Etiology of Diarrhea Requiring Hospitalization in Bangladesh by Quantitative PCR, 2014-2018


Mami TaniuchiKamrul IslamMd Abu SayeedJames A Platts-MillsMd Taufiqul IslamMd Imam Ul KhabirMuntasir RahmanZahid Hasan KhanYasmin Ara BegumFarhana KhanamAshraful Islam KhanJie LiuEric R HouptFirdausi Qadri


Background: Diarrhea remains a major public health problem and characterization of etiology is needed to prioritize interventions. However, most data are from single-site studies of children. We tested samples from participants of any age from 11 geographically diverse hospitals in Bangladesh to describe pathogen-specific burdens of diarrhea.

Methods: We utilized two existing diarrhea surveillance systems: a Nationwide network at 10 sentinel hospitals and at the icddr,b hospital. We tested stools from enrolled participants and non-diarrheal controls for enteropathogens using quantitative PCR and calculated pathogen-specific attributable fractions (AFs) of diarrhea.

Results: We analyzed 5516 diarrheal patients and 735 controls. Overall, rotavirus had the highest attributable burden of diarrhea (Nationwide AF 17.7%, 95% confidence interval: 14.3, 20.9; icddr,b AF 39.9%; 38.0, 41.8), followed by adenovirus 40/41 (Nationwide AF 17.9%, CI: 13.9, 21.9; icddr,b AF 16.6%; CI: 14.4, 19.4) and Vibrio cholerae (Nationwide AF 10.2%, CI: 9.1, 11.3; icddr,b AF 13.3%, CI: 11.9, 15.1). Rotavirus was the leading pathogen in children under 5 years of age and was consistent across the sites (coefficient of variation = 56.3%). Adenovirus 40/41 was the second leading pathogen in both children and adults. V. cholerae was the leading pathogen in individuals above 5 years old but was more geographically variable (coefficient of variation = 71.5%). Other attributable pathogens included astrovirus, norovirus, Shigella, Salmonella, ETEC, sapovirus, and typical EPEC.

Conclusions: Rotavirus, adenovirus 40/41, and V. cholerae were the leading etiologies of infectious diarrhea requiring hospitalization in Bangladesh. Other pathogens were important in certain age groups or sites.

Click here to read the article, published in Clinical Infectious Diseases.