Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990–2016

Alexandria C Brown ,Christopher Troeger,Judd L Walson ,Simon I Hay ,Puja C Rao,Firdausi Qadri,Mark S Riddle ,Gagandeep Kang,A Duncan Steele ,David A Shoultz ,Edward T Ryan ,Stephen P Luby ,Calman A Maclennan ,Ali H Mokdad ,Myron M Levine ,Eric R Houpt ,Patricia B Pavlinac,Brigette F Blacker ,Christopher J L Murray,William Pan ,Thomas G Brewer ,Karen L Kotloff ,Robert C Reiner ,James A Platts-Mills,John W Sanders ,Cyril Engmann ,Ibrahim Khalil ,Deborah Atherly

doi:10.1016/s1473-3099(18)30475-4

Abstract

SummaryBackgroundShigella and enterotoxigenic Escherichia coli (ETEC) are bacterial pathogens that are frequently associated with diarrhoeal disease, and are a significant cause of mortality and morbidity worldwide. The Global Burden of Diseases, Injuries, and Risk Factors study 2016 (GBD 2016) is a systematic, scientific effort to quantify the morbidity and mortality due to over 300 causes of death and disability. We aimed to analyse the global burden of shigella and ETEC diarrhoea according to age, sex, geography, and year from 1990 to 2016.MethodsWe modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We used a compartmental meta-regression tool to model the incidence of shigella and ETEC, which enforces an association between incidence, prevalence, and remission on the basis of scientific literature, population representative surveys, and health-care data. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsShigella was the second leading cause of diarrhoeal mortality in 2016 among all ages, accounting for 212 438 deaths (95% UI 136 979–326 913) and about 13·2% (9·2–17·4) of all diarrhoea deaths. Shigella was responsible for 63 713 deaths (41 191–93 611) among children younger than 5 years and was frequently associated with diarrhoea across all adult age groups, increasing in elderly people, with broad geographical distribution. ETEC was the eighth leading cause of diarrhoea mortality in 2016 among all age groups, accounting for 51 186 deaths (26 757–83 064) and about 3·2% (1·8–4·7) of diarrhoea deaths. ETEC was responsible for about 4·2% (2·2–6·8) of diarrhoea deaths in children younger than 5 years.InterpretationThe health burden of bacterial diarrhoeal pathogens is difficult to estimate. Despite existing prevention and treatment options, they remain a major cause of morbidity and mortality globally. Additional emphasis by public health officials is needed on a reduction in disease due to shigella and ETEC to reduce disease burden.FundingBill & Melinda Gates Foundation.

Highlights

We modelled shigella and enterotoxigenic Escherichia coli (ETEC)-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data
We have previously reported the number of diarrhoea deaths attributable to shigella (212 400 deaths, 95% uncertainty interval [uncertainty intervals (UIs)] 137 000–326 900) and to enterotoxigenic Escherichia coli (ETEC; 51 186 deaths, 26 757–83 064).[1]
As previously reported,[1] shigella was responsible for an estimated 212 438 deaths (95% UI 136 979–326 913; table) globally among all ages in 2016, which accounts for roughly 13·2% of all diarrhoea deaths (9·2–17·4; figure 1)

Summary

Introduction

We modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We calculated 95% uncertainty intervals (UIs) for the point estimate

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