Etiology of Diarrhea Requiring Hospitalization in Bangladesh by Quantitative Polymerase Chain Reaction, 2014–2018

• Published in: Clinical infectious diseases 2021-11, Vol.73 (9), p.e2493-e2499
• Main Authors: Taniuchi, Mami, Islam, Kamrul, Sayeed, Md Abu, Platts-Mills, James A, Islam, Md Taufiqul, Khabir, Md Imam Ul, Rahman, Muntasir, Khan, Zahid Hasan, Begum, Yasmin Ara, Khanam, Farhana, Khan, Ashraful Islam, Liu, Jie, Houpt, Eric R, Qadri, Firdausi
• Format: Article
• Language: English
• Subjects: Online only
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa840

Abstract Background Diarrhea remains a major public health problem and characterization of its 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 2 existing diarrhea surveillance systems: a Nationwide network at 10 sentinel hospitals and at the icddr,b hospital. We tested stools from enrolled participants and nondiarrheal controls for enteropathogens using quantitative polymerase chain reaction and calculated pathogen-specific attributable fractions (AFs) of diarrhea. Results We analyzed 5516 patients with diarrhea and 735 controls. Overall, rotavirus had the highest attributable burden of diarrhea (Nationwide AF, 17.7%; 95% confidence interval [CI], 14.3–20.9%; icddr,b AF, 39.9%; 38.0–41.8%), followed by adenovirus 40/41 (Nationwide AF, 17.9%; 95% CI: 13.9–21.9%; icddr,b AF, 16.6%; 95% CI, 14.4–19.4%) and Vibrio cholerae (Nationwide AF, 10.2%; 95% CI, 9.1–11.3%; icddr,b AF, 13.3%; 95% CI: 11.9–15.1%). Rotavirus was the leading pathogen in children 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. Patients of all ages were enrolled in the sentinel surveillance from 11 Bangladesh hospitals. Rotavirus, adenovirus 40/41, and Vibrio cholerae were the leading causes of diarrhea across age and geography with variations in frequency. Other pathogens were important in certain ages or sites.