The incidence of acute gastrointestinal illness in Sweden

Prevalence and distribution of acute gastrointestinal illness in the community of China: a population-based face-to-face survey, 2014-2015

BACKGROUND

The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI.

METHODS

We conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014-2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday.

RESULTS

Among 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23-0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0-4 and young adults aged 15-24, people living in rural areas and people who traveled frequently had higher prevalence of AGI.

CONCLUSION

Results showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China.

A population-based survey of the prevalence of self-reported acute gastrointestinal illness in Zhejiang Province, China

Acute gastrointestinal illness (AGI) is a prevalent public health concern worldwide. This study investigated the magnitude, distribution and burden of self-reported AGI among residents of Zhejiang Province, China. A face-to-face household survey was conducted using a multi-stage stratified random sampling method in 10 counties in Zhejiang Province between July 2018 and June 2019. In total, 12,021 participants were recruited. The prevalence of AGI 28 days after standardization was 1.8% (95% confidence interval (CI), 1.6–2.1), with an incidence rate of 0.24 episodes of AGI per person-year and an estimated 14 million cases of AGI in Zhejiang Province. Univariate and multivariable analyses showed a higher AGI prevalence among people who performed housework and were unemployed in summer and autumn among respondents living in western or northern cities (p < 0.05). More than 50% of AGI cases were attributed to the consumption of contaminated food. The disease burden caused by AGI in Zhejiang Province was approximately 975 million Chinses yuan (CNY). These results indicated that the disease burden of AGI in Zhejiang Province should be addressed and highlights the need for an improved active surveillance system of foodborne diseases to assess the impact of AGI on society and health.

Antibiotics for gastroenteritis in general practice and out-of-hour services in Norway 2006-15

BACKGROUND

When patients with gastroenteritis (GE) seek health care, they are generally managed in primary care. Little is known about the use of antibiotic treatment in these cases.

OBJECTIVE

The aim of this study was to investigate time trends and patient characteristics associated with antibiotic treatment for GE in Norwegian primary care in a 10-year period.

METHODS

We linked data from two nationwide registries, reimbursement claims data from Norwegian primary care (the KUHR database) and The Norwegian Prescription Database, for the period 2006-15. GE consultations were extracted, and courses of systemic antibiotics dispensed within 1 day were included for further analyses.

RESULTS

Antibiotic treatment was linked to 1.8% (n = 23 663) of the 1 279 867 consultations for GE in Norwegian primary care in the period 2006-15. The proportion of GE consultations with antibiotic treatment increased from 1.4% in 2006 to 2.2% in 2012 and then decreased to 1.8% in 2015. Fluoroquinolones (28.9%) and metronidazole (26.8%) were most frequently used. Whereas the number of fluoroquinolones courses decreased after 2012, the number of metronidazole courses continued to increase until year 2015. The antibiotic treatment proportion of GE consultations was lowest in young children and increased with increasing age.

CONCLUSION

Antibiotic treatment is infrequently used in GE consultations in Norwegian primary care. Although there was an overall increase in use during the study period, we observed a reduction in overall use after year 2012. Young children were treated with antibiotics in GE consultations less frequent than older patients.

Training and illness characteristics of cross-country skiers transitioning from junior to senior level

Objective

This study aimed to describe the endurance training and incidence of illnesses reported by a group of well-trained cross-country (XC) skiers throughout their transition from junior to senior level.

Methods

Changes in self-reported training and performance, from 31 well-trained XC skiers, were analyzed from the start of the season they turned 16 y until the end of the season they turned 22 y, using linear mixed-effects models. Differences in the incidence of self-reported illness episodes were analyzed using incidence rate ratios, and the relationships between self-reported illness and training volumes were analyzed using linear mixed-effects models in a sub-group of 23 of the skiers.

Results

In total, 145 seasons of training data (including 85,846 h of endurance training) and 109 person-years of illness data (including 380 self-reported illness episodes) were analyzed. The athletes progressively increased their annual endurance training volume from age 16 to 22 y in a linear fashion, from ~ 470 to 730 h. Low- and high-intensity training volumes increased by 51.4 ± 2.4 h·y^-1 (p < .001) and 4.9 ± 0.6 h·y^-1 (p < .001), respectively. Sport-specific and non-specific training increased by 50.0 ± 2.2 h·y^-1 (p < .001) and 4.6 ± 2.0 h·y^-1 (p < .001), respectively. The athletes reported a median (range) of 3 (0–8) illness episodes and 17 (0–80) days of illness per year, and there was an inverse relationship between self-reported illness days and annual training volume (-0.046 ± 0.013 d·h^-1; p < .001).

Conclusions

This group of well-trained XC skiers increased their endurance training volume in a linear fashion by ~ 55 h annually. This was primarily achieved through an increase in low-intensity and sport-specific training. Furthermore, higher training volumes were associated with a lower number of self-reported illness days.

Magnitude, distribution, risk factors and care-seeking behaviour of acute, self-reported gastrointestinal illness among US Army Soldiers: 2015

Throughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66-20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04-2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7-3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance under-estimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.

Community water service and incidence of respiratory, skin, and gastrointestinal infections in rural Alaska, 2013-2015

BACKGROUND

Communities in rural Alaska have access to multiple types of water service (piped, vehicle-hauled, and self-hauled) and experience varying levels of water service coverage. We assessed the incidence rate of inpatient and outpatient infectious disease visits among communities with different water service types and coverage levels.

METHODS

We classified ICD-9 codes for inpatient and outpatient visits to the Yukon-Kuskokwim Health Corporation facilities between 2013 and 2015 into six infectious disease categories. Using Poisson models, we compared the incidence of visits in each category across communities with differing water service coverage levels as defined by water service billing data for the same years. Using census data, we adjusted for community median household income, median age, crowding, and health aide staffing.

RESULTS

We included 48 communities in this analysis. After adjusting for possible confounders, each 10% increase in piped water coverage was associated with a 4% lower incidence of pneumonia/influenza visits (adjusted incidence rate ratio [IRR] 0.96, 95% CI 0.93-0.98), a 2% lower incidence of other respiratory infection visits (adjusted IRR 0.98, 95% CI 0.97-0.99), an 8% lower incidence of methicillin-resistant Staphylococcus visits (adjusted IRR 0.92, 95% CI 0.87-0.97), and a 4% lower incidence of other skin infections visits (adjusted IRR 0.96, 95% CI 0.95-0.98). Each 10% increase in vehicle-hauled water coverage was associated with a 2% lower incidence of respiratory infection visits (adjusted IRR 0.98, 95% CI 0.97-0.996) and a 3% lower incidence of skin infection visits (adjusted IRR 0.97, 95% CI 0.95-0.99), also after adjustment.

CONCLUSIONS

Higher levels of water service coverage were associated with lower incidence rates of visits for several infectious disease categories. These associations were more pronounced for communities with piped water service compared to vehicle-hauled water service.

Burden of gastrointestinal illness in Sweden-SMS as a tool for collecting self-reported gastrointestinal illness

We collected monthly reports on gastrointestinal illness (GII) episodes among 2348 adults in a 1-year cohort in South West Sweden. The GII episodes were collected by SMS (Short Message System) and validated by telephone interviews among the cohort participants and nationwide. The annual incidence was 0.64 and 0.43 cases per person-year for 28-day self-defined GII (any symptom) and acute GII (vomiting and/or ≥3 episodes of diarrhoea), respectively. The incidence was about 20% higher for the 14-day recall, compared with 28-day recall. The duration of illness was on average 2.3 days. We observed a unimodal seasonal distribution of GII, with the highest prevalence during winter. Responses collected by SMS highly correlated with responses collected by telephone. SMS survey was an efficient tool for the collection of repeated estimates of GII.

Factors that influence treatment-seeking expectations in response to infectious intestinal disease: Original survey and multinomial regression

BACKGROUND

Infectious intestinal disease affects 25% of the UK population annually; 1 in 50 affected people consult health professionals about their illness.

AIMS

We tested if anticipated treatment-seeking decisions for suspected infectious intestinal disease could be related to emotional response, tolerance of symptoms, or beliefs about the consequential benefits and harms of seeking treatment (or not).

METHODS

Questionnaire survey of adults living in the UK with statistical analysis of responses. A vignette was presented about a hypothetical gastrointestinal illness. People stated their emotional reactions, expected actions in response and beliefs about possible benefits or harms from seeking treatment (or not getting treatment). Multinomial regression looked for predictors of anticipated behaviour.

RESULTS

People were inclined to consult a GP when they believed that seeking treatment would be beneficial and that its absence would be harmful. Seeking treatment was less anticipated if the condition was expected to improve quickly. Respondents were also more likely to consult if they strongly disliked fever or headache, and/or if the illness made them feel anxious or angry. Treatment-seeking (or lack of it) was not linked to harms from treatment-seeking, other specific symptoms and emotional responses.

CONCLUSION

It was possible to link anticipated treatment-seeking behaviour to specific factors: expected prognosis, perceived benefits of seeking treatment, some emotions and some specific symptoms.

Consultations for gastroenteritis in general practice and out-of-hours services in Norway 2006-15

BACKGROUND

Most of the patients with gastroenteritis seeking health care services are managed in primary care; yet, little is known about these consultations. Syndromic-based surveillance of gastrointestinal infections is used in several countries, including Norway.

AIM

To investigate the extent of, and explore characteristics associated with, consultations for gastroenteritis in primary care and to compare consultations in daytime general practice and out-of-hours (OOH) services in Norway.

DESIGN AND SETTING

Registry-based study using reimbursement claims data from all consultations in general practice and OOH services in Norway over the 10-year period, 2006-15.

METHODS

The main outcome variable was whether the consultation took place in general practice or OOH services. Possible associations with patient age and sex, time and use of point-of-care C-reactive protein (CRP) testing and sickness certificate issuing were investigated.

RESULTS

Gastroenteritis consultations (n = 1 281 048) represented 0.9% of all consultations in primary care (n = 140 199 637), of which 84.4% were conducted in general practice and 15.6% in OOH services. Young children and young adults dominated among the patients. Point-of-care CRP testing was used in 36.1% of the consultations. Sickness certificates were issued in 43.6% of consultations with patients in working age. Age-specific time variations in consultation frequencies peaking in winter months were observed.

CONCLUSIONS

The proportion of gastroenteritis consultations was higher in the OOH services when compared with daytime general practice. Young children and young adults dominated among the patients. The seasonal variation in consultation frequency is similar to that shown for gastroenteritis caused by norovirus.

The health and economic impact of acute gastroenteritis in Belgium, 2010-2014

Acute gastroenteritis (AGE) remains a common condition in both low- and high-income countries. In Belgium, however, there is currently a lack of information on the societal health and economic impact of AGE. We conducted a retrospective study using mortality and cause-of-death data, hospital data, primary care data, health interview survey data and other published data. We estimated the burden of illness during a 5-year period (2010-2014) in Belgium in terms of deaths, patients admitted to hospitals, patients consulting their general practitioner (GP) and cases occurring in the community. We further quantified the health impact in terms of disability-adjusted life years (DALYs) and the economic impact in terms of cost-of-illness estimates. We estimated 343 deaths, 27 707 hospitalised patients, 464 222 GP consultations and 10 058 741 episodes occurring in the community (0.91 cases/person) on average per year. AGE was associated with 11 855 DALYs per year (107 DALY per 100 000 persons). The economic burden was estimated to represent direct costs of €112 million, indirect costs of €927 million (90% of the total costs) and an average total cost of €103 per case and €94 per person. AGE results in a substantial health and economic impact in Belgium, justifying continued mitigation efforts.

The burden of gastroenteritis in Switzerland (BUGS) study: a research proposal for a 1-year, prospective cohort study

Objectives

Acute gastroenteritis (AG) is a usually self-limiting, but common disease worldwide. In Europe, incidence estimates range from 0.3–1.5 AG episodes/person-year. For Switzerland, available information on AG is restricted to notifiable foodborne diseases and findings from research studies starting at primary care level. The aims of this 1-year, population-based prospective cohort study are to assess the incidence, burden of disease, aetiology and socio-economic impact of AG in the Swiss general population. Additionally, the prevalence of bacterial gastrointestinal pathogens and bacteria harbouring antimicrobial resistances in the asymptomatic population shall be assessed.

Results

Weekly follow-up of the cohort consisting of 3000 participants will provide incidence estimates of AG. Furthermore, information collected will be used to assess risk factors for experiencing an episode of AG, to explore determinants for help seeking, and to characterise the socio-economic impact of AG including absence from work and inability to perform daily activities. Aetiology of AG is determined by investigating stool samples from symptomatic participants. Finally, stool samples from participants collected during an asymptomatic period will be used to assess the prevalence of enterohaemorrhagic E. coli, Campylobacter spp., Salmonella spp. and Shigella spp. as well as of resistance to different antibiotics (extended-spectrum beta-lactamase-, fluoroquinolone- and carbapenemase-resistance).

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3916-2) contains supplementary material, which is available to authorized users.

Cost of Illness for Five Major Foodborne Illnesses and Sequelae in Sweden

OBJECTIVES

The main objective of this study was to derive cost estimates of five major foodborne illnesses (campylobacteriosis, salmonellosis, enterohemorrhagic Escherichia coli (EHEC), yersiniosis and shigellosis) in Sweden. These estimates provide a necessary contribution to perform future cost-benefit analyses aimed at reducing the burden of foodborne disease. A secondary aim was to obtain estimates of the true number of cases that occur in the community, thus providing necessary ground for calculating costs.

METHODS

The true number of cases for each foodborne illness was simulated by multiplying the reported number of cases by sequential multipliers, one for each potential source of information loss about a case. This assessment of the true number of cases was then used to estimate the number of cases of sequelae for each illness. An incidence-based analysis was then used to calculate direct medical and non-medical costs, as well as indirect costs. Data for estimating the true number of cases for each illness were primarily based on an expert panel, while the derivation of costs mainly utilized national registries, databases and published literature.

RESULTS

The estimated number of cases was between 7- and 11-fold higher than the reported number of cases, indicating the importance of taking information loss into account when calculating costs. By far the most common pathogen of the five was campylobacter, with an estimated 101,719 (90% credibility interval [CI] 59,640-158,025) human cases occurring annually. For salmonella, 19,678 (90% CI 8394-40,456) cases were estimated to occur each year, while the other three pathogens were less common, with a yearly incidence of approximately 2500-5500 cases each. The total cost for the five pathogens (including sequelae) amounted to €142 million annually. Campylobacter was the most costly pathogen, representing 69% of the total costs. Salmonellosis and EHEC constituted 18 and 9% of these costs, respectively, while yersiniosis and shigellosis represented approximately 2% each. Costs for sequelae were significant and accounted for approximately 50% of the total costs.

CONCLUSIONS

Our simulations indicated that campylobacter infection was more common and more costly than salmonella, EHEC, yersinia and shigella combined. Estimated costs for all illnesses were highly influenced by (1) considering potential information losses about cases in the population (which increased costs 7- to 11-fold), and (2) taking account of post-infection sequelae (which doubled the costs).

The Incidence of Acute Gastrointestinal Illness in Canada, Foodbook Survey 2014-2015

Acute gastrointestinal illness (AGI) is an important public health issue, with many pathogen sources and modes of transmission. A one-year telephone survey was conducted in Canada (2014-2015) to estimate the incidence of self-reported AGI in the previous 28 days and to describe health care seeking behaviour, using a symptom-based case definition. Excluding cases with respiratory symptoms, it is estimated that there are 0.57 self-reported AGI episodes per person-year, almost 19.5 million episodes in Canada each year. The proportion of cases seeking medical care was nearly 9%, of which 17% reported being requested to submit a sample for laboratory testing, and 49% of those requested complied and provided a sample. Results can be used to inform burden of illness and source attribution studies and indicate that AGI continues to be an important public health issue in Canada.

High added value of a population-based participatory surveillance system for community acute gastrointestinal, respiratory and influenza-like illnesses in Sweden, 2013-2014 using the web

In 2013-2014, the Public Health Agency of Sweden developed a web-based participatory surveillance system, Hӓlsorapport, based on a random sample of individuals reporting symptoms weekly online, to estimate the community incidence of self-reported acute gastrointestinal (AGI), acute respiratory (ARI) and influenza-like (ILI) illnesses and their severity. We evaluated Hӓlsorapport's acceptability, completeness, representativeness and its data correlation with other surveillance data. We calculated response proportions and Spearman correlation coefficients (r) between (i) incidence of illnesses in Hӓlsorapport and (ii) proportions of specific search terms to medical-advice website and reasons for calling a medical advice hotline. Of 34 748 invitees, 3245 (9·3%) joined the cohort. Participants answered 81% (139 013) of the weekly questionnaires and 90% (16 351) of follow-up questionnaires. AGI incidence correlated with searches on winter-vomiting disease [r = 0·81, 95% confidence interval (CI) 0·69-0·89], and ARI incidence correlated with searches on cough (r = 0·77, 95% CI 0·62-0·86). ILI incidence correlated with the web query-based estimated incidence of ILI patients consulting physicians (r = 0·63, 95% CI 0·42-0·77). The high response to different questionnaires and the correlation with other syndromic surveillance systems suggest that Hӓlsorapport offers a reasonable representation of AGI, ARI and ILI patterns in the community and can complement traditional and syndromic surveillance systems to estimate their burden in the community.

Quantifying the incidence and cost of acute gastrointestinal illness in Sweden, 2013-2014

In Sweden, acute gastrointestinal illness (AGI) incidence, severity, impact on productivity, related healthcare usage and associated costs are not ascertained. We measured these in 2013-2014 using a population-based cohort reporting weekly. We defined AGI as ⩾3 episodes of loose stools or vomiting/24 h; or loose stools or vomiting with ⩾2 other gastrointestinal symptoms. After each AGI episode, we collected information about perceived severity, healthcare use and absenteeism. We calculated incidence rates, AGI absenteeism and costs comprising direct healthcare costs and productivity loss due to work/school absenteeism. A total of 3241 participants reported 1696 AGI episodes [incidence 360/1000 person-years, 95% confidence interval (CI) 326-395; highest in the <5 years age group]. In the <5 years age group, 31% of episodes were perceived as mild, 61% as moderate and 8% as severe; 9·4% led to primary-care consultations, and 1·4% to hospital admissions. In the ⩾5 years age group, 18% of episodes were perceived as mild, 64% as moderate and 18% as severe; 6·4% led to primary-care consultations, and 1·9% to hospital admissions. AGI caused 8 891 000 days of absenteeism (95% CI 6 009 000-12 780 000). AGI cost €1 005 885 000 (95% CI 754 309 000-1 257 195 000) nationally for the year. In Sweden, a minority of cases perceive AGI as a mild illness. AGI is a burden on the healthcare system and causes productivity loss, with high costs. Countries may consider these estimates when prioritizing health interventions.

Training-related and competition-related risk factors for respiratory tract and gastrointestinal infections in elite cross-country skiers

AIM

To examine symptoms indicative of respiratory tract and gastrointestinal infections and determine risk factors for such symptoms in elite cross-country skiers.

METHODS

Self-reported training and symptom data for 37 elite cross-country skiers from 2007 to 2015 were analysed using multilevel logistic regression equations with symptom incidence and duration as outcome variables, and sex, performance level, season, competition, air travel, altitude exposure and training characteristics as independent variables.

RESULTS

Data for 7016 person-weeks were analysed, including 464 self-reported infection events and 110 959 h of training. Athletes reported median (range) 3 (1-7) respiratory tract and/or gastrointestinal events per year, with symptoms lasting 5 (1-24) days. During the winter, symptoms occurred more frequently (OR 2.09, p<0.001) and lasted longer (b=0.043, p<0.001) compared with summer. Competition and air travel increased the risk of symptoms, with ORs of 2.93 (95% CI 2.24 to 3.83) and 4.94 (95% CI 3.74 to 6.53), respectively (p<0.001). Athletes with higher training monotony had lower risk of symptoms (OR 0.87 (95% CI 0.73 to 0.99), p<0.05). Other training variables were not associated with symptoms. Athletes who had won an Olympic/World Championship medal reported shorter symptom duration compared with less successful athletes (b=-0.019, p<0.05) resulting in significantly fewer symptomatic days/year (14 (6-29) vs 22 (8-43) days/year).

CONCLUSIONS

Air travel and competition are major risk factors for acute respiratory tract and gastrointestinal symptoms in this population. Athletes who have large fluctuations in training load experience such symptoms more frequently. Shorter duration of symptoms appears to be associated with success in cross-country skiing.