Global Causes of Diarrheal Disease Mortality in Children <5 Years of Age: A Systematic Review

Estimation of pathogen-specific causes of child diarrhea deaths is needed to guide vaccine development and other prevention strategies. We did a systematic review of articles published between 1990 and 2011 reporting at least one of 13 pathogens in children <5 years of age hospitalized with diarr...

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Veröffentlicht in:	PloS one Jg. 8; H. 9; S. e72788
Hauptverfasser:	Lanata, Claudio F., Fischer-Walker, Christa L., Olascoaga, Ana C., Torres, Carla X., Aryee, Martin J., Black, Robert E.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Public Library of Science 04.09.2013 Public Library of Science (PLoS)
Schlagworte:	Adenoviruses Age Age determination Antibiotics Caliciviridae Infections - epidemiology Caliciviridae Infections - etiology Caliciviridae Infections - mortality Campylobacter Cell culture Child mortality Child, Preschool Children Children & youth Childrens health Cryptosporidium Developing countries Diarrhea Diarrhea - epidemiology Diarrhea - etiology Diarrhea - mortality E coli Entamoeba Epidemiology Escherichia coli Escherichia coli Infections - epidemiology Escherichia coli Infections - etiology Escherichia coli Infections - mortality Fatalities Giardia lamblia Health surveillance Humans Identification Immunization Infant Infant, Newborn Infection Laboratories LDCs Medical research Microscopy Mortality Nosocomial infection Nosocomial infections Outbreaks Pathogens Pediatric diseases Polymerase chain reaction Public health Rotavirus Rotavirus Infections - epidemiology Rotavirus Infections - etiology Rotavirus Infections - mortality Salmonella Shigella Studies Systematic review Vaccine development Vaccines Vibrio Vibrio cholerae Viruses United States > US Maryland Peru Baltimore Maryland
ISSN:	1932-6203, 1932-6203
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Zusammenfassung:	Estimation of pathogen-specific causes of child diarrhea deaths is needed to guide vaccine development and other prevention strategies. We did a systematic review of articles published between 1990 and 2011 reporting at least one of 13 pathogens in children <5 years of age hospitalized with diarrhea. We included 2011 rotavirus data from the Rotavirus Surveillance Network coordinated by WHO. We excluded studies conducted during diarrhea outbreaks that did not discriminate between inpatient and outpatient cases, reporting nosocomial infections, those conducted in special populations, not done with adequate methods, and rotavirus studies in countries where the rotavirus vaccine was used. Age-adjusted median proportions for each pathogen were calculated and applied to 712 000 deaths due to diarrhea in children under 5 years for 2011, assuming that those observed among children hospitalized for diarrhea represent those causing child diarrhea deaths. 163 articles and WHO studies done in 31 countries were selected representing 286 inpatient studies. Studies seeking only one pathogen found higher proportions for some pathogens than studies seeking multiple pathogens (e.g. 39% rotavirus in 180 single-pathogen studies vs. 20% in 24 studies with 5-13 pathogens, p<0.0001). The percentage of episodes for which no pathogen could be identified was estimated to be 34%; the total of all age-adjusted percentages for pathogens and no-pathogen cases was 138%. Adjusting all proportions, including unknowns, to add to 100%, we estimated that rotavirus caused 197 000 [Uncertainty range (UR) 110 000-295 000], enteropathogenic E. coli 79 000 (UR 31 000-146 000), calicivirus 71 000 (UR 39 000-113 000), and enterotoxigenic E. coli 42 000 (UR 20 000-76 000) deaths. Rotavirus, calicivirus, enteropathogenic and enterotoxigenic E. coli cause more than half of all diarrheal deaths in children <5 years in the world.
Bibliographie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Article-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 ObjectType-Undefined-4 Conceived and designed the experiments: CFL CLF REB. Performed the experiments: CFL ACO CXT CLF REB. Analyzed the data: CFL CLF MJA. Contributed reagents/materials/analysis tools: MJA. Wrote the paper: CFL CLF MJA REB. Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0072788