Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED).
Pathogen-specific burdens of community diarrhoea in developing countries: a multisite birth cohort study (MAL-ED).
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DOI：
10.1016/s2214-109x(15)00151-5
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
MAL-ED Network Investigators
中科院分区：
文献类型：
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作者：
Platts-Mills JA;Babji S;Bodhidatta L;Gratz J;Haque R;Havt A;McCormick BJ;McGrath M;Olortegui MP;Samie A;Shakoor S;Mondal D;Lima IF;Hariraju D;Rayamajhi BB;Qureshi S;Kabir F;Yori PP;Mufamadi B;Amour C;Carreon JD;Richard SA;Lang D;Bessong P;Mduma E;Ahmed T;Lima AA;Mason CJ;Zaidi AK;Bhutta ZA;Kosek M;Guerrant RL;Gottlieb M;Miller M;Kang G;Houpt ER;MAL-ED Network Investigators
发展中国家的大多数腹泻病因学研究都检查了需要护理的严重疾病，而通过基于社区的监测对腹泻负担的病原体特异性估计是有限的。我们进行了一项出生队列研究，对腹泻进行了深入的社区监测，并从南美洲、非洲和亚洲的八个地点定期收集非腹泻粪便。使用培养、酶免疫分析和 PCR 分析粪便中的多种肠道病原体。共检测了 2,145 名 0-24 个月儿童的 7,318 份腹泻粪便和 24,310 份非腹泻粪便。病原体检测在非腹泻粪便中很常见，并且在腹泻期间增加。诺如病毒 GII（调整归因分数 (AF) 5·2；95% CI 3·0-7·1）、轮状病毒（4·8；4·5-5·0）、弯曲杆菌（3·5；0·4-6·3）、星状病毒（2·7；2·2-3·1）和隐孢子虫（2·0；1·3-2·6）表现出最高的归因出生第一年的腹泻负担。与出生后第二年腹泻相关的主要病原体是弯曲杆菌（7·9；3·1-12·1）、诺如病毒GII（5·4；2·1-7·8）、轮状病毒（4·9；4·4-5·2）、星状病毒（4·2；3·5-4·7）和志贺氏菌（4·0；3·6-4·3）。对于未接种轮状病毒疫苗 (RV) 的场所，轮状病毒的 AF 最高，对于接种 RV 的场所，轮状病毒的 AF 最高。根据地理、严重程度和季节的不同，病原体存在很大差异。血性腹泻主要与弯曲杆菌和志贺氏菌有关，发烧和呕吐与轮状病毒有关，呕吐与诺如病毒 GII 有关。在没有腹泻症状的情况下检测到肠道病原体是很常见的。腹泻的病原体特异性负担存在很大的异质性，重要的决定因素包括年龄、地理位置、季节、轮状病毒疫苗的使用和症状。我们观察到与弯曲杆菌、诺如病毒 GII 和星状病毒相关的疾病负担很高。
Most aetiologic studies of diarrhoea in developing countries have examined severe disease presenting for care, while pathogen-specific estimates of diarrhoea burden through community-based surveillance are limited. We performed a birth cohort study with intensive community surveillance for diarrhoea as well as routine collection of non-diarrhoeal stools from eight sites in South America, Africa and Asia. Stools were analysed for a broad range of enteropathogens using culture, enzyme immunoassay, and PCR. A total of 7,318 diarrhoeal and 24,310 non-diarrhoeal stools from 2,145 children aged 0-24 months were tested. Pathogen detection was common in non-diarrhoeal stools and increased during diarrhoea. Norovirus GII (adjusted attributable fraction (AF) 5·2; 95% CI 3·0-7·1), rotavirus (4·8; 4·5-5·0), Campylobacter (3·5; 0·4-6·3), astrovirus (2·7; 2·2-3·1), and Cryptosporidium (2·0; 1·3-2·6) exhibited the highest attributable burdens of diarrhoea in the first year of life. The major pathogens associated with diarrhoea in the second year of life were Campylobacter (7·9; 3·1-12·1), norovirus GII (5·4; 2·1-7·8), rotavirus (4·9; 4·4-5·2), astrovirus (4·2; 3·5-4·7), and Shigella (4·0; 3·6-4·3). Rotavirus had the highest AF for sites without rotavirus vaccination (RV) and the fifth highest AF for sites with RV. There was substantial variation in pathogens based on geography, severity, and season. Bloody diarrhoea was primarily associated with Campylobacter and Shigella, fever and vomiting with rotavirus, and vomiting with norovirus GII. Detection of enteropathogens in the absence of diarrhoeal symptoms was common. There was substantial heterogeneity in pathogen-specific burdens of diarrhoea, with important determinants including age, geography, season, rotavirus vaccine usage, and symptomatology. We observed a high burden of disease associated with Campylobacter, norovirus GII, and astrovirus.