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Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food

Monday, 28th of December 2015

Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food

Sara M. Pires,^1,* Christa L. Fischer-Walker,² Claudio F. Lanata,^3,4 Brecht Devleesschauwer,⁵ Aron J. Hall,⁶ Martyn D. Kirk,⁷ Ana S. R. Duarte,¹ Robert E. Black,² and Frederick J. Angulo⁶

Linda Anne Selvey, Editor

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This article has been cited by other articles in PMC.

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Background

Diarrhoeal diseases are major contributors to the global burden of disease, particularly in children. However, comprehensive estimates of the incidence and mortality due to specific aetiologies of diarrhoeal diseases are not available. The objective of this study is to provide estimates of the global and regional incidence and mortality of diarrhoeal diseases caused by nine pathogens that are commonly transmitted through foods.

Methods and Findings

We abstracted data from systematic reviews and, depending on the overall mortality rates of the country, applied either a national incidence estimate approach or a modified Child Health Epidemiology Reference Group (CHERG) approach to estimate the aetiology-specific incidence and mortality of diarrhoeal diseases, by age and region. The nine diarrhoeal diseases assessed caused an estimated 1.8 billion (95% uncertainty interval [UI] 1.1–3.3 billion) cases and 599,000 (95% UI 472,000–802,000) deaths worldwide in 2010. The largest number of cases were caused by norovirus (677 million; 95% UI 468–1,153 million), enterotoxigenic Escherichia coli (ETEC) (233 million; 95% UI 154–380 million), Shigella spp. (188 million; 95% UI 94–379 million) and Giardia lamblia (179 million; 95% UI 125–263); the largest number of deaths were caused by norovirus (213,515; 95% UI 171,783–266,561), enteropathogenic E. coli (121,455; 95% UI 103,657–143,348), ETEC (73,041; 95% UI 55,474–96,984) and Shigella(64,993; 95% UI 48,966–92,357). There were marked regional differences in incidence and mortality for these nine diseases. Nearly 40% of cases and 43% of deaths caused by these nine diarrhoeal diseases occurred in children under five years of age.

Conclusions

Diarrhoeal diseases caused by these nine pathogens are responsible for a large disease burden, particularly in children. These aetiology-specific burden estimates can inform efforts to reduce diarrhoeal diseases caused by these nine pathogens commonly transmitted through foods.

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Diarrhoeal diseases are a major cause of disease burden worldwide [1]. The Global Burden of Disease Study 2010 (GBD 2010) ranked diarrhoeal diseases as the fourth largest disease burden, accounting for 3.6% of the total disease burden globally. Diarrhoeal diseases accounted for an even higher proportion (5%) of the total disease burden in children <5 years of age [1]. Diarrhoeal diseases have a substantially higher impact in low-income countries and regions with poor water quality, sanitation and food safety.

Diarrhoeal diseases are caused by a variety of bacteria, viruses, and parasites, many of which are commonly transmitted through food [2]. Despite the large disease burden caused by these pathogens, the global contribution of specific aetiological agents of diarrhoeal diseases is largely unknown. For example, recent studies have estimated the worldwide incidence of diarrhoeal diseases in children <5 years of age [3], and in older children and adults [4], but did not provide aetiology-specific estimates. Lanata et al. [5] and Fisher Walker et al. [6] provided aetiology-specific estimates, but only for diarrhoeal deaths among children <5 years of age, and diarrhoeal cases in persons ≥5 years of age, respectively. Another large-scale study estimated diarrhoeal aetiologies in children <5 years of age in specific study sites, particularly in sub-Saharan Africa and South Asia [7]. Other studies have estimated the incidence of specific foodborne diseases, many of which cause diarrhoea, but each focused on a single developed country [8–14].

To identify and prioritize targeted interventions to reduce the public health impact of foodborne diseases, public health policy makers and other stakeholders need aetiology-specific regional and global estimates of the incidence and mortality of diarrhoeal diseases caused by pathogens that are commonly transmitted through foods. These estimates, combined with knowledge on the proportion of this burden that is derived from foods, will form the basis for the estimation of the global and regional burden of foodborne diseases.

As part of the effort by the World Health Organization (WHO) Foodborne Disease Burden Epidemiology Reference Group (FERG; http://www.who.int/foodsafety/areas_work/foodborne-diseases/ferg/en/) to estimate the disease burden of foodborne diseases, we estimated the global and regional incidence and mortality of diarrhoeal diseases which are commonly transmitted through foods.