1
|
Black RE, Perin J, Yeung D, Rajeev T, Miller J, Elwood SE, Platts-Mills JA. Estimated global and regional causes of deaths from diarrhoea in children younger than 5 years during 2000-21: a systematic review and Bayesian multinomial analysis. Lancet Glob Health 2024; 12:e919-e928. [PMID: 38648812 PMCID: PMC11099298 DOI: 10.1016/s2214-109x(24)00078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Information on the causes of deaths from diarrhoea in children younger than 5 years is needed to design improved preventive and therapeutic approaches. We aimed to conduct a systematic analysis of studies to report estimates of the causes of deaths from diarrhoea in children younger than 5 years at global and regional levels during 2000-21. METHODS For this systematic review and Bayesian multinomial analysis, we included 12 pathogens with the highest attributable incidence in the Global Enteric Multicenter Study. We searched PubMed, Scopus, Embase, Web of Science, Global Health Index Medicus, Global Health OVID, IndMed, Health Information Platform for the Americas (PLISA), Africa-Wide Information, and Cochrane Collaboration for articles published between Jan 1, 2000, and Dec 31, 2020, using the search terms "child", "hospital", "diarrhea", "diarrhoea", "dysentery", "rotavirus", "Escherichia coli", "salmonella", "shigella", "campylobacter", "Vibrio cholerae", "cryptosporidium", "norovirus", "astrovirus", "sapovirus", and "adenovirus". To be included, studies had to have a patient population of children younger than 5 years who were hospitalised for diarrhoea (at least 90% of study participants), at least a 12-month duration, reported prevalence in diarrhoeal stools of at least two of the 12 pathogens, all patients with diarrhoea being included at the study site or a systematic sample, at least 100 patients with diarrhoea, laboratory tests done on rectal swabs or stool samples, and standard laboratory methods (ie, quantitative PCR [qPCR] or non-qPCR). Studies published in any language were included. Studies were excluded if they were limited to nosocomial, chronic, antibiotic-associated, or outbreak diarrhoea or to a specific population (eg, only children with HIV or AIDS). Each article was independently reviewed by two researchers; a third arbitrated in case of disagreement. If both reviewers identified an exclusion criterion, the study was excluded. Data sought were summary estimates. Data on causes from published studies were adjusted when necessary to account for the poor sensitivity of non-qPCR methods and for attributable fraction based on quantification of pathogens in children who are ill or non-ill. The causes of deaths from diarrhoea were modelled on the causes of hospitalisations for diarrhoea. We separately modelled studies reporting causes of diarrhoea in children who were hospitalised in low-income and middle-income countries (LMICs) and in high-income countries (HICs). FINDINGS Of 74 282 papers identified in the initial database search, we included 138 studies (91 included data from LMICs and 47 included data from HICs) from 73 countries. We modelled estimates for 194 WHO member states (hereafter referred to as countries), including 42 HICs and 152 LMICs. We could attribute a cause to 1 003 448 (83·8%) of the estimated 1 197 044 global deaths from diarrhoea in children younger than 5 years in 2000 and 360 730 (81·3%) of the estimated 443 833 global deaths from diarrhoea in children younger than 5 years in 2021. The cause with the largest estimated global attribution was rotavirus; in LMICs, the proportion of deaths from diarrhoea due to rotavirus in children younger than 5 years appeared lower in 2021 (108 322 [24·4%] of 443 342, 95% uncertainty interval 21·6-29·5) than in 2000 (316 382 [26·5%] of 1 196 134, 25·7-28·5), but the 95% CIs overlapped. In 2000, the second largest estimated attribution was norovirus GII (95 817 [8·0%] of 1 196 134 in LMICs and 225 [24·7%] of 910 in HICs); in 2021, Shigella sp had the second largest estimated attribution in LMICs (36 082 [8·1%] of 443 342), but norovirus remained with the second largest estimated attribution in HICs (84 [17·1%] of 490). INTERPRETATION Our results indicate progress in the reduction of deaths from diarrhoea caused by 12 pathogens in children younger than 5 years in the past two decades. There is a need to increase efforts for prevention, including with rotavirus vaccine, and treatment to eliminate further deaths. FUNDING Bill & Melinda Gates Foundation via Johns Hopkins University and the University of Virginia.
Collapse
Affiliation(s)
- Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Jamie Perin
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Diana Yeung
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tushara Rajeev
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacob Miller
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sarah E Elwood
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
2
|
Njifon HLM, Kenmoe S, Ahmed SM, Roussel Takuissu G, Ebogo-Belobo JT, Njile DK, Bowo-Ngandji A, Mbaga DS, Kengne-Nde C, Mouiche MMM, Njouom R, Perraut R, Leung DT. Epidemiology of Rotavirus in Humans, Animals, and the Environment in Africa: A Systematic Review and Meta-analysis. J Infect Dis 2024; 229:1470-1480. [PMID: 37962924 PMCID: PMC11095554 DOI: 10.1093/infdis/jiad500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Globally, rotavirus infections are the most common cause of diarrhea-related deaths, especially among children under 5 years of age. This virus can be transmitted through the fecal-oral route, although zoonotic and environmental contributions to transmission are poorly defined. The purpose of this study is to determine the epidemiology of rotavirus in humans, animals, and the environment in Africa, as well as the impact of vaccination. METHODS We searched PubMed, Web of Science, Africa Index Medicus, and African Journal Online, identifying 240 prevalence data points from 224 articles between 2009 and 2022. RESULTS Human rotavirus prevalence among patients with gastroenteritis was 29.8% (95% confidence interval [CI], 28.1%-31.5%; 238 710 participants), with similar estimates in children under 5 years of age, and an estimated case fatality rate of 1.2% (95% CI, .7%-2.0%; 10 440 participants). Prevalence was estimated to be 15.4% and 6.1% in patients with nongastroenteritis illnesses and apparently healthy individuals, respectively. Among animals, prevalence was 9.3% (95% CI, 5.7%-13.7%; 6115 animals), and in the environmental water sources, prevalence was 31.4% (95% CI, 17.7%-46.9%; 2530 samples). DISCUSSION Our findings highlight the significant burden of rotavirus infection in Africa, and underscore the need for a One Health approach to limiting the spread of this disease.
Collapse
Affiliation(s)
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Sharia M Ahmed
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Guy Roussel Takuissu
- Centre for Food, Food Security, and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | - Cyprien Kengne-Nde
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Ronald Perraut
- Annex of Garoua, Centre Pasteur du Cameroon, Garoua, Cameroon
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
3
|
Baqar S, Bonavia A, Louis Bourgeois A, Campo JJ, Clifford A, Hanevik K, Hasso-Agopsowicz M, Hausdorff W, Kaminski R, MacLennan CA, Mantis N, Martin LB, Omore R, Pasetti M, Pavlinac P, Phalipon A, Poly F, Porter C, Ramasamy MN, Rogawski McQuade ET, Sztein MB, Walker R. The 2022 Vaccines Against Shigella and Enterotoxigenic Escherichia coli (VASE) Conference: Summary of breakout workshops. Vaccine 2024; 42:1445-1453. [PMID: 38036392 PMCID: PMC10953702 DOI: 10.1016/j.vaccine.2023.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
The global public health nonprofit organization PATH hosted the third Vaccines Against Shigella and Enterotoxigenic Escherichia coli (VASE) Conference in Washington, DC, from November 29 to December 1, 2022. This international gathering focused on cutting-edge research related to the development of vaccines against neglected diarrheal pathogens including Shigella, enterotoxigenic Escherichia coli (ETEC), Campylobacter, and non-typhoidal Salmonella. In addition to the conference's plenary content, the agenda featured ten breakout workshops on topics of importance to the enteric vaccine field. This unique aspect of VASE Conferences allows focused groups of attendees to engage in in-depth discussions on subjects of interest to the enteric vaccine development community. In 2022, the workshops covered a range of topics. Two focused on the public health value of enteric vaccines, with one examining how to translate evidence into policy and the other on the value proposition of potential combination vaccines against bacterial enteric pathogens. Two more workshops explored new tools for the development and evaluation of vaccines, with the first on integrating antigen/antibody technologies for mucosal vaccine and immunoprophylactic development, and the second on adjuvants specifically for Shigella vaccines for children in low- and middle-income countries. Another pair of workshops covered the status of vaccines against two emerging enteric pathogens, Campylobacter and invasive non-typhoidal Salmonella. The remaining four workshops examined the assessment of vaccine impact on acute and long-term morbidity. These included discussions on the nature and severity of intestinal inflammation; cellular immunity and immunological memory in ETEC and Shigella infections; clinical and microbiologic endpoints for Shigella vaccine efficacy studies in children; and intricacies of protective immunity to enteric pathogens. This article provides a brief summary of the presentations and discussions at each workshop in order to share these sessions with the broader enteric vaccine field.
Collapse
Affiliation(s)
| | - Aurelio Bonavia
- Bill & Melinda Gates Medical Research Institute, United States
| | | | | | | | - Kurt Hanevik
- University of Bergen, Norway; Norwegian National Advisory Unit for Tropical Infectious Diseases, Medical Department, Haukeland University Hospital, Norway
| | | | - William Hausdorff
- PATH, United States; Faculty of Medicine, Université Libre de Bruxelles, Belgium
| | | | - Calman A MacLennan
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, United Kingdom; The Jenner Institute, United Kingdom
| | - Nicholas Mantis
- Wadsworth Center, New York State Department of Health, United States
| | | | - Richard Omore
- Kenya Medical Research Institute Center for Global Health Research, Kenya
| | | | | | | | | | - Chad Porter
- Naval Medical Research Command, United States
| | | | | | | | | |
Collapse
|
4
|
Armah G, Lopman BA, Vinjé J, O'Ryan M, Lanata CF, Groome M, Ovitt J, Marshall C, Sajewski E, Riddle MS. Vaccine value profile for norovirus. Vaccine 2023; 41 Suppl 2:S134-S152. [PMID: 37951692 DOI: 10.1016/j.vaccine.2023.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/11/2023] [Accepted: 03/16/2023] [Indexed: 11/14/2023]
Abstract
Norovirus is attributed to nearly 1 out of every 5 episodes of diarrheal disease globally and is estimated to cause approximately 200,000 deaths annually worldwide, with 70,000 or more among children in developing countries. Noroviruses remain a leading cause of sporadic disease and outbreaks of acute gastroenteritis even in industrialized settings, highlighting that improved hygiene and sanitation alone may not be fully effective in controlling norovirus. Strengths in global progress towards a Norovirus vaccine include a diverse though not deep pipeline which includes multiple approaches, including some with proven technology platforms (e.g., VLP-based HPV vaccines). However, several gaps in knowledge persist, including a fulsome mechanistic understanding of how the virus attaches to human host cells, internalizes, and induces disease.
Collapse
Affiliation(s)
- George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Ben A Lopman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, University of Chile and Instituto de Sistemas Complejos de Ingenierìa (ISCI), Santiago, Chile
| | | | - Michelle Groome
- National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared Ovitt
- Office of Medical Research, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | | | - Elizabeth Sajewski
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Mark S Riddle
- Office of Medical Research, University of Nevada, Reno School of Medicine, Reno, Nevada, USA.
| |
Collapse
|
5
|
Cates J, Cardemil CV, Mirza SA, Lopman B, Hall AJ, Holodniy M, Lucero-Obusan C. Risk of Hospitalization and Mortality Following Medically Attended Norovirus Infection-Veterans Health Administration, 2010-2018. Open Forum Infect Dis 2023; 10:ofad556. [PMID: 38023542 PMCID: PMC10667024 DOI: 10.1093/ofid/ofad556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Background While prior studies have suggested a role for norovirus gastroenteritis in contributing to severe morbidity and mortality, the importance of norovirus as a causal pathogen for hospitalization and mortality remains poorly understood. We estimated the effect of laboratory-confirmed norovirus infection on hospitalization and mortality among a national cohort of veterans who sought care within the Veterans Affairs health care system. Methods We analyzed electronic health record data from a cohort study of adults who were tested for norovirus within the Veterans Affairs system between 1 January 2010 and 31 December 2018. Adjusted risk ratios (aRRs) for hospitalization and mortality were estimated using log-binomial regression models, adjusting for age, Clostridioides difficile, underlying medical conditions, and nursing home residence. Results In total, 23 196 veterans had 25 668 stool samples tested for norovirus; 2156 samples (8.4%) tested positive. Testing positive for norovirus infection, compared with testing negative, was associated with a slight increased risk of hospitalization (aRR, 1.13 [95% confidence interval, 1.06-1.21]) and a significant increased risk of mortality within 3 days after the norovirus test (2.14 [1.10-4.14]). The mortality aRR within 1 week and 1 month were reduced to 1.40 (95% confidence interval, .84-2.34) and 0.97 (.70-1.35), respectively. Conclusions Older veterans with multiple comorbid conditions were at a slight increased risk of hospitalization and significant increased risk of mortality in the 3 days after a norovirus-positive test, compared with those testing negative. Clinicians should be aware of these risks and can use these data to inform clinical management for veterans with norovirus.
Collapse
Affiliation(s)
- Jordan Cates
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ben Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark Holodniy
- Public Health National Program Office, Department of Veterans Affairs, Palo Alto, California, and Washington, DC, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California USA
| | - Cynthia Lucero-Obusan
- Public Health National Program Office, Department of Veterans Affairs, Palo Alto, California, and Washington, DC, USA
| |
Collapse
|
6
|
Rodriguez-Valverde D, Giron JA, Hu Y, Nataro JP, Ruiz-Perez F, Santiago AE. Highly-conserved regulatory activity of the ANR family in the virulence of diarrheagenic bacteria through interaction with master and global regulators. Sci Rep 2023; 13:7024. [PMID: 37120613 PMCID: PMC10148876 DOI: 10.1038/s41598-023-33997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
ANR (AraC negative regulators) are a novel class of small regulatory proteins commonly found in enteric pathogens. Aar (AggR-activated regulator), the best-characterized member of the ANR family, regulates the master transcriptional regulator of virulence AggR and the global regulator HNS in enteroaggregative Escherichia coli (EAEC) by protein-protein interactions. On the other hand, Rnr (RegA-negative regulator) is an ANR homolog identified in attaching and effacing (AE) pathogens, including Citrobacter rodentium and enteropathogenic Escherichia coli (EPEC), sharing only 25% identity with Aar. We previously found that C. rodentium lacking Rnr exhibits prolonged shedding and increased gut colonization in mice compared to the parental strain. To gain mechanistic insights into this phenomenon, we characterized the regulatory role of Rnr in the virulence of prototype EPEC strain E2348/69 by genetic, biochemical, and human organoid-based approaches. Accordingly, RNA-seq analysis revealed more than 500 genes differentially regulated by Rnr, including the type-3 secretion system (T3SS). The abundance of EspA and EspB in whole cells and bacterial supernatants confirmed the negative regulatory activity of Rnr on T3SS effectors. We found that besides HNS and Ler, twenty-six other transcriptional regulators were also under Rnr control. Most importantly, the deletion of aar in EAEC or rnr in EPEC increases the adherence of these pathogens to human intestinal organoids. In contrast, the overexpression of ANR drastically reduces bacterial adherence and the formation of AE lesions in the intestine. Our study suggests a conserved regulatory mechanism and a central role of ANR in modulating intestinal colonization by these enteropathogens despite the fact that EAEC and EPEC evolved with utterly different virulence programs.
Collapse
Affiliation(s)
- Diana Rodriguez-Valverde
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, MR-4 Building, P.O. Box 801326, Charlottesville, VA, 22908, USA
| | - Jorge A Giron
- Centro de Detección Biomolecular, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- Translational Genomics Research Institute, 445 N. 5th St, Phoenix, AZ, 85004, USA
| | - Yang Hu
- CD Genomics, Shirley, NY, USA
| | - James P Nataro
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, MR-4 Building, P.O. Box 801326, Charlottesville, VA, 22908, USA
| | - Fernando Ruiz-Perez
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, MR-4 Building, P.O. Box 801326, Charlottesville, VA, 22908, USA
| | - Araceli E Santiago
- Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, MR-4 Building, P.O. Box 801326, Charlottesville, VA, 22908, USA.
| |
Collapse
|
7
|
Libby TE, Delawalla MLM, Al-Shimari F, MacLennan CA, Vannice KS, Pavlinac PB. Consequences of Shigella infection in young children: a systematic review. Int J Infect Dis 2023; 129:78-95. [PMID: 36736579 PMCID: PMC10017352 DOI: 10.1016/j.ijid.2023.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/07/2023] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES We conducted a systematic review of the longitudinal consequences of Shigella infection in children to inform the value proposition for an effective vaccine. METHODS We searched PubMed and Embase for studies published from January 01, 1980 to December 12, 2022 and conducted in low- and middle-income countries that included longitudinal follow-up after Shigella detection among children aged <5 years, irrespective of language. We collected data on all outcomes subsequent to Shigella detection, except mortality. RESULTS Of 2627 papers identified, 52 met inclusion criteria. The median sample size of children aged <5 years was 66 (range 5-2172). Data were collected in 20 countries; 56% (n = 29) of the publications included Bangladesh. The most common outcomes related to diarrhea (n = 20), linear growth (n = 14), and the mean total cost of a Shigella episode (n = 4; range: $ 6.22-31.10). Among children with Shigella diarrhea, 2.9-61.1% developed persistent diarrhea (≥14 days); the persistence was significantly more likely among children who were malnourished, had bloody stool, or had multidrug-resistant Shigella. Cumulative Shigella infections over the first 2 years of life contributed to the greatest loss in length-for-age z-score. CONCLUSION We identified evidence that Shigella is associated with persistent diarrhea, linear growth faltering, and economic impact to the family.
Collapse
Affiliation(s)
- Tanya E Libby
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.
| | | | - Fatima Al-Shimari
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|