Khalil IA, et al. - Considering the frequent association of Shigella and enterotoxigenic Escherichia coli (ETEC) with diarrheal disease, as well as mortality and morbidity worldwide, researchers investigated the global burden of Shigella and ETEC diarrhea in accordance to age, sex, geography, and year (1990-2016). Estimation of the health burden of bacterial diarrheal pathogens was difficult. However, data showed that pathogens remain a major cause of morbidity and mortality globally despite existing prevention and treatment options. To reduce disease burden, the authors recommended public health officials further emphasize reduction in disease due to Shigella and ETEC.

Methods

• Researchers used a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types based on vital registration and verbal autopsy data to model Shigella- and ETEC-related mortality.
• They modelled the incidence of Shigella and ETEC using a compartmental meta-regression tool.
• Calculation of 95% uncertainty intervals (UIs) was done for the point estimates.

Results

• In 2016, Shigella was identified to be the second leading cause of diarrheal mortality among all ages; it accounted for 212,438 deaths and about 13.2% of all diarrhea deaths.
• Among children younger than 5 years of age, Shigella was noted to be responsible for 63,713 deaths; it was frequently associated with diarrhea across all adult age groups, increasing in elderly people, with broad geographical distribution.
• In 2016, ETEC was eighth among all leading causes of diarrhea mortality among all age groups; it accounted for 51,186 deaths and about 3.2% diarrhea deaths.
• In children younger than 5 years of age, about 4.2% of diarrhea deaths were related to ETEC.