5
Fig 5. Relative contribution of nine diarrhoeal agents and of unknown aetiology for diarrhoeal deaths in children <5 and the population ≥5 years of age.
Estimates exclude the proportion of the mortality envelope attributable to “other pathogens”, because these were not considered in Approach 1 (applied to 60 countries within EURO, AMRO sub-region A, and WPRO sub-region A).
See this image and copyright information in PMC

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