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Lancet Infect Dis. 2018 Nov;18(11):1229-1240. doi: 10.1016/S1473-3099(18)30475-4. Epub 2018 Sep 25.

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990-2016.

Author information

1
Institute for Health Metrics and Evaluation, Seattle WA, USA.
2
Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA.
3
Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
4
Maternal, Newborn, Child Health & Nutrition, PATH, Seattle, WA, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
5
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
6
Translational Health Science and Technology Institute, Faridabad, India.
7
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
8
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
9
Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
10
Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA.
11
Institute for Health Metrics and Evaluation, Seattle WA, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
12
Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
13
Uniformed Services University, Bethesda, MD, USA.
14
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology & Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
15
Drug Development, PATH, Seattle, WA, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Albers School of Business & Economics, Seattle University, Seattle, WA, USA.
16
Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA.
17
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
18
Institute for Health Metrics and Evaluation, Seattle WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
19
Institute for Health Metrics and Evaluation, Seattle WA, USA. Electronic address: bcreiner@uw.edu.

Erratum in

Abstract

BACKGROUND:

Shigella and enterotoxigenic Escherichia coli (ETEC) are bacterial pathogens that are frequently associated with diarrhoeal disease, and are a significant cause of mortality and morbidity worldwide. The Global Burden of Diseases, Injuries, and Risk Factors study 2016 (GBD 2016) is a systematic, scientific effort to quantify the morbidity and mortality due to over 300 causes of death and disability. We aimed to analyse the global burden of shigella and ETEC diarrhoea according to age, sex, geography, and year from 1990 to 2016.

METHODS:

We modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We used a compartmental meta-regression tool to model the incidence of shigella and ETEC, which enforces an association between incidence, prevalence, and remission on the basis of scientific literature, population representative surveys, and health-care data. We calculated 95% uncertainty intervals (UIs) for the point estimates.

FINDINGS:

Shigella was the second leading cause of diarrhoeal mortality in 2016 among all ages, accounting for 212 438 deaths (95% UI 136 979-326 913) and about 13·2% (9·2-17·4) of all diarrhoea deaths. Shigella was responsible for 63 713 deaths (41 191-93 611) among children younger than 5 years and was frequently associated with diarrhoea across all adult age groups, increasing in elderly people, with broad geographical distribution. ETEC was the eighth leading cause of diarrhoea mortality in 2016 among all age groups, accounting for 51 186 deaths (26 757-83 064) and about 3·2% (1·8-4·7) of diarrhoea deaths. ETEC was responsible for about 4·2% (2·2-6·8) of diarrhoea deaths in children younger than 5 years.

INTERPRETATION:

The health burden of bacterial diarrhoeal pathogens is difficult to estimate. Despite existing prevention and treatment options, they remain a major cause of morbidity and mortality globally. Additional emphasis by public health officials is needed on a reduction in disease due to shigella and ETEC to reduce disease burden.

FUNDING:

Bill & Melinda Gates Foundation.

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