Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016

Effectiveness of infrastructural interventions to improve access to safe drinking water in Latin America and the Caribbean on the burden of diarrhoea in children <5 years: a systematic literature review and narrative synthesis

Globally, Latin America and the Caribbean (LAC) has one of the lowest rates of equitable access to safely managed drinking water. This systematic literature review assessed the effectiveness of infrastructure interventions to provide equitable access to safely managed drinking water in LAC on the burden of diarrhoea in children <5 years. The review was conducted in February 2024 using Ovid MEDLINE, Embase, Global Health, and the Cochrane Library with inclusion criteria: quantitative study designs of intervention effectiveness on burden of diarrhoea in children; conducted in LAC; studies published since 1 January 2000; and full-text available in English. Study quality was assessed via the US Agency for Healthcare Research and Quality scale. Reported quantitative data for diarrhoea burden of disease were extracted, and thematic analysis informed a narrative synthesis. Six studies from three countries in LAC with >110,000 data-points were included. Water supply infrastructure interventions were effective at reducing the burden of diarrhoea in children <5 years. Household level, rather than community level, access to a piped water supply, a continuous reliable service with <1 day of service interruption per month, and cash transfer programs for environmental public health programs, were identified as key contributors to water infrastructure intervention effectiveness. Previous water supply infrastructure interventions which include the provision of a safe drinking water supply are effective in reducing burden of diarrhoea in children. Future studies are needed to develop a comprehensive understanding of the unique features which contribute to water infrastructure effectiveness.

Rotavirus vaccine coverage, completion, and compliance: A systematic literature review

Rotavirus, a leading cause of severe acute gastroenteritis in children, is largely preventable through immunization with two internationally licensed oral rotavirus vaccines (RVVs) included in national programs across over 100 countries. These RVVs are administered in either two (Rotarix™; 2D-RV) or three (RotaTeq®; 3D-RV) doses. We aimed to assess the global coverage, completion, and compliance of 2D-RV and 3D-RV in various settings, and to identify factors influencing vaccine coverage. We conducted a systematic review of PubMed and Embase for articles published between 2006 and 2021. We included 74 publications across 31 countries. RVV coverage rates and the factors associated with coverage varied widely among countries based on income level, RVV used, and the year of vaccination. Due to market bias and insufficient studies, valid RVVs coverage comparisons couldn't be made. However, 2D-RV had better completion/compliance rates than 3D-RV in Italy, Mexico, and the US.

A study on the willingness and influencing factors of non-EPI vaccines recommendations among Chinese vaccination staff under major infectious disease outbreaks

WHO had warned of the impending "X disease," emphasizing the need to quickly establish an immune barrier. The willingness of vaccination staff to recommend vaccines was crucial in such scenarios. This study aimed to investigate willingness and influencing factors of Non-EPI Vaccines recommendations among Chinese vaccination staff in Hangzhou, China. We selected vaccination staff in 191 vaccination clinics from Hangzhou for a questionnaire-based survey using a cross-sectional survey. Descriptive statistics were made on the characteristics of participants. Univariate and multivariable analyses were used to determine the influencing factors of Non-EPI Vaccines recommendations. The overall recommendation rate was 76.2%. Compared to Supplementary and Individual Non-EPI Vaccines, vaccination staff were more willing to recommend Alternative (x 2  = 215.655, P < 0.05) and Combined Non-EPI Vaccines (x 2  = 214.998, P < 0.05). Multivariate logistic regression analysis showed that vaccination staff who did not participate in COVID-19 vaccination work (OR = 2.942, 95%CI:1.121 ~ 9.302), believe they had an obligation to recommend Non-EPI Vaccines (OR disagree = 7.957, 95%CI:1.238 ~ 87.69; OR neutrality = 4.187, 95%CI:1.66 ~ 10.563), and think that the effects of non-routine immunization vaccines were very good (OR disagree = 3.133, 95%CI:1.677 ~ 14.495; OR neutrality = 2.512, 95%CI:1.164 ~ 5.418) were more willing to recommend Non-EPI Vaccines. On the contrary, vaccination staff who believe that recommending Non-EPI vaccines increased their workload (OR disagree = 0.307, 95%CI:0.11 ~ 0.856; OR neutrality = 0.642, 95%CI:0.258 ~ 0.986) would decrease willingness to recommend them. The most of vaccination staff were willing to recommend non-EPI vaccines under major infectious disease outbreaks. To further control the pandemic of major infectious diseases, the health management departments should enhance the knowledge of vaccines among vaccination staff and alleviate their workload.

Immunogenicity and preclinical efficacy characterization of ShecVax, a combined vaccine against Shigella and enterotoxigenic Escherichia coli

No licensed vaccines are available for the largely antibiotic-resistant Shigella or enterotoxigenic Escherichia coli (ETEC), the two most common bacteria causing children's diarrhea and travelers' diarrhea. Virulence heterogeneity is a key obstacle to developing vaccines against Shigella or ETEC. By applying a multiepitope fusion antigen (MEFA) vaccinology platform, we recently constructed epitope- and structure-based polyvalent proteins to induce cross-protective antibodies against heterogeneous Shigella or ETEC strains. In this study, we combined a polyvalent Shigella protein with two polyvalent ETEC proteins, examined antigen compatibility and broad immunogenicity, and evaluated the potential of developing a combined vaccine against the two groups of bacteria. Data showed that mice intramuscularly immunized with the combined vaccine candidate (ShecVax) developed antibodies to all the following target virulence factors: Shigella IpaB, IpaD, VirG, GuaB, StxA, Stx2A, and StxB, and ETEC STa, LT, CFA/I, CS1, CS2, CS3, CS4, CS5, and CS6. ShecVax-induced antibodies significantly inhibited the invasion of all Shigella species and important serotypes, prevented the adherence of all important ETEC pathotypes, and neutralized the enterotoxicity of ETEC toxins STa and LT. Moreover, ShecVax prevented mice from lethal pulmonary infection with Shigella sonnei or S. flexneri 2a, significantly reduced ETEC bacterial colonization in rabbit small intestines, and passively protected newborn pigs against ETEC toxin-mediated clinical diarrhea. These results indicated that ShecVax is broadly immunogenic and cross-protective against Shigella and ETEC, suggesting ShecVax can be a Shigella/ETEC combined vaccine against children's and travelers' diarrhea, and the MEFA platform can be generally applied for vaccine development against heterogeneous pathogens or different diseases.IMPORTANCEThere are no effective countermeasures against Shigella and enterotoxigenic E. coli (ETEC), two antibiotic-resistant groups of bacteria and the leading causes of diarrhea in children in developing countries (children's diarrhea) and international travelers (travelers' diarrhea). Vaccines are a more practical approach to protect against infectious diseases, including diarrhea caused by Shigella or ETEC. A combined vaccine cross-protective against Shigella and ETEC can save hundreds of thousands of lives and prevent hundreds of millions of diarrhea cases yearly; it can also reduce antibiotic prescription and decrease antibiotic resistance, thus significantly improving global health. In addition, we may apply the MEFA platform to develop combined vaccines against heterogeneous pathogens or different diseases to accommodate an increasingly crowded expanded program on immunization (EPI).

Evaluating impacts of improved flooring on enteric and parasitic infections in rural households in Kenya: study protocol for a cluster-randomised controlled trial

INTRODUCTION

Earthen floors are often damp or dusty and difficult to clean, providing an ideal environment for faecal pathogens and parasites. Observational studies have revealed associations between household flooring and health outcomes, but robust experimental evidence is scant. This study will evaluate the impact of an improved household flooring intervention on enteric infections, soil-transmitted helminth (STH) infections and tungiasis through implementation of a cluster-randomised trial in two rural settings in Kwale and Bungoma Counties, Kenya.

METHODS AND ANALYSES

440 clusters (households) across both sites are allocated to control or intervention group, in which a low-cost, sealed, washable, cement-based floor is installed in eligible buildings of the dwelling, alongside a floor-care guide provided during an induction meeting. Following baseline assessments in both groups, all individuals over 1 year receive albendazole and those infected with tungiasis receive benzyl benzoate. Primary outcomes are as follows: prevalence of enteric infections in children under 5 years assessed via stool surveys and PCR; prevalence of tungiasis infection in children 1-14 years based on clinical exam; and prevalence of STH infection in all household members over 1 year assessed via Kato-Katz. Secondary outcomes include the following: intensity of STH and tungiasis infections; prevalence of caregiver-reported gastrointestinal illness in children under 5; quality of life and well-being measures; and environmental contamination. A process evaluation investigates intervention acceptability, durability, practicality and cost.

ETHICS AND DISSEMINATION

The protocol has been approved by ethics committees of The Kenya Medical Research Institute, The Kenya National Commission for Science Technology and Innovation, and The London School of Hygiene & Tropical Medicine. Following the 12-month implementation period and final assessments, control households are offered improved floors. Results will be disseminated within Kenya, to the Ministries of Health and of Lands, Public Works, Housing and Urban Development, and to subnational leadership and communities. Dissemination will also occur through publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05914363.

Macleaya cordata protopine total alkaloids as potential treatment for diarrhoea: Mechanistic insights and target identification

Diarrhoea remains a major public health concern, particularly affecting young children and livestock. Macleaya cordata protopine total alkaloids (MPTA), a standardized extract approved in China for poultry diarrhoea, has demonstrated anti-inflammatory properties in intestinal disorders. The study aims to investigate the antidiarrheal mechanism of MPTA using castor oil- and E. coli-induced diarrhoea models in mice. We first tested MPTA for acute oral toxicity. Subsequently, the effect of MPTA on castor oil- and E. coli-induced diarrhoea in mice based on LD50 results. Network pharmacology analysis and target competition assays (inhibitors and antagonists) were integrated to identify targets for MPTA's antidiarrheal effects. Molecular docking was used to verify the binding ability of MPTA components to these receptors. The LD50 of MPTA was determined to be 426.1 mg/kg. The optimal MPTA activity was found at 8 mg/kg in both castor oil and in infectious models. Network pharmacology analysis revealed potential targets and pathways of MPTA against intestinal motility. The impact of MPTA on cholinergic, serotonin, dopaminergic, and adrenergic receptors was assessed using standard inhibitors and agonists to induce intestinal smooth muscle contractions or relaxations. Molecular docking confirmed the binding ability of MPTA components to these receptors. In conclusion, MPTA exhibits significant antidiarrheal effects in both castor oil and E. coli-induced diarrhoea models. Its mechanism may involve modulation of cholinergic, serotonin, dopaminergic, and adrenergic receptors, as well as inhibition of ion channels and anti-inflammatory actions. These findings highlight the potential of MPTA as a novel therapeutic agent for diarrhoea.

Provision of primary healthcare centers and women's healthcare-seeking behaviour: Evidence from Bangladesh

This study examines the association between the establishment of primary healthcare providers- community clinics (CCs)- and healthcare-seeking behavior in Bangladesh. Initiated in 1998, CCs aim to provide accessible healthcare services to remote households, particularly focusing on women and children. Using cluster-level data on healthcare provider availability alongside individual-level data from the Bangladesh Demographic and Health Survey (BDHS) for 2011, 2014, and 2017-18, the respective sample sizes are 17842, 17886, and 20127 ever-married women, the study offers robust estimates that address endogeneity concerns present in individual-level analyses. Lagged health indicators are utilized to consider contextual factors influencing CC establishment in specific regions. Results indicate positive associations between CC presence and various healthcare-seeking behaviors, such as increased contraceptive use, higher attendance at antenatal care visits, and improved treatment-seeking for children's illnesses. Notably, rural-urban disparities in healthcare-seeking behavior highlight existing access inequalities. To mitigate this divide, the study recommends expanding CCs nationwide, demonstrating that low-cost healthcare interventions can enhance healthcare-seeking behaviors and suggest potential scalability in similar contexts.

Protein-specific immune response elicited by the Shigella sonnei 1790GAHB GMMA-based candidate vaccine in adults with varying exposure to Shigella

Shigella is a leading cause of diarrheal morbidity and mortality in young children from low- and middle-income countries. Here, we aimed to verify the ability of the generalized modules for membrane antigens (GMMA)-based Shigella sonnei candidate vaccine 1790GAHB to elicit an anti-protein antibody response. Serum samples from previous clinical trials in adults (a dose-escalation study and its extension in France, a vaccine efficacy study after human challenge in the United States, and a study in Kenya) were investigated using pan-proteome microarrays consisting of 3,150 full-length or fragmented Shigella proteins. Pre-/post-vaccination comparisons identified subsets of proteins that were highly immunoreactive and largely overlapped across all trials; the T3SS lipochaperone family protein (expressed on GMMA) was the most reactive in all studies. Responses to several microarray antigens correlated well with S. sonnei LPS serum IgG antibody levels. Overall, we confirmed the ability of GMMA to elicit an anti-protein IgG/IgA response; however, no association with protection against shigellosis was identified. In the challenge study, IgG response to seven antigens (IpaC, IpaB, IpaA, IpaD, IpaH, IpgC, and MxiD; not expressed on GMMA) was associated with a decreased risk of shigellosis. These antigens were observed to also have high IgG responses at baseline in individuals naturally exposed to Shigella and could constitute targets for future vaccine development.IMPORTANCEShigella remains a major cause of diarrheal disease, especially in children aged under 5 years from low-to-middle-income countries. No vaccine against shigellosis is yet widely available despite the high public health need. An ideal vaccine would provide protection against the most prevalent species, Shigella flexneri and Shigella sonnei; therefore, it could be relevant to identify common antigens. We developed a microarray containing 3,150 full-length or fragmented proteins selected across Shigella species. Sera collected in four clinical trials conducted in three countries of varying endemicity to evaluate a S. sonnei GMMA-based candidate vaccine were tested against these proteins. We identified several Shigella proteins (IpaC, IpaB, IpaA, IpaD, IpaH, IpgC, MxiD) that induced robust antibody response following experimental challenge or natural infection. These proteins correlated with a reduced risk of shigellosis after the S. sonnei challenge. We found no apparent role for anti-GMMA proteins' IgG or IgA response in protection against shigellosis.

Effectiveness of rBS/WC cholera vaccine against bacterial infectious diarrhea: A test-negative study on children aged 2-6 years in Guangzhou China

BACKGROUND

Recombinant B-subunit/Whole Cell Cholera Vaccine (rBS/WC) represents a new and effective way to protect against and control diarrhea. A test-negative case-control study was conducted to investigate the cross-protective effect of cholera vaccine immunization against bacterial infectious diarrhea in a real-world setting.

METHODS

Using a test-negative design, children aged 2-6 years with infectious diarrhea in Guangzhou City were selected as study subjects. A 1:4 propensity score matching based on the basic characteristics of the included study subjects, and vaccine effects were calculated after correcting for confounders.

RESULTS

A total of 2796 children with laboratory-confirmed infectious diarrhea were enrolled in the study, and 316 pairs were successfully enrolled in the matching after Propensity Score Matching(PSM), totaling 1306. By conditional logistic regression analysis, The results showed that the total protective effect of ≥1 dose of rBS/WC vaccine against bacterial infectious diarrhea in children aged 2-6 years was 57.7 % (95 % CI: 30.3-74.3); the rBS/WC vaccine had the best protective effect of 74.8 % (95 % CI: 16.8-95.6) within 6 months of vaccination and then showed a decreasing trend. The vaccine's protective effect was 54.6 % (95 % CI: 22.1-73.5) against Salmonella and 69.2 % (95 % CI: -133.7-95.9) against Escherichia coli. Stratified analyses revealed higher point estimates of the protective effect obtained by vaccination among healthy children with good hygiene.

CONCLUSIONS

These findings support the idea that the rBS/WC vaccination program is effective in the real world in preventing bacterial diarrhea in children. For people who are susceptible to bacterial diarrhea, the cholera vaccine is a good preventive option.

Microbial Water Quality at the Point of Use: The Role of Socio-Economic Factors and Water Handling Practices in Kitwe District, Zambia

Background

The scarcity of safe drinking water affects individuals living in low income areas, increasing their vulnerability to waterborne diseases. This study aimed to investigate the relationship between socio-economic factors, water handling practices and microbial water quality in Kitwe District, Zambia.

Methods

A cross-sectional study was conducted among 215 households using a semi-structured questionnaire along with microbiological analysis of water samples during the dry and wet season. A total of 44 water samples (per season) from the point of use and 16 source samples were analyzed for pH, temperature, residual chlorine, total coliforms, and Escherichia coli. Multivariable logistic regression analyzed associations between socio-economic factors, water handling practices, and water quality.

Results

The prevalence of Escherichia coli contamination was 61.3% during the dry season and 77.3% during the wet season. Key factors associated with household water quality included, household monthly income, education level, family size, season, storage container design, water withdrawal method, covering storage containers, water treatment practices, and hand washing with soap. Notably, households that used narrow-mouthed containers (AOR = 0.090, 0.014-0.580), covered their storage containers (AOR = 0.113, 0.014-0.889), and practiced water treatment (AOR = 0.120, 0.022-0.656) showed significantly reduced risks of E. coli contamination.

Conclusion and recommendations

The findings highlight the importance of socio-economic factors and proper water handling practices in improving household water quality. To enhance water safety and reduce water-related diseases, targeted interventions should focus on educating communities about the effective handling of water. Furthermore, addressing socio-economic factors and improving access to safe water are essential for mitigating contamination risks in low-income areas.

Potential for a Combined Oral Inactivated Whole-Cell Vaccine Against ETEC and Shigella: Preclinical Studies Supporting Feasibility

BACKGROUND

Enteric disease caused by Shigella, Campylobacter, and enterotoxigenic Escherichia coli (ETEC) represents a significant global health burden, particularly among children in low-resource settings. However, no licensed vaccines are currently available for these bacterial pathogens. Given the wide range of enteric pathogens and the constraints posed by an increasingly crowded infant immunization schedule, the development of combination vaccines or combined administration of individual oral vaccines may offer a practical approach to address this unmet need.

OBJECTIVES

In this study, we evaluated the combined administration of two multicomponent oral vaccine candidates: ETVAX, targeting ETEC, and a trivalent whole-cell vaccine targeting Shigella.

METHODS

The vaccine candidates were administered orally in mice, both individually and in combination, with and without the inclusion of the double-mutant heat-labile toxin (dmLT) adjuvant.

RESULTS

The results demonstrated systemic and intestinal-mucosal immune responses to the key protective antigens following both individual and combined vaccine administration. Importantly, the combination of the two vaccines did not compromise the elicitation of specific antibody responses. The inclusion of dmLT as an adjuvant significantly enhanced immune responses to several antigens, highlighting its potential to improve vaccine efficacy.

CONCLUSIONS

These findings underscore the feasibility of combining ETEC and Shigella vaccine candidates into a single formulation without compromising immunogenicity. This combined approach has the potential to provide broad protective coverage, thereby mitigating the global impact of enteric diseases and streamlining vaccine delivery within existing childhood immunization programs. Our results support further development of this combination vaccine strategy as a promising tool in combating enteric infections and improving health outcomes, particularly among young children in endemic regions who are vulnerable to enteric disease.

Epidemic characteristics and effectiveness of vaccine intervention on rotavirus infection: a real-world observational study in Zhejiang Province, China

Background

Rotavirus infection, the most common cause of infant infectious diarrhoea and related deaths worldwide, has imposed a high disease burden in China, especially in Zhejiang Province. This study described the overall epidemiological characteristics and trends of reported rotavirus infections in Zhejiang Province from 2005 to 2022 and evaluated the effectiveness of rotavirus vaccines on the incidence of rotavirus infection.

Materials and methods

Data on reported cases of rotavirus infection from 2005 to 2022 were extracted from the China Disease Prevention and Control Information System. Information on rotavirus vaccination was obtained from the Zhejiang Provincial Viral Diarrhoea Surveillance Site in 2022. Join-point regression, spatial and temporal aggregation analysis, and an age-period-cohort model were used to explore the epidemiological trends of rotavirus infection. Interrupted time series analysis and an overdispersed Poisson model were used to quantify the effectiveness of rotavirus vaccines.

Results

The average age-standardized reporting incidence rate (ASRIR) of rotavirus infection in Zhejiang Province was 38.58/100,000, particularly in children aged 0-2 years, who had the highest average annual incidence of 951.63/100,000. The annual ASRIR of all ages showed a significant upward trend before 2017 (average percentage change [APC] = 21.64%) and then decreased significantly (APC = -23.02%). However, in children aged 6-19 years, the annual incidence presented a sustained and significant upward trend over time. The rotavirus infection peak showed a seasonal drift in Zhejiang Province, shifting from November before 2014 to January after 2014. Spatiotemporal aggregation revealed two clusters. The spatio-temporal scanning found two spatio-temporal aggregation areas, the first level spatio-temporal aggregation area was distributed in Hangzhou, Jiaxing and Huzhou, and the second level spatio-temporal aggregation area was Lishui. The age-period-cohort model indicated that the risk of rotavirus infection was primarily concentrated in children aged 0-4 years. The vaccine effectiveness (VE) of rotavirus vaccines was 71.62% (95% confidence interval [CI]: 45.21-86.05%) in children aged 2-59 months, in which the VE of the human-bovine reassortant pentavalent vaccine (RV5) was 91.31% (95% CI: 74.39-97.97%). Since the implementation of RV5 vaccination in September 2018, the number of cases of rotavirus infection per month has decreased by 3,061 (65.27%) in Zhejiang Province.

Conclusion

The disease burden of rotavirus infection in Zhejiang Province was high, especially in children. Rotavirus vaccination have significantly reduced the incidence rate of rotavirus infection. Therefore, the prevention of infectious diarrhoea should be further strengthened, especially through increased coverage with the rotavirus vaccine.

Comparing the Power of Low vs High-Precision Methods for Measuring E. coli in Drinking Water in Low-Resource Settings

Methods to measure Escherichia coli concentrations in water vary in precision, complexity, and cost. Low-precision methods are more affordable, faster, and simpler to implement in low-resource settings but may reduce statistical power. We compared the statistical power of low- and high-precision methods using data from UNICEF's Multiple Indicator Cluster Surveys across 11 low-income regions, and from a birth cohort study in Ecuador. Both data sets included continuous E. coli concentrations from high-precision methods, which we categorized to emulate low-precision methods outcomes. Using logistic regression, we modeled associations between water quality and two dichotomous outcomes: water treatment (treated/untreated) and water storage (stored/not stored). We compared the sample size needed to reach 80% power for detecting statistically significant differences between these groups. Power was calculated using a bootstrap-based algorithm. Compared to continuous measures, categorizing E. coli concentrations required 10-90% larger sample sizes in treatment models and about 10% in storage models, except in regions with good water quality, where similar or lower sample sizes were sufficient. Our findings indicate that low-precision methods can reliably infer associations between water practices and water quality but often require larger sample sizes, highlighting a trade-off between cost and statistical power in resource-limited settings.

Seasonality of medically attended norovirus gastroenteritis and its association with climatic factors within an US integrated healthcare system, 2016-2019

BACKGROUND

While acute gastroenteritis (AGE) occurs year-round, norovirus has a winter seasonality in the United States.

OBJECTIVE

We analyzed norovirus seasonality within a US integrated healthcare delivery system from 2016-2019.

METHODS

Electronic medical records were collected for acute gastroenteritis (AGE) encounters with specific ICD-9/10 codes or clinical stool testing. Norovirus percent positivity was calculated as the 8-week centered rolling average. Temperature and absolute humidity data were measured via weather station. The relationship between these factors and weekly norovirus episodes were modeled via negative binomial models.

RESULTS

From 2016-2019, there were 198,181 AGE episodes reported; among the 18,998 episodes tested, 892 (5%) were norovirus positive. Norovirus percent positivity peaked in epidemiologic week 7 at 9%. Two negative binomial models showed significant inverse relationships between weekly number of norovirus episodes and both temperature and absolute humidity.

CONCLUSION

Norovirus AGE exhibited winter seasonality from 2016-2019, associated with lower temperatures and humidity. Understanding this seasonality may help predict peak transmission periods and their impact on healthcare resources.

Disease burden of rotavirus related diarrhea in children under 5 years in China: a meta-analysis

Rotavirus (RV) is a leading cause of severe diarrhea among children under five years of age in China. In this meta-analysis, we assessed the disease burden of RV-related diarrhea by analyzing 73 studies retrieved from the PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases (2013-2023). The incidence of RV-related diarrhea ranged from 0.637 /1000 to 31.46/1000 persons. The pooled RV positivity rate for the under-5 age group was 24.7% (95% confidence interval: 22.1-27.4), with higher positivity rates observed among inpatients compared to outpatients (24.1% vs. 22.2%). Notably, the RV positivity rate declined from 27.3 to 21.5% pre- and post- the RotaTeq® licensure and 28.8-22.5% following the COVID-19 pandemic. The G9P[8] genotype was predominant, accounting for 71.7% of the RV cases in the under-5 age group. Given the dynamic nature of the incidence rate of RV-related diarrhea and the prevalence of the G9P[8] genotype, it is imperative to enhance surveillance efforts targeting incidence of RV-related diarrhea and the circulating genotypes of rotavirus.

Rotavirus prevalence and genotypes in the Central African Republic, 2011-2021

BACKGROUND

Rotavirus gastroenteritis is one of major causes of death in infants, particularly in sub-Saharan Africa. In the Central African Republic (CAR), sentinel surveillance of rotavirus gastroenteritis was established in 2011. In this study, we assessed the burden of rotavirus gastroenteritis and identified rotavirus strains circulating in CAR during 2011-2021.

METHODS

Stool samples were collected from < 5-year-old children with diarrhoea according to WHO criteria, at the sentinel site in Bangui, CAR. Samples were screened for group A rotavirus antigen by EIA. RNA was extracted from all EIA-positive samples which were subjected to genotyping using a semi nested RT-PCR assay.

RESULTS

From 2011 to 2021, 1855 stool samples were collected and 854 (46.0%) were positive for rotavirus by EIA. Genotypes were obtained from 77.3% (660/854) EIA positive samples. Of these 660 samples, genotypes funds were: G1 (35.4%) and G2 (26.6%) for VP7, and P[6] (42.7%) and P[8] (35.6%) for the VP4 gene. The most frequent genotype combinations were G1P[8], 19.3% and G1P[6], 15.0%.

CONCLUSION

This study reports the prevalence of rotavirus genotypes that circulated for ten years, providing a pre-vaccine baseline data genotype estimate for rotavirus gastroenteritis sentinel surveillance in the Central African Republic.

CLINICAL TRIAL NUMBER

Not applicable.

Electrolyte abnormalities and clinical outcomes in children aged one month to 13 years hospitalized with acute gastroenteritis in two large referral hospitals in Botswana

Acute gastroenteritis (AGE) is a common childhood disease, with a median of 2.5 diarrhoea episodes per child per year in both low- and middle-income countries. Morbidity and mortality from AGE result from a number of causes, including electrolyte abnormalities. This study characterized children hospitalized for AGE in Botswana with and without electrolyte abnormalities. This was a prospective observational study of children under the age of 13 years who were admitted with AGE in Princess Marina Hospital (PMH) and Nyangabgwe Referral Hospital (NRH) between May 2011 and April 2013. All children with serum electrolyte values obtained within 48 hours of admission were included. Patient characteristics and prevalence of electrolyte abnormalities were described. Risk factors for mortality were explored using univariate and multivariate logistic regression analyses. Among 544 patients, 37% had electrolyte abnormalities, namely hyponatraemia (9%), hypernatraemia (12%) and hypokalaemia (16%). Patients with hypernatraemia were younger (median age 6 months) compared to those with normal electrolytes (median age 9 months, p < 0.001). Patients with hypokalaemia presented after a longer duration of diarrhoea (median 4 days) compared to those with normal electrolytes (median 2 days, p < 0.001). Length of stay was longer in hypokalaemic (5 days) and hyponatraemic (5 days) patients compared to patients with hypernatraemia (3 days) and those without electrolyte abnormalities (3 days, p < 0.002). Those with malnutrition were significantly more likely to have electrolyte imbalances, with 19% having hypokalaemia. In multivariate analysis, the strongest predictors of mortality were malnutrition (OR 4.3; 95% CI 1.44-12.9); hypokalaemia (OR 5.5; 95% CI 1.84-16.6) and hypernatraemia (OR 3.9; 95% CI 1.11-13.5). Given the global impact of paediatric AGE, it is important that clinicians take additional care and precautions when admitting children with AGE and hypokalaemia, hypernatraemia, or malnutrition, as these increase the length of stay and odds of mortality.

Evaluating Chinese migrant workers' housing conditions by diarrhea disease prevalence

Chinese migrant workers often face significant health-related social inequalities, particularly in housing, in urban China. However, there is limited research investigating the health impacts of housing inequalities among migrant workers. We examined the accommodation types associated with the prevalence of diarrhea among migrant workers in urban China. We used a nationwide survey data to investigate the overall housing conditions and applied multilevel logistic regression models to analyze the association between diarrhea and housing types. The findings highlight that the prevalence of diarrhea among migrant workers is significantly associated with housing types rather than neighborhood or income levels. Compared with living in private rental properties, migrants living in government-subsidized properties have significantly increased odds of reporting diarrhea episodes (OR = 1.41; 95% CI 1.23-1.61; p < 0.001). This study indicated the need to address the quality and maintenance of housing infrastructure rather than ownership status alone.

A systematic review and meta-analysis of the global prevalence of human enteric adenovirus infections

Human adenovirus (HAdV), especially HAdV species F (HAdV-F) is recognized as a cause of acute gastroenteritis (AGE) worldwide. To assess the global prevalence of HAdV in case-patients of all ages with AGE, we conducted a systematic literature search for studies published in English during 2015-2022. We generated pooled prevalence estimates using generalized linear mixed models. Using data from 147 included articles, the overall pooled prevalence among AGE case-patients of any species of HAdV (pan-HAdV) was 5.8 % and 6.0 % for HAdV-F. The prevalence of HAdV was significantly higher among case-patients < 5 years of age compared with case-patients ≥ 5 years of age (pan-HAdV: 6.6 % vs. 2.0 %, p < 0.0001; HAdV-F: 8.7 % vs. 2.3 %, p = 0.04). Prevalence was significantly higher in high mortality developing countries and lowest in developed countries (pan-HAdV: 9.4 % vs. 4.0 %, p < 0.0001; HAdV-F: 11.6 % vs. 3.2 %, p = 0.0003). Understanding the burden of HAdV-associated AGE may be useful for targeted interventions, including future vaccine development.

Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021.

METHODS

We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age-sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework.

FINDINGS

In 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793-1·62) deaths globally, representing a 60·3% (50·6-69·0) decrease since 1990 (2·93 million [2·31-3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4-84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147-221) in 1990 to 51·4 million (39·9-65·9) in 2021. In 2021, an estimated 59·0 million (47·2-73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1-42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1-5 months and 2-4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2-73·2) to 4·99 million (1·99-10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4-20·1), followed by norovirus at 10·6% (2·3-17·0) and Cryptosporidium spp at 10·2% (7·03-14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7-43·0), followed by Shigella spp at 24·0% (15·2-37·9) and adenovirus at 23·8% (14·8-36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenicEscherichia coli, and enterotoxigenic E coli producing heat-stable toxin.

INTERPRETATION

The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial.

FUNDING

Bill & Melinda Gates Foundation.

Temporal trends of diarrheal diseases and associated treatment responses among children aged under five: Insight from the multiple Indicator Cluster surveys from 2006 to 2019

BACKGROUND

Despite significant progress in its health sector, Bangladesh has a high burden of diarrheal mortality and morbidity in the South Asian region. Given recent major social and economic transitions in Bangladesh, it is important to examine how patterns of diarrhea and its treatment have evolved over the past few decades. The current study aims to assess the temporal changes in the frequency of diarrhea and identify the factors that influence whether affected children receive proper treatment.

METHODS

The current study utilized data from three Bangladesh Multiple Indicator Cluster Surveys (MICS), 2006, 2012-13, and 2019, respectively. Binary logistic regressions were conducted, and the reported results included odds ratios (OR) and 95% confidence intervals (CIs). A p-value of <0.05 was considered statistically significant (α = 0.05).

RESULTS

The prevalence of diarrhea in Bangladesh declined from 7.05% in 2006 to 3.91% in 2012-13, but then increased to 8.78% in 2019. The proportion of children with diarrhea who received oral rehydration therapy (ORT) was 68.91%, 77.35%, and 70.59% respectively. Binary logistic regression indicated that older children (OR:0.54; CI:0.51-0.58), females (OR:0.92; CI:0.86-0.98), children from upper quintile families, and children from mothers having primary education (OR:0.9; CI:0.83-0.98) were less likely to suffer from diarrhea. However, the odds of receiving proper treatment with ORT were higher among older children (OR:1.45; CI:1.26-1.68), children from the rich and richest quintiles (OR:1.85; CI:1.47-2.32 and OR:1.7; CI:1.32-2.2 respectively). Also, it was the same for children from mothers with primary (OR:1.19; CI:1.01-1.41) and secondary or above education (OR:1.32; CI:1.12-1.56).

CONCLUSION

A targeted approach is needed to reduce diarrhea and promote the use of ORT. Maternal education can be an important intervention, and steps should be taken to reduce poverty. Future policies should consider strategies focusing on socioeconomic and environmental factors.

Co-occurrence of maternal intimate partner violence and violent discipline and its associations with child morbidity in the Philippines

BACKGROUND

Violence against women and children is a global issue with profound impacts on health and well-being. Intimate partner violence (IPV) and violent discipline often coexist within households, yet the impact of their co-occurrence on child health remains understudied, particularly in low- and middle-income countries (LMICs) like the Philippines.

OBJECTIVE

This study sought to assess the independent and joint associations of IPV and violent discipline within households on child morbidity outcomes.

METHODS

Using data from 6414 mother-child pairs from the 2022 Philippine National Demographic and Health Survey, logistic regression models were used to analyze the independent and joint associations between past-year maternal IPV, past-month violent child discipline and child morbidity (acute respiratory infection (ARI), fever and diarrhea in the past two weeks). Stratified analyses were performed by household wealth.

RESULTS

About 16 % of the mothers experienced IPV in the past year, 62 % of children experienced violent discipline in the past month, and 12 % of families experienced both. In the two weeks preceding the survey, fever was the most prevalent symptom of child illness (10.5 %), followed by diarrhea (5.8 %) and ARI (1.3 %). IPV and violent discipline were independently associated with increased risks of ARI, fever, and diarrhea in children under five. Their co-occurrence further heightened the risk of child morbidity (ARI aOR: 3.5, 95 % CI 1.7-7.1, fever aOR: 2.5, 95 % CI: 1.8-3.3, and diarrhea aOR: 2.5, 95 % CI 1.8-3.5), and these associations were consistent between poor and wealthy households.

CONCLUSIONS

These findings call for comprehensive interventions, such as parenting and community-based programs that aim to address family violence, including IPV and violent discipline, to mitigate impacts on child health in LMICs.

Empowering Women, Enhancing Health: The Role of Education in Water, Sanitation, and Hygiene (WaSH) and Child Health Outcomes

Background: Adequate water, sanitation, and hygiene (WaSH) are critical to maintaining good health and hygiene. However, health is a function of many health determinants, and WASH services alone may not be sufficient to improve health outcomes. Objective: To identify whether the presence of WaSH services is associated with fewer children under five years of age experiencing symptoms of diarrhea in Katoma, Geita, Tanzania. Method: A cross-sectional study was conducted to collect health data, demographics, and other variables, such as WASH, food insecurity, education of the mother, vaccination data, and household income data, for 452 households with children under five. Surveys were completed in-person through interviews. Health outcome data included being sick with diarrhea or symptoms. Data analysis was performed using SAS OnDemand for Academics. Multivariate logistic regression and mixed-effects logistic regression models were employed to determine the association between the covariates and sickness of inclusion children and all the children involved in the study, respectively. Results: The findings suggest that WASH services alone do not have a significant impact on diarrhea, but other determinants of health, including the education of the mother, showed a significant impact on health outcomes among children with at least one WASH service. These demographic variables were also associated with lower food insecurity and poverty. The findings highlight the need to (1) include other covariates when analyzing WASH data to understand health outcomes; and (2) improve education attainment for women to maximize health benefits for their children.

Dynamics of the gut microbiome in subjects challenged with Shigella sonnei 53G in a controlled human infection model

Shigella is a significant cause of diarrhea, predominantly affecting children in low- and middle-income countries, as well as international travelers. Not all individuals exposed to Shigella or other enteropathogens have symptomatic responses, and investigating the differences between symptomatic and asymptomatic individuals can further our understanding of enteropathogen proliferation and symptomatic responses. Here, we profiled the fecal microbiomes of 45 individuals infected with Shigella sonnei strain 53G through 16S rRNA sequencing in a controlled human infection model before and during infection, after antibiotic treatment, and after clinical recovery. This model allowed for a detailed exploration of microbiome temporal dynamics during infection, as well as a comparative analysis between those with shigellosis (defined as severe symptoms caused by Shigella infection, including severe diarrhea, fever, and/or abdominal pain) and those without shigellosis. Alpha diversity decreased to a greater degree in individuals with shigellosis. Perturbations in microbial composition during infection and antibiotic treatment were significantly larger in individuals diagnosed with shigellosis than in those who were not. Participants with shigellosis had persistent changes to their microbiomes after recovery, while those without shigellosis recovered to a composition resembling their pre-infection microbiomes. These persistent changes included taxa associated with gut inflammation, such as a decrease in Faecalibacterium and an increase in Ruminococcus gnavus. Furthermore, the initial microbiomes of participants who did not develop shigellosis had a greater abundance of taxa associated with short-chain fatty acid production than participants who did develop shigellosis, including Bifidobacterium, Roseburia, and Faecalibacterium. These data could help prevent Shigella infection or symptoms.IMPORTANCEDiarrheal disease is a major contributor to the global disease burden and can lead to an increased individual risk of chronic sequelae post-infection, such as irritable bowel syndrome, reactive arthritis, and altered gut permeability. Understanding the differential responses of individuals to enteropathogen exposure can elucidate factors that could lead to treatments or preventative measures to reduce the disease burden. Here, we use a controlled human infection model study to directly identify the effects of Shigella sonnei 53G infection on the microbiome. We identified taxa that were more or less abundant in participants who would develop shigellosis during the study, as well as persistent changes after recovery in the microbiomes of participants who developed severe symptoms. Understanding these changes could elucidate ways to prevent Shigella infection or recover altered microbiomes after recovery.CLINICAL TRIALSThis study is registered with ClinicalTrials.gov as NCT02816346.

Care-seeking for diarrheal illness: A systematic review and meta-analysis

Monitoring and treating diarrheal illness often relies on individuals seeking care at hospitals or clinics. Cases that seek care through pharmacies and community health workers (CHW) are frequently excluded from disease burden estimates, which are used to allocate mitigation resources. Studies on care-seeking behavior can help identify these gaps but typically focus on children under five, even though diarrheal diseases like cholera and Enterotoxigenic E. coli affect all age groups. This study aimed to estimate the proportion of individuals seeking care for themselves or their children with diarrhea, considering different age groups, case definitions, and study settings. We conducted a systematic review of population-based primary research studies published during 2000-2024 that examined care-seeking behavior for diarrhea. We included 166 studies from 62 countries. Hospitals and clinics were the most common source of care sought outside the home, with CHW and health posts rarely reported. Using a random-effects meta-analysis, we found substantial heterogeneity in care-seeking between studies from low- and middle-income countries (I2 = 99.3) and estimated that the proportion of diarrhea cases seeking care at a hospital or clinic was 32.8% on average (95% Confidence Interval (CI) 28.1% to 37.9%; prediction interval 3.3% to 87.5%). Although there were trends toward higher care-seeking for children compared to adults, substantial variation existed between studies, and the differences were not significant. We estimated that the adjusted odds of seeking care at a hospital or clinic were significantly higher for severe diarrhea and cholera compared to general diarrhea (Odds Ratio 3.43; 95% CI 1.71 to 6.88). Our findings confirm that passive surveillance through hospitals and clinics may substantially undercount the number of people with diarrhea, particularly those with milder symptoms, although this proportion varied widely. Additionally, our findings underscore the importance of including care-seeking questions across all age groups in future studies, as we cannot assume lower care-seeking for adults across all settings. Our study was limited by fewer data on care-seeking from health posts, traditional healers, and CHW compared to hospitals and clinics, highlighting a need for further research on these sources of care.

Prevalence of Shiga toxin-producing Escherichia coli, Salmonella, and Campylobacter species among diarrheal patients from three major hospitals in Ethiopia

Diarrheal illness remains a major global health challenge, causing millions of deaths annually. Non-typhoidal Salmonella (NTS), Shiga toxin-producing Escherichia coli (STEC), and Campylobacter species (CAMPY) significantly contribute to this burden. Given the limited information on these pathogens in Ethiopia, this study aimed to estimate their prevalence among diarrhea patients in Ethiopia and identify risk factors for infection. A cross-sectional study was conducted from October 2021 to November 2022 in three hospitals in Ethiopia (Addis Ababa, Gondar, and Harar). Sociodemographic characteristics, clinical signs and symptoms were collected from study participants using a structured questionnaire. Stool samples were tested for NTS, STEC, and CAMPY using standardized methods. The prevalence of targeted pathogens was estimated overall and by study sites. Univariable and multivariable logistic regression were used to identify associated factors. A total of 2,331 patients were enrolled. The overall prevalence of NTS, STEC (stx only), STEC (stx + eae), and CAMPY was 1.29% (95%CI: 0.91, 1.84), 12.56% (95%CI: 11.29, 13.98), 3.43% (95%CI: 2.77, 4.25), and 4.46% (95%CI: 4.61, 8.00), respectively. Harar had the highest prevalence of all the pathogens compared to Addis Ababa and Gondar. Odds of NTS in Harar were over 10 (AOR: 10.43: 95%CI: 2.95, 69.20) and 3.5 times (AOR: 3.57: 95%CI: 1.50, 9.90) higher than that in Addis Ababa and Gondar, respectively. Odds of STEC (stx only) in the dry (AOR: 1.97: 95%CI: 1.37, 2.90) and long rainy (AOR: 1.80: 95%CI: 1.20, 2.69) seasons were nearly twice the odds in the short rainy season. Odds of CAMPY infection decreased by 3.29% (AOR: 0.97: 95%CI: 0.95, 0.98) with every one-year increase in age. Moreover, the odds of CAMPY infection for rural residents (AOR: 1.93, 95%CI: 1.15, 3.19) were nearly twice that of urban residents. This is the first study to estimate the prevalence of NTS, STEC, and CAMPY simultaneously across all age groups and diverse regions in Ethiopia, revealing significant variations. Results can be used to understand the burden of disease, inform clinical management and risk mitigation strategies to reduce illness in Ethiopia.

Microbiota and metabolome dynamics induced by Shiga toxin-producing E. coli in an in vitro model of an infant's colon

Shiga toxin-producing Escherichia coli (STEC) is a major food-borne pathogen causing human diseases ranging from diarrhea to life-threatening complications, mainly in young children. Colonization, virulence, and interactions of STEC strains with human gut microbiota are pivotal during infection but remain poorly described, particularly in children, the most affected population. In this work, we evaluated changes in the microbiota and metabolome composition in the in vitro gut model: Toddler ARtificial COLon (T-ARCOL) infected with EHEC O157:H7 strain EDL 933. Stool samples collected from children with STEC-positive diarrhea and stool from the same children after recovery from the diarrheal episode (n=5) were used to inoculate the T-ARCOL model. STEC colonization was progressively reduced throughout fermentation in T-ARCOL with diarrhea or recovery fecal samples. Beta diversity showed that the diarrhea-associated microbiota was significantly distinct from the recovery microbiota and exhibited a lower α-diversity. In contrast to recovery conditions, diarrheal conditions were characterized by an increased abundance of potential pathobionts such as members of the Clostridiaceae family and higher acetate, succinate, and N-acetylneuraminic acid levels. Our results provide new evidence of the impact of EHEC in the microbiota and metabolome dynamics in an in vitro gut model that could be useful in understanding their physiopathology in this at-risk population, considering inter-individual variabilities in gut microbiota.

Association of Escherichia coli pathotypes with fecal markers of enteropathy and nutritional status among underweight adults in Bangladesh

Introduction

Environmental enteric dysfunction (EED), a subclinical intestinal disorder, is characterized by chronic fecal-oral exposure to entero-pathogens and could be diagnosed by measuring non-invasive biomarkers. Escherichia coli is the one of the key bacterial enteric pathogens that drives EED, but there is a lack of information on the E. coli pathotypes in relation to the biomarkers of EED in malnourished adults. Here, we intended to measure the possible association of these pathotypes with EED biomarkers and nutritional status of adults residing in a slum in Bangladesh.

Method

Fecal samples were collected from 524 malnourished adults (BMI ≤18.5 kg/m2) living in a slum-setting in Dhaka from March 2016 to September 2019 and analyzed by TaqMan Array Card assays to evaluate the presence of E. coli pathotypes and other entero-pathogens. The multivariable linear regression model was used to assess the association.

Results

In these malnourished adults, the most prevalent pathotype of E. coli was EAEC (61.7%) and the least prevalent was STEC (6.7%). The prevalence of atypical EPEC, ETEC and Shigella/EIEC were 52%, 48.9% and 45.1% respectively. The infection with atypical EPEC had significant positive association with levels of Myeloperoxidase (b = 0.38; 95% CI = 0.11, 0.65; p-value = 0.006). Similarly, a significantly higher concentration of alpha-1-antitrypsin (b = 0.13; 95% CI = 0.03, 0.22; p-value = 0.011) was found in the STEC-infected adults. However, no notable association was found between the E. coli pathotypes and nutritional status of these adult participants. Moreover, Plesiomonas infected adults were more likely to be infected with EAEC (p-value = 0.017), ETEC (p-value <0.001) and STEC (pvalue = 0.002). Significant coinfection was also detected among the pathotypes and other entero-pathogens such as Giardia, Ascaris, Campylobacter, Salmonella, Enterocytozoon bieneusi, and Adenovirus.

Discussion

The study results imply that there is an influence of particular E. coli pathotypes (EPEC and STEC) on intestinal inflammation and gut permeability of the malnourished Bangladeshi adults, but no association with nutritional status is found. Potential pathogenicity of the E. coli pathotypes is also observed when co-infection with other pathogens exists in these adults.

Determinants of diarrheal diseases among patients attending public health centers in Addis Ababa and Hossana, Ethiopia: a matched case-control study

BACKGROUND

The incidence of diarrheal diseases varies widely between and within countries due to different socioeconomic, environmental and behavioural factors. The aim of this study was to assess the determinants of diarrheal diseases among patients attending public health facilities in Addis Ababa and Hossana, Ethiopia.

METHODS

An age-matched case-control study was conducted in health facilities to recruit study participants and collect data from December 2021 to September 2022. Socio-demographic data and other risk factors were collected from study participants using a structured questionnaire. Conditional logistic regression was used to identify the independent predictor variables. The strength of the associations was measured using the adjusted odds ratio with the corresponding 95%CI. Statistical significance is indicated whenever the p value is less than 0.05.

RESULTS

Being partially vaccinated (AOR: 2.70; 95% CI 1.2, 5.9), use of tap water for drinking (AOR: 2.20; 95% CI 1.1, 4.4) and use of protected well/spring water for drinking (AOR: 13.90; 95% CI 3.7, 51.5), overcrowded sleeping places (AOR: 1.50; 95% CI 1.2, 1.8), contact with animal feces/food (AOR: 15.10; 95% CI 4.2, 53.6), the cleaning frequency of water-fetching materials (i.e., cleaned sometimes (AOR: 2.40; 95% CI 1.2, 4.5) and rarely (AOR: 3.03; 95% CI 1.2, 7.4)), and using an open latrine (AOR: 5.61; 95% CI 1.5, 21.0) were significantly associated with an increased likelihood of diarrhea. A higher BMI (AOR: 0.75; 95% CI 0.7, 0.8) was significantly associated with not having diarrhea.

CONCLUSIONS

The incidence of diarrheal diseases was influenced by several factors, including children's immunization status and unhygienic living conditions. Therefore, timely immunization, access to safe drinking water, proper hygiene practices and improved sanitation facilities are essential for the control of diarrheal diseases and safeguarding public health.

Global burden of diarrhea disease in the older adult and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

Introduction

Diarrhea disease among the older adult is an underappreciated global health issue despite its substantial burden. This study provides a comprehensive analysis of the epidemiological trends of diarrhea in individuals over 65 years, examining incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021.

Methods

Utilizing data from the Global Burden of Diseases (GBD) 2021, this cross-sectional study assesses the older adult population across 204 countries and territories. The analysis includes metrics such as incidence, prevalence, mortality, DALYs, and estimated annual percentage changes (EAPCs), stratified by region, country, age, sex, and Sociodemographic Index (SDI).

Results

A nearly 200% increase in incidence and prevalence was observed worldwide, with the highest rise in those over 95 years. Mortality and DALYs have declined, especially in the 65-69 age group. High SDI regions showed the largest increase in incidence rates and are the only areas with increasing mortality and DALYs trends. Unsafe water sources emerged as the primary risk factor for diarrhea-related deaths among the older adult.

Discussion

The burden of diarrhea in the older adult has significantly increased, particularly in high-income regions, warranting targeted interventions. The positive correlation between EAPC and the Human Development Index underscores the need for improved water safety to mitigate the disease burden. This study's findings are crucial for shaping public health strategies and informing policy decisions regarding the older adult population.

Use of stool molecular panel in hospitalized patients with diarrhea. Experience in a tertiary care center

Infectious diarrhea is a common health issue that affects a large number of individuals each year. It causes significant morbidity and mortality, greatly impacting healthcare system costs. Rapid detection of the causative organism and timely treatment alters the management and outcome of the condition. Molecular panels in stool allow to analyze a wide range of pathogens quickly and easily. For this study, a cross-sectional cohort analysis with a retrospective analysis of adult patients hospitalized with diarrhea and negative conventional stool bacteriological studies was conducted. Data obtained from the use of molecular panels in stool and the role of endoscopy in the diagnostic pathway were analyzed. A positivity rate of 52% (n=41) out of a total of 79 samples was reported. The test contributed to a change in therapeutic approach in 58% (n=46) of the patients. Among the patients with a negative molecular panel, 39.5% underwent further evaluation with colonoscopy involving biopsies, resulting in a diagnostic yield of 87%. Based on these results, we can conclude that molecular techniques contribute to the diagnosis and change in therapeutic approach in hospitalized patients with diarrhea.

Identifying risk factors for vomiting during diarrhea: A secondary analysis of a randomized trial of zinc supplementation

OBJECTIVES

Supplemental zinc during acute diarrhea reduces illness duration but also increases vomiting. In a recent trial, we found that children receiving lower daily doses of zinc (5 mg or 10 mg vs. 20 mg) had lower rates of vomiting with comparable stool output and duration of diarrhea. We performed a secondary analysis to identify sociodemographic and clinical factors associated with vomiting in children with acute diarrhea.

METHODS

We performed a secondary data analysis of 4500 children aged 6-59 months with an acute episode of diarrhea (<72 h before enrollment) in a randomized, double-blind controlled trial in India and Tanzania. To identify clinically important risk factors for overall, regimen-related, and regimen-unrelated vomiting, we created log-binomial models with relative risks (RRs) and 95% confidence intervals (CIs).

RESULTS

The trial enrolled 4500 children, of whom 1203 (26.7%) had any vomiting. After adjusting for multiple demographic and clinical characteristics, the presence of dehydration (RR: 1.45, 95% CI: 1.10-1.92), being underweight (RR: 1.22, 95% CI: 1.05-1.41), receipt of the rotavirus vaccine (RR: 1.89, 95% CI: 1.69-2.12), and household wealth above the median (RR: 1.17, 95% CI: 1.07-1.29) were factors associated with an increased risk of vomiting. Rotavirus vaccine receipt was nearly 100% concordant with the study site of Tanzania. Older age and lower zinc dosing were associated with a lower risk of vomiting.

CONCLUSIONS

Young, underweight, or dehydrated children are more likely to have concurrent vomiting with zinc supplementation. Identification of these factors may allow providers to better monitor such children, thus reducing the chances of recurrent dehydration or inadequate dietary intake.

The current state of pediatric gastroenterology in under-resourced nations

Background

Pediatric gastroenterology (GI) care in low- and middle-income countries (LMICs) faces substantial challenges due to limited healthcare infrastructure, inadequate resources, and a shortage of specialized healthcare professionals. These challenges lead to delayed diagnoses and treatment, exacerbating the morbidity and mortality associated with pediatric GI diseases, which include both infectious conditions like diarrhea and chronic conditions such as inflammatory bowel disease (IBD) and liver diseases.

Aim

The aim of this review is to examine the current state of pediatric GI care in LMICs, identify the key challenges these regions face, and propose strategies to improve healthcare outcomes for children affected by GI disorders.

Methods

This review synthesizes existing literature from a range of LMICs, analyzing factors such as the economic burden of healthcare, barriers to access, the availability of diagnostic and therapeutic services, and the state of pediatric hepatology and endoscopy. Studies included in the review were sourced from countries in sub-Saharan Africa, South Asia, and other LMIC regions, focusing on pediatric GI disorders and healthcare delivery.

Results

Economic burden: Families in LMICs face significant economic barriers in accessing pediatric GI care, with treatment costs often exceeding household income, especially in private healthcare settings. Healthcare access: Limited access to healthcare facilities, especially in rural areas, coupled with the shortage of trained pediatric gastroenterologists and necessary medical equipment, leads to delayed diagnoses and inadequate care for conditions like Helicobacter pylori infections and chronic liver diseases. Sanitation and infectious diseases: Poor sanitation and lack of access to clean water contribute to the high prevalence of diarrheal diseases, which can be reduced through better hygiene practices and improved infrastructure. Training gaps: The shortage of trained healthcare workers, particularly pediatric specialists, hinders effective care delivery, with healthcare workers often overburdened due to workforce migration and low salaries. Hepatology and endoscopy: Pediatric hepatology, especially in the context of viral hepatitis, and the availability of pediatric GI endoscopy are severely limited in LMICs, further complicating the management of liver diseases and GI conditions in children.

Conclusion

Improving pediatric GI care in LMICs requires addressing systemic challenges such as inadequate healthcare infrastructure, limited financial resources, and a shortage of trained professionals. Prevention strategies like vaccination, sanitation improvements, and public health education campaigns are crucial for reducing the prevalence of pediatric GI diseases. In addition, enhancing access to specialized training, healthcare services, and diagnostic tools will improve outcomes for children in resource-limited settings. Continued international collaboration and investment in local healthcare systems are essential for creating sustainable solutions and bridging the gap in pediatric GI care.

A machine learning approach to predicting inpatient mortality among pediatric acute gastroenteritis patients in Kenya

Background

Mortality prediction scores for children admitted with diarrhea are unavailable, early identification of at-risk patients for proper management remains a challenge. This study utilizes machine learning (ML) to develop a highly sensitive model for timelier identification of at-risk children admitted with acute gastroenteritis (AGE) for better management.

Methods

We used seven ML algorithms to build prognostic models for the prediction of mortality using de-identified data collected from children aged <5 years hospitalized with AGE at Siaya County Referral Hospital (SCRH), Kenya, between 2010 through 2020. Potential predictors included demographic, medical history, and clinical examination data collected at admission to hospital. We conducted split-sampling and employed tenfold cross-validation in the model development. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC) for each of the models.

Results

During the study period, 12 546 children aged <5 years admitted at SCRH were enrolled in the inpatient disease surveillance, of whom 2271 (18.1%) had AGE and 164 (7.2%) subsequently died. The following features were identified as predictors of mortality in decreasing order: AVPU scale, Vesikari score, dehydration, sunken eyes, skin pinch, maximum number of vomits, unconsciousness, wasting, vomiting, pulse, fever, sunken fontanelle, restless, nasal flaring, diarrhea days, stridor, <90% oxygen saturation, chest indrawing, malaria, and stunting. The sensitivity ranged from 46.3%-78.0% across models, while the specificity and AUC ranged from 71.7% to 78.7% and 56.5%-82.6%, respectively. The random forest model emerged as the champion model achieving 78.0%, 76.6%, 20.6%, 97.8%, and 82.6% for sensitivity, specificity, PPV, NPV, and AUC, respectively.

Conclusions

This study demonstrates promising predictive performance of the proposed algorithm for identifying patients at risk of mortality in resource-limited settings. However, further validation in real-world clinical settings is needed to assess its feasibility and potential impact on patient outcomes.

Efficacy of rotavirus vaccines in Indonesia: A review of genotype distribution and impact

Rotavirus remains the leading cause of diarrhea among children under five years of age, with an incidence of 31.1-90.9% in Indonesia. Initially, a rotavirus vaccination program was introduced in several provinces of Indonesia in 2022, which would be conducted nationally. This review provides information on the rotavirus genotype distribution in Indonesia, efficacy and effectiveness data of the rotavirus vaccine, and an update on the status of rotavirus vaccine implementation worldwide. The results show a varied distribution of G and P genotypes from 1978 to 2018, with G1-G3, G9, P[4], P[6], and P[8] as the prevalent genotypes, followed by a small proportion of G4, P[9], P[10], and P[11]. Three rotavirus vaccines, which are prequalified by the World Health Organization (WHO) and available in Indonesia, showed an efficacy of 17.6-76.9% in high-mortality countries. The Indonesian government procured ROTAVAC with a G9P[11] genotype for the national immunization program, which showed 31.3-69.1% protective efficacy against severe gastroenteritis caused by other strains. This review suggested that the decision to choose the rotavirus vaccine for the national program should take into account the country's prevalent circulating genotype and the vaccine's efficacy against severe diarrhea. The use of a pentavalent rotavirus vaccine with high efficacy in high-mortality countries can be regarded as the prime choice for the program. Another alternative is the rotavirus vaccine, which showed efficacy data in multiple high-mortality countries. In addition, regular surveillance of the rotavirus genotypes and the clinical manifestations of diarrhea are necessary to design vaccination strategies in Indonesia.

Entamoeba histolytica extracellular vesicles drive pro-inflammatory monocyte signaling

The parasitic protozoan Entamoeba histolytica secretes extracellular vesicles (EVs), but so far little is known about their function in the interaction with the host immune system. Infection with E. histolytica trophozoites can lead to formation of amebic liver abscesses (ALAs), in which pro-inflammatory immune responses of Ly6Chi monocytes contribute to liver damage. Men exhibit a more severe pathology as the result of higher monocyte recruitment and a stronger immune response. To investigate the role of EVs and pathogenicity in the host immune response, we studied the effect of EVs secreted by low pathogenic EhA1 and highly pathogenic EhB2 amebae on monocytes. Size and quantity of isolated EVs from both clones were similar. However, they differed in their proteome and miRNA cargo, providing insight into factors potentially involved in amebic pathogenicity. In addition, EVs were enriched in proteins with signaling peptides compared with the total protein content of trophozoites. Exposure to EVs from both clones induced monocyte activation and a pro-inflammatory immune response as evidenced by increased surface presentation of the activation marker CD38 and upregulated gene expression of key signaling pathways (including NF-κB, IL-17 and TNF signaling). The release of pro-inflammatory cytokines was increased in EV-stimulated monocytes and more so in male- than in female-derived cells. While EhA1 EV stimulation caused elevated myeloperoxidase (MPO) release by both monocytes and neutrophils, EhB2 EV stimulation did not, indicating the protective role of MPO during amebiasis. Collectively, our results suggest that parasite-released EVs contribute to the male-biased immunopathology mediated by pro-inflammatory monocytes during ALA formation.

Comparative analysis of adenovirus and rotavirus gastroenteritis: insights into inflammatory response and temporal variations

Background

Acute viral gastroenteritis remains a leading cause of healthcare costs globally, prompting the need for effective yet simple diagnostic strategies. This study aimed to comprehensively examine the demographic, clinical, and seasonal characteristics, hemogram parameters, and C-reactive protein levels in children diagnosed with adenovirus and rotavirus gastroenteritis.

Methods

By conducting a retrospective study, three groups of children diagnosed with gastroenteritis (Rotavirus positive, adenovirus positive, and rota/adenovirus negative group) were compared in terms of demographic, clinical, and laboratory parameters.

Results

Among 265 children with gastroenteritis, 59.6% were under 36 months, and 36.8% of this group tested positive for rotavirus, while 30% of them tested positive for adenovirus. A statistically significant association was observed between rotavirus gastroenteritis and high neutrophil/lymphocyte value (2.76 ± 1.52) and decreased mean platelet volume (7.47 ± 0.36 fL). Temporal analysis revealed numerical peaks in the adenovirus group in summer and rotavirus in winter; however, these differences were not statistically significant (p = 0.684, 0.851). Unlike rotavirus, our study did not reveal any prominent laboratory marker that serves as a distinctive feature of adenovirus.

Conclusions

Our findings suggested that decreased mean platelet volume and high neutrophil/lymphocyte ratio were found statistically significant in rotavirus gastroenteritis, distinguishing it from other causes of acute gastroenteritis.

BECC-engineered live-attenuated Shigella vaccine candidates display reduced endotoxicity with robust immunogenicity in mice

Shigella spp. infection contributes significantly to the global disease burden, primarily affecting young children in developing countries. Currently, there are no FDA-approved vaccines against Shigella, and the prevalence of antibiotic resistance is increasing, making therapeutic options limited. Live-attenuated vaccine strains WRSs2 (S. sonnei) and WRSf2G12 (S. flexneri 2a) are highly immunogenic, making them promising vaccine candidates, but possess an inflammatory lipid A structure on their lipopolysaccharide (LPS; also known as endotoxin). Here, we utilized bacterial enzymatic combinatorial chemistry (BECC) to ectopically express lipid A modifying enzymes in WRSs2 and WRSf2G12, as well as their respective wild-type strains, generating targeted lipid A modifications across the Shigella backgrounds. Dephosphorylation of lipid A, rather than deacylation, reduced LPS-induced TLR4 signaling in vitro and dampened endotoxic effects in vivo. These BECC-modified vaccine strains retained the phenotypic traits of their parental strains, such as invasion of epithelial cells and immunogenicity in mice without adverse endotoxicity. Overall, our observations suggest that BECC-engineered live attenuated vaccines are a promising approach to safe and effective Shigella vaccines.

Highly Drug-Resistant Escherichia coli from Hospital Wastewater with Several Evolutionary Mutations: An Integrated Insights from Molecular, Computational, and Biophysics

Many people around the world are still unable to get access to clean drinking water. Escherichia coli is a common waterborne pathogen that frequently results from insufficient hygiene measures and needs attention to address health problems. The present study aimed to evaluate antibiotic resistance of Escherichia coli isolated from wastewater and drinking water samples of hospital and non-hospital settings at Peshawar. Out of 462 samples collected, 111 tested positive for E. coli. The majority of isolates were resistant to many antibiotics including Ampicillin, Gentamicin, Tobramycin, Imipenem, Meropenem, Tetracycline, Cefepime, Amikacin, Piperacillin, Levofloxacin, Ciprofloxacin, Ceftriaxone, and Cefazolin. However, they showed susceptibility to Chloramphenicol, Fosfomycin 200 mg, Colistin, and Tigecycline. Genetic analysis revealed various antibiotic resistance genes within the isolates, i.e., marA(20%), marB(40%) marR(30%), rob(30%), and soxS(35%). Following PCR, the resulting products underwent next-generation sequencing. marA exhibited T10P and D101H mutations, while MarR showed substitutions at M1G, V142S, L143P, and P144C positions. In Rob, D2I, A4P, L10F, I12N, and L253P mutations were observed. The SoxS displayed alterations at H105P, R106A, and L107V positions. Asinex antibacterial library was used to study molecular docking based on virtual screening. SWISS ADME was used to in silico evaluate the pharmacokinetics of these substances. 100 ns molecular dynamics simulation was conducted to estimate free binding energies, confirmation, and stability of the binding mode of the identified compounds. Screening results revealed that LAS-52505571, LAS52171241, LAS52202332, and LAS22461675 compounds showed high affinity to MarA, MarR, SoxS, and Rob proteins, respectively, with the lowest binding energies across the library. In brief, the current study aimed at establishing potential chemical entities that could facilitate the evolution of silicon drugs against antibiotic-resistant E. coli strains.

Bacillus subtilis-Derived Surfactin Alleviates Offspring Intestinal Inflammatory Injuries Through Breast Milk

BACKGROUND

Enteric and diarrheal diseases pose a significant threat to infant health, highlighting the importance of immune defenses in early life, especially maternal protection, in establishing a robust gastrointestinal environment. Surfactin, a bioactive peptide from Bacillus subtilis, has immunomodulatory properties, yet its influence on offspring via maternal gut interference is not fully understood. This study examines the effects of maternal surfactin consumption on breast milk's immunological properties and its consequent effects on neonatal intestinal health.

METHODS

Twenty-eight gravid mice were randomly categorized into two cohorts and were given surfactin or not in drinking water from one week after conception to 21 days postpartum. Cross-fostering experiments were conducted within 12 h after birth. Pups from the surfactin-supplemented dams were fostered and nursed by the control dams, while the pups from the control dams were nursed by the surfactin-supplemented dams.

RESULTS

The findings show that the pups from the surfactin-supplemented dams had increased body weight, improved intestinal morphology with longer villus and deeper crypts, the upregulation of genes related to mucins and antimicrobial peptides, and an increase in IgA+ and CD3+ T cells within the intestinal mucosa. Further, the cross-fostering experiments suggested that the pups nursed by the surfactin-supplemented dams gained more weight, had less intestinal damage, less inflammation, and lower oxidative stress levels induced by Salmonella typhimurium, indicating the immunological benefits of surfactin conveyed through breast milk. Additionally, the expression of pro-inflammatory factors, including nitric oxide, TNF-α, IL-1β, IL-6, MCP-1, and ROS, induced by LPS in the macrophages was significantly inhibited with milk from the surfactin-supplemented dam (MSD) treatment. Interestingly, the MSD treatment induced a shift in macrophage polarization from pro-inflammatory (M1-like) to anti-inflammatory (M2-like), evidenced by the decreased expression of IL-12p40 and iNOS and the increased expression of CD206, TGF-β, and Arg-1. In terms of mechanism, surfactin improved the contents of the anti-inflammatory factors IL-4, IL-10, and TGF-β in the breast milk.

CONCLUSIONS

This research contributes to understanding how maternal interference can modulate breast milk composition, influence infant gastrointestinal development and immunity, and provide nutritional strategy insights.

Intestinal Microbiota and Vaccinations: A Systematic Review of the Literature

Background: Vaccination constitutes a low-cost, safe, and efficient public health measure that can help prevent the spread of infectious diseases and benefit the community. The fact that vaccination effectiveness varies among populations, and that the causes of this are still unclear, indicates that several factors are involved and should be thoroughly examined. The "intestinal microbiota" is the most crucial of these elements. Numerous clinical studies demonstrate the intestinal microbiota's significance in determining the alleged "immunogenicity" and efficacy of vaccines. This systematic review aimed to review all relevant scientific literature and highlight the role of intestinal microbiota in COVID-19, Salmonella typhi, Vibrio cholerae, and rotavirus vaccinations. Materials and Methods: The MESH terms "vaccines" and "microbiota" were used to search the major scientific databases PubMed, SciVerse Scopus, Web of Knowledge, and the Cochrane Central Register of Controlled Clinical Trials. Results: Between February 2024 and October 2024, the analysis was conducted using electronic databases, yielding a total of 235 references. Finally, 24 RCTs were chosen after meeting all inclusion criteria: eight studies of COVID-19, two studies of Salmonella typhi, three studies of Vibrio cholerae, and eleven studies of rotavirus. Only six of these demonstrated good study quality with a Jadad score of three or four. Conclusions: According to the review's results, the intestinal microbiota surely plays a role in vaccinations' enhanced immunogenicity, especially in younger people. As it is still unclear what mechanisms underlie this effect, more research is needed to better understand the role of the intestinal microbiota.

Neutrophil recruitment during intestinal inflammation primes Salmonella elimination by commensal E. coli in a context-dependent manner

Foodborne bacterial diarrhea involves complex pathogen-microbiota-host interactions. Pathogen-displacing probiotics are increasingly popular, but heterogeneous patient outcomes highlighted the need to understand individualized host-probiotic activity. Using the mouse gut commensal Escherichia coli 8178 and the human probiotic E. coli Nissle 1917, we found that the degree of protection against the enteric pathogen Salmonella enterica serovar Typhimurium (S. Tm) varies across mice with distinct gut microbiotas. Pathogen clearance is linked to enteropathy severity and subsequent recruitment of intraluminal neutrophils, which differs in a microbiota-dependent manner. By combining mouse knockout and antibody-mediated depletion models with bacterial genetics, we show that neutrophils and host-derived reactive oxygen species directly influence E. coli-mediated S. Tm displacement by potentiating siderophore-bound toxin killing. Our work demonstrates how host immune factors shape pathogen-displacing probiotic efficiency while also revealing an unconventional antagonistic interaction where a gut commensal and the host synergize to displace an enteric pathogen.

Clinical and microbiological profile of patients with diarrhea evaluated using the gastrointestinal panel in a high-complexity center

INTRODUCTION

Gastrointestinal infections represent a worldwide public health problem. In Colombia, the incidence reaches 21.4 cases per 1,000 inhabitants. Given the limitations of traditional diagnostic methods in terms of sensitivity and specificity, the gastrointestinal panel (GIP) has emerged as a promising tool, allowing rapid detection of 22 pathogens. This study aimed to describe the clinical and microbiological characteristics of immunosuppressed and immunocompetent adult patients with diarrhea and the influence of the gastrointestinal panel in their treatment in a high-complexity hospital in Colombia.

MATERIALS AND METHODS

A cross-sectional observational study was carried out including 350 adult patients treated at the Fundación Valle del Lili hospital between 2021 and 2022. Demographic and clinical variables, GIP findings and treatment were analyzed by univariate and bivariate analysis. We compare immunocompromised and immunocompetent adult patients using Chi-square tests, Fisher's F test for qualitative variables, Student's t-test, and the Mann-Whitney U test for quantitative variables. A significance level of 5% was applied to demonstrate the significance of the variables in all the tests used.

RESULTS

The results showed that 52% were men, with an average age of 52 years. 72.0% presented acute diarrhea, being inflammatory in 60.1%. 39.1% of the patients were immunosuppressed, mainly transplant recipients (31.3%). 53% of the GIPs were positive, with up to 5 pathogens per sample. Bacteria were detected in 80%, viruses in 14.4%, and parasites in 5.5%. The most frequent bacteria were enteropathogenic E. coli (43.0%), enteroaggregative E. coli (18.6%), and C. difficile (17.4%). Norovirus was the predominant virus (67.7%) and Cryptosporidium the most common parasite (41.7%). A higher frequency of Vibrio spp. was observed in non-immunosuppressed patients (p = 0.004) and of enterotoxigenic E. coli in immunosuppressed patients. 41.0% of patients received antibiotic/antiviral therapy, 83% empirically. GIP influenced the treatment of 56.7% of patients, with a 90.0% recovery rate.

CONCLUSION

This study confirms that GIP is a valuable diagnostic tool in the management of adult patients with diarrheal disease, particularly in immunocompromised patients. In our setting it is still a costly and difficult to access test, which makes it necessary to standardize the indications for its application. Future studies could evaluate its cost-effectiveness in our context.

Plant-Made Vaccines Targeting Enteric Pathogens-Safe Alternatives for Vaccination in Developing Countries

Enteric diseases by pathogenic organisms are one of the leading causes of death worldwide, particularly in low-income countries. Despite antibiotics, access to clean water and vaccination are the most economically affordable options to prevent those infections and their health consequences. Vaccines, such as those approved for rotavirus and cholera, have played a key role in preventing several enteric diseases. However, vaccines for other pathogens are still in clinical trials. Distribution and cost remain significant barriers to vaccine access in developing regions due to poor healthcare infrastructure, cold-chain requirements, and high production costs. Plant-made vaccines offer a promising alternative to address these challenges. Plants can be easily grown, lowering production costs, and can be administered in oral forms, potentially eliminating cold-chain dependency. Although there are some promising prototypes of vaccines produced in plants, challenges remain, including yields and achieving sufficient immunogenicity. This review aims to describe common enteric pathogens and available vaccines, followed by a strategic summary of plant-made vaccine development and a discussion of plant-made enteric vaccine prototypes. Trends to overcome the key challenges for plant-made vaccines are identified and placed in perspective for the development of affordable and effective vaccines for populations at the highest risk of enteric diseases.

Global estimates of rotavirus vaccine efficacy and effectiveness: a rapid review and meta-regression analysis

Background

Rotavirus is the leading cause of diarrhoea worldwide, particularly affecting young children. While national rotavirus immunization programs have reduced rotavirus morbidity and mortality, vaccine performance varies considerably between high-income and low-income settings.

Methods

We updated a previous systematic review of studies reporting rotavirus vaccine efficacy and vaccine effectiveness against severe rotavirus-associated gastroenteritis (RVGE) by performing a rapid review from July 1, 2020 through October 16, 2024. We included randomized controlled trials reporting vaccine efficacy against severe RVGE and case-control and cohort studies reporting vaccine effectiveness against hospitalization with RVGE in children <5 years old for current internationally licensed vaccines. We developed a meta-regression model for vaccine efficacy and effectiveness using widely available country-specific predictors of rotavirus vaccine performance and simultaneously estimated the relationship between vaccine efficacy and effectiveness. We used the model to predict vaccine efficacy and effectiveness for all countries and assessed its predictive accuracy using a modified leave-one-country-out validation approach.

Findings

Predicted vaccine efficacy ranged from 69.6% to 94.3% across countries in the Americas, European, and Western Pacific Regions, with a decreased efficacy ranging from 18.6% to 85.3% in the African, South-East Asian, and Eastern Mediterranean regions. Estimates of vaccine effectiveness were generally lower than vaccine efficacy when efficacy was greater than 60%, but effectiveness was predicted to be higher when vaccine efficacy was low. A strong correlation (r = 0.63) was found between the observed and predicted vaccine efficacy and effectiveness, with 98.2% of observed efficacy and effectiveness estimates falling within the 95% prediction intervals.

Interpretation

Our approach enhances the understanding of global variation in rotavirus vaccine performance and can be used to inform predictions of the potential impact of rotavirus vaccines for countries that have yet to introduce them. Higher-quality data on predictor variables and broader regional representation in vaccine trials are required for more robust vaccine performance estimates.

Funding

National Institutes of Health/National Institute of Allergy and Infectious Diseases (R01AI112970) and the Bill & Melinda Gates Foundation (INV-17940).

Assessment of the Communicable Disease Status of Children in Türkiye: A Community-Based Cross-Sectional Study

AIM

Assessment of children's communicable disease status is effective in preventing child morbidity. This study aims to evaluate the infectious disease status of children aged 0-14 in Türkiye.

METHODS

The research is a cross-sectional study conducted using the microdataset of the "Türkiye Health Survey 2022" obtained from the Turkish Statistical Institute. Seven thousand nineteen individuals aged 0-14 were included in the analysis. Data on communicable diseases of children aged 0-14 years in the 6-month period before the survey date was obtained by asking the household head.

RESULTS

In our research, the data of 7019 individuals aged 0-14 was evaluated. It was determined that 2.2% of children had a vaccine-preventable infectious disease in the last 6 months. It was observed that the frequency of upper respiratory tract infection, lower respiratory tract infection, urinary tract infection, and diarrhea in children was higher in the 0-6 age group than in the 7-14 age group. Urinary tract infections were more common in girls, whereas respiratory tract infections, communicable diseases, and diarrhea were more common in boys.

CONCLUSION

It was determined that diarrhea and upper respiratory tract infections occur in approximately one out of every three children in the 0-6 age group.

Norovirus GII.17 gastroenteritis outbreak in a nursing home

INTRODUCTION

Gastrointestinal norovirus infections are highly prevalent, causing outbreaks especially in institutions such as nursing homes. We describe an outbreak caused by an emerging norovirus genotype.

MATERIAL AND METHODS

We defined a case as a resident or worker of the centre with clinical signs and symptoms of AGE from 14 to 29 May 2022, with no underlying pathology to justify it. A clinical-epidemiological survey was carried out and stool samples were collected from patients with diarrhoea at the time of the study. Virological analysis was performed at the Microbiology Department of our hospital by antigenic detection (Certest®, Biotec SL) and/or multiplex PCR (AllplexTM GI-Virus Assay, Seegene®). Viral genotyping by sequencing was performed by the Centro Nacional de Microbiología (CNM).

RESULTS

The outbreak totaled 114 cases (99 residents, 15 workers), extending over 16 days. The most frequent symptoms were vomiting and diarrhoea. The overall attack rate was 30.8% (in workers 12.7%). Cases increased rapidly in the first 48h, falling progressively over successive days. Food contamination was ruled out, with person-to-person transmission being the most likely. Those affected improved clinically in less than 72h, with no deaths. We tested 14 samples from residents, which were positive for norovirus GII. The CNM received 8 samples, detecting norovirus genogroup GII, genotype 17 [P17] in 6.

CONCLUSIONS

Outbreaks of norovirus GEA in nursing homes can affect numerous users. In our case, norovirus genotype GII.17 was the aetiological agent, confirming its widespread dissemination in the last decade worldwide.