The Roles of Clostridium difficile and Norovirus Among Gastroenteritis-Associated Deaths in the United States, 1999-2007
The Roles of Clostridium difficile and Norovirus Among Gastroenteritis-Associated Deaths in the United States, 1999-2007
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DOI：
10.1093/cid/cis386
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发表时间：
2012-07-15
影响因子：
11.8
通讯作者：
Lopman, Ben A.
中科院分区：
文献类型：
--
作者：
Hall, Aron J.;Curns, Aaron T.;Lopman, Ben A.
背景资料。在全球范围内，胃肠炎被认为是儿童死亡率的一个重要因素，但关于成人胃肠炎死亡的人口数据和特定病原体的贡献有限。我们的目标是描述美国所有年龄段的胃肠炎死亡趋势，并具体评估艰难梭菌和诺如病毒的作用。美国1999-2007年间与胃肠炎相关的死亡是从国家卫生统计中心的多死因死亡数据中确定的。包括胃肠炎的潜在原因或任何致病原因的所有死亡病例。使用时间序列回归模型确定可能由特定原因引起的不明原因的胃肠炎死亡；分析模型残差的季节性以估计诺如病毒相关的死亡。在研究期间，胃肠炎死亡率平均为39/100万人年(每年1255例死亡)，从1999-2000年的25/100万人年增加到2006-2007年的57/100万人年(P<；.001)。65岁的成年人占胃肠炎死亡的83%(258/100万人年)。艰难梭菌死亡率从1999-2000年的10/100万人年增加到2006-2007年的48/100万人年，增加了5倍(P<；.001)。据估计，诺沃克病毒每年导致797人死亡(3/100万人年)，在与紧急病毒株相关的流行季节，诺沃克病毒造成的死亡人数激增高达50%。与胃肠炎相关的死亡率在过去十年中增加了一倍多，主要影响到老年人。艰难梭菌是胃肠炎相关死亡的主要贡献者，这在很大程度上是增加趋势的原因，而诺沃克病毒可能是第二大感染性原因。这些发现有助于指导适当的临床管理策略和疫苗开发。
Background. Globally, gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus.Methods. Gastroenteritis-associated deaths in the United States during 1999-2007 were identified from the National Center for Health Statistics multiple-cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed gastroenteritis were included. Time-series regression models were used to identify cause-unspecified gastroenteritis deaths that were probably due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths.Results. Gastroenteritis mortality averaged 39/1 000 000 person-years (11 255 deaths per year) during the study period, increasing from 25/1 000 000 person-years in 1999-2000 to 57/1 000 000 person-years in 2006-2007 (P < .001). Adults aged >= 65 years accounted for 83% of gastroenteritis deaths (258/1 000 000 person-years). C. difficile mortality increased 5-fold from 10/1 000 000 person-years in 1999-2000 to 48/1 000 000 person-years in 2006-2007 (P < .001). Norovirus contributed to an estimated 797 deaths annually (3/1 000 000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains.Conclusions. Gastroenteritis-associated mortality has more than doubled during the past decade, primarily affecting the elderly. C. difficile is the main contributor to gastroenteritis-associated deaths, largely accounting for the increasing trend, and norovirus is probably the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development.