Abstract
Acute diarrhea leads to a substantial disease burden among the elderly worldwide. However, in the context of increasingly aging trend in China, the prevalence of etiological agents among elderly diarrheal patients was undetermined. This study aimed to explore the major enteropathogens of acute diarrhea among outpatients older than 65 years in China, and also the epidemiological features of the pathogens. Demographic and clinical data for acute diarrhea among outpatients older than 65 years were collected from 213 participating hospitals from 2009 to 2014. Stool specimens were collected and tested for 13 enteric viruses and bacteria. The proportion of outpatients positive for targeted pathogens was analyzed by residential areas and seasonal patterns. Among the 7,725 patients enrolled, 1,617 (20.9%)were positive for any one of the 13 study pathogens. The predominant pathogen was norovirus (9.0%), followed by diarrheagenic Escherichia coli (DEC) (5.5%), rotavirus (3.9%), non-typhoidal Salmonella (NTS) (2.9%), and Shigella spp. (2.5%). The prevalence of Shigella spp. among rural patients (6.9%) was higher than that among urban patients (1.6%) (p < 0.001), with opposite trend for DEC (3.6% versus 5.9%, p = 0.007). An obvious seasonal pattern was observed for major pathogens, with peak for norovirus in autumn, rotavirus in winter and DEC, NTS, and Shigella spp. in summer. A wide variety of enteropathogens were detected among the elderly with acute diarrhea in China, with norovirus and DEC being the most commonly isolated pathogens. A strong seasonal pattern was observed for major pathogens of acute diarrhea among the elderly.
Highlights
Diarrhea is one of the leading causes of morbidity and mortality worldwide
During the study period from January 1, 2009 to December 31, 2014, a total of 7,725 elderly outpatients with acute diarrhea were included in the study
Comparing with patients living in urban areas, Shigella spp. had a higher prevalence in patients living in rural areas, while diarrheagenic Escherichia coli (DEC) had a lower prevalence in rural areas
Summary
Diarrhea is one of the leading causes of morbidity and mortality worldwide. mortality rate of diarrhea among adults is lower than that in children less than 5 years [1], the burden of diarrhea in the elderly remains much high in a number of high-income countries, with the diarrhea-related deaths five times more than that in children in some circumstance [2]. In the United States, there was approximately 179 million patients of acute diarrhea each year, 83% of which deaths were the elderly [3]. Investigating the etiology of diarrhea among the elderly in China is an important public health priority for providing the evidence for disease prevention and control, vaccine development and policy recommendation in future. In this nationwide laboratory-based observational study, we detected pathogens, both bacterial and viral infections, for the acute diarrheal illness among patients aged over 65 years who presented to the hospital outpatient setting during 2009–2014
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