Etiological, epidemiological, and clinical features of acute diarrhea in China

Liping Wang ,Li‐Qun Fang ,Xin Wang ,Shi-Xia Zhou ,Shiwen Zhao ,Xiao-Ai Zhang ,Jun Li ,Huaiqi Jing ,Lusha Shi ,Zhenghong Yuan ,Liuyu Huang ,Zhongjie Li ,Zhigang Yi ,Zeyu Yang ,Yifei Wang ,Sheng-Hong Lin ,Cuihong Zhang ,Qing‐Bin Lu ,Yuliang Zhu ,Wenbo Xu ,Xinhua Wang ,Meng-Yang Liu ,Haiyang Zhang ,Yu Chen ,Ai‐Li Cui ,Shengjie Lai ,George F Gao ,Mengfeng Li ,Mengjie Geng ,Xiao Chen ,Xiang Ren ,Wei Liu ,Lu Meng ,Yingle Liu ,Simon I Hay ,Weizhong Yang

doi:10.1038/s41467-021-22551-z

Abstract

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018. Here we report the etiological, epidemiological, and clinical features of the 152,792 eligible patients enrolled in this analysis. Rotavirus A and norovirus are the two leading viral pathogens detected in the patients, followed by adenovirus and astrovirus. Diarrheagenic Escherichia coli and nontyphoidal Salmonella are the two leading bacterial pathogens, followed by Shigella and Vibrio parahaemolyticus. Patients aged <5 years had higher overall positive rate of viral pathogens, while bacterial pathogens were more common in patients aged 18‒45 years. A joinpoint analysis revealed the age-specific positivity rate and how this varied for individual pathogens. Our findings fill crucial gaps of how the distributions of enteropathogens change across China in patients with diarrhea. This allows enhanced identification of the predominant diarrheal pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures.

Highlights

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018
From January 2009 to December 2018, 157,883 patients with acute diarrhea were recruited, from whom 5091 patients were excluded due to incomplete data or not initially diagnosed in the sentinel hospitals, 152,792 patients were used for the final analysis (Fig. 1)
58,620 patients were tested for all seven viruses, 59,384 patients were tested for all 13 bacteria, 11,167 patients were tested for all three parasites, and 3330 patients were tested for all 23 pathogens

Summary

Introduction

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018. Our findings fill crucial gaps of how the distributions of enteropathogens change across China in patients with diarrhea This allows enhanced identification of the predominant diarrheal pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures. A better understanding of the epidemiology, etiology, and seasonality of acute diarrhea would be valuable for planning and adopting targeted preventive measures, as well as antimicrobial therapy. Based on a national surveillance network for patients with acute diarrhea, we made the systematic attempt to identify the etiological, epidemiological, and clinical features of acute diarrhea in an all-age population for a decade in China. It is anticipated that long-term continuous collection of surveillance data will be representative of a wide range of patients valuable for planning and adopting targeted preventive measures and therapy

Methods

Results

Conclusion