Burden of enterotoxigenic Escherichia coli and shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: a modelling analysis
Burden of enterotoxigenic Escherichia coli and shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: a modelling analysis
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DOI：
10.1016/s2214-109x(18)30483-2
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发表时间：
2019-03-01
影响因子：
34.3
通讯作者：
Rheingans, Richard
中科院分区：
文献类型：
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作者：
Anderson, John D.;Bagamian, Karoun H.;Rheingans, Richard
背景产肠毒素大肠埃希菌(ETEC)和志贺菌是引起5岁以下儿童中重度腹泻的两种主要病原体。腹泻与发育迟缓的风险增加有关，从而使儿童面临因其他传染病而死亡的风险。方法我们对ETEC相关和志贺氏菌相关的死亡率以及中到重度腹泻的影响进行建模，以确定在79个低收入和低中等收入国家中因这些感染而出现发育迟缓的儿童数量。我们对发育迟缓儿童中因其他传染病死亡人数增加的人群归因风险进行了研究。我们计算了点估计的95%不确定区间(UI)。我们估计在5岁以下儿童中发现的ETEC和志贺氏菌腹泻每年发生1.96亿例(95%UI 135-269)，导致350万(0.8-5.4)例中到重度发育迟缓，2015年ETEC死亡总数44 400(29 400-59 800)，志贺氏菌死亡总数63 100(44 000-81 900)。由于发育迟缓造成的额外传染病死亡率比腹泻发作造成的直接死亡增加了24%(ETEC为8-34)和28%(志贺氏菌为10-39)。死亡率和发病率的分布因地域而异，非洲区域和东地中海区域国家负担最重。解释说，非致命性ETEC和志贺氏菌相关腹泻发作的扩大影响可能会产生持久的后果。预防这些感染可以减少直接死亡、发育迟缓和其他传染病造成的死亡的风险。了解疾病风险最高的国家和人口有助于针对最脆弱人口采取干预措施。版权所有(C)2019作者(S)。爱思唯尔有限公司出版。
Background Enterotoxigenic Escherichia coli (ETEC) and shigella are two major pathogens that cause moderate-to-severe diarrhoea in children younger than 5 years. Diarrhoea is associated with an increased risk of stunting, which puts children at risk of death due to other infectious diseases.Methods We modelled ETEC-related and shigella-related mortality and the effect of moderate-to-severe diarrhoea episodes to determine the number of children with stunting due to these infections in 79 low-income and lower middle-income countries. We applied population attributable risk for increased number of deaths due to other infectious diseases in children who are stunted. We calculated 95% uncertainty intervals (UIs) for the point estimates.Findings In children younger than 5 years, we estimate 196 million (95% UI 135-269) episodes of ETEC and shigella diarrhoea occur annually, resulting in 3.5 million (0.8-5.4) cases of moderate-to-severe stunting and 44 400 (29 400-59 800) total ETEC deaths and 63 100 (44 000-81 900) total shigella deaths in 2015. Additional infectious disease mortality due to stunting resulted in increases of 24% (8-34; for ETEC) and 28% (10-39; for shigella) over direct deaths due to diarrhoeal episodes. The distribution of mortality and morbidity varied geographically, with African Region and Eastern Mediterranean Region countries bearing the greatest burden.Interpretation The expanded effects of non-fatal ETEC and shigella-related diarrhoeal episodes can have lasting consequences. Prevention of these infections could reduce the risk of direct death and stunting and deaths due to other infectious diseases. Understanding the countries and populations with the highest disease risk helps to target interventions for the most vulnerable populations. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.