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. 2021 Nov 2;73(9):e2493-e2499.
doi: 10.1093/cid/ciaa840.

Etiology of Diarrhea Requiring Hospitalization in Bangladesh by Quantitative Polymerase Chain Reaction, 2014-2018

Mami Taniuchi  1 , Kamrul Islam  2 , Md Abu Sayeed  2 , James A Platts-Mills  1 , Md Taufiqul Islam  2 , Md Imam Ul Khabir  2 , Muntasir Rahman  2 , Zahid Hasan Khan  2 , Yasmin Ara Begum  2 , Farhana Khanam  2 , Ashraful Islam Khan  2 , Jie Liu  1 , Eric R Houpt  1 , Firdausi Qadri  2
Affiliations

Etiology of Diarrhea Requiring Hospitalization in Bangladesh by Quantitative Polymerase Chain Reaction, 2014-2018

Mami Taniuchi et al. Clin Infect Dis. .

Abstract

Background: Diarrhea remains a major public health problem and characterization of its 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 2 existing diarrhea surveillance systems: a Nationwide network at 10 sentinel hospitals and at the icddr,b hospital. We tested stools from enrolled participants and nondiarrheal controls for enteropathogens using quantitative polymerase chain reaction and calculated pathogen-specific attributable fractions (AFs) of diarrhea.

Results: We analyzed 5516 patients with diarrhea and 735 controls. Overall, rotavirus had the highest attributable burden of diarrhea (Nationwide AF, 17.7%; 95% confidence interval [CI], 14.3-20.9%; icddr,b AF, 39.9%; 38.0-41.8%), followed by adenovirus 40/41 (Nationwide AF, 17.9%; 95% CI: 13.9-21.9%; icddr,b AF, 16.6%; 95% CI, 14.4-19.4%) and Vibrio cholerae (Nationwide AF, 10.2%; 95% CI, 9.1-11.3%; icddr,b AF, 13.3%; 95% CI: 11.9-15.1%). Rotavirus was the leading pathogen in children <5 years and was consistent across the sites (coefficient of variation = 56.3%). Adenovirus 40/41 was the second leading pathogen in both children and adults. Vibrio cholerae was the leading pathogen in individuals >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.

Keywords: Bangladesh; TAC; diarrheal diseases; surveillance.

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Figures

Figure 1.
Figure 1.
Map of the sentinel surveillance sites across Bangladesh. Study participants were enrolled from 11 sentinel sites indicated by red crosses: the Nationwide surveillance included 10 hospitals and the 2% surveillance was carried out at the icddr,b Dhaka hospital. Abbreviation: icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh.
Figure 2.
Figure 2.
Pathogen-specific attributable fractions of diarrhea requiring hospitalization using quantitative molecular diagnostics in each surveillance network. Error bars denote 95% CIs. Abbreviations: CI, confidence interval; EPEC, enteropathogen Escherichia coli; ETEC, enterotoxigenic Escherichia coli; icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh.
Figure 3.
Figure 3.
Pathogen-specific attributable fractions of diarrhea requiring hospitalization using quantitative molecular diagnostics by age category, both surveillance networks combined. Error bars denote 95% CIs. Abbreviations: CI, confidence interval; EPEC, enteropathogen Escherichia coli; ETEC, enterotoxigenic Escherichia coli.
Figure 4.
Figure 4.
Pathogen-specific attributable fractions of diarrhea requiring hospitalization using quantitative molecular diagnostics in each of the 10 sites of the Nationwide surveillance system. Error bars denote 95% CIs. Abbreviations: CI, confidence interval; EPEC, enteropathogen Escherichia coli; ETEC, enterotoxigenic Escherichia coli.
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