Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network
Authors: Cohen Adam L , Platts-Mills James A , Nakamura Tomoka , Operario Darwin J , Antoni Sébastien , Mwenda Jason M , Weldegebriel Goitom , Rey-Benito Gloria , de Oliveira Lucia H , Ortiz Claudia , Daniels Danni S , Videbaek Dovile , Singh Simarjit , Njambe Emmanuel , Sharifuzzaman Mohamed , Grabovac Varja , Nyambat Batmunkh , Logronio Josephine , Armah George , Dennis Francis E , Seheri Mapaseka L , Magagula Nokululeko , Mphahlele Jeffrey , Fumian Tulio M , Maciel Irene T A , Gagliardi Leite Jose Paulo , Esona Matthew D , Bowen Michael D , Samoilovich Elena , Semeiko Galina , Abraham Dilip , Giri Sidhartha , Praharaj Ira , Kang Gagandeep , Thomas Sarah , Bines Julie , Liu Na , Kyu Hmwe H , Doxey Matthew , Rogawski McQuade Elizabeth T , McMurry Timothy L , Liu Jie , Houpt Eric R , Tate Jacqueline E , Parashar Umesh D , Serhan Fatima 
Published: September 2022

IntroductionDiarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise interventions.MethodsWe established the Global Pediatric Diarrhea Surveillance network, in which children under 5 years hospitalised with diarrhoea were enrolled at 33 sentinel surveillance hospitals in 28 low-income and middle-income countries. Randomly selected stool specimens were tested by quantitative PCR for 16 causes of diarrhoea. We estimated pathogen-specific attributable burdens of diarrhoeal hospitalisations and deaths. We incorporated country-level incidence to estimate the number of pathogen-specific deaths on a global scale.ResultsDuring 2017–2018, 29 502 diarrhoea hospitalisations were enrolled, of which 5465 were randomly selected and tested. Rotavirus was the leading cause of diarrhoea requiring hospitalisation (attributable fraction (AF) 33.3%; 95% CI 27.7 to 40.3), followed byShigella(9.7%; 95% CI 7.7 to 11.6), norovirus (6.5%; 95% CI 5.4 to 7.6) and adenovirus 40/41 (5.5%; 95% CI 4.4 to 6.7). Rotavirus was the leading cause of hospitalised diarrhoea in all regions except the Americas, where the leading aetiologies wereShigella(19.2%; 95% CI 11.4 to 28.1) and norovirus (22.2%; 95% CI 17.5 to 27.9) in Central and South America, respectively. The proportion of hospitalisations attributable to rotavirus was approximately 50% lower in sites that had introduced rotavirus vaccine (AF 20.8%; 95% CI 18.0 to 24.1) compared with sites that had not (42.1%; 95% CI 33.2 to 53.4). Globally, we estimated 208 009 annual rotavirus-attributable deaths (95% CI 169 561 to 259 216), 62 853Shigella-attributable deaths (95% CI 48 656 to 78 805), 36 922 adenovirus 40/41-attributable deaths (95% CI 28 469 to 46 672) and 35 914 norovirus-attributable deaths (95% CI 27 258 to 46 516).ConclusionsDespite the substantial impact of rotavirus vaccine introduction, rotavirus remained the leading cause of paediatric diarrhoea hospitalisations. Improving the efficacy and coverage of rotavirus vaccination and prioritising interventions againstShigella, norovirus and adenovirus could further reduce diarrhoea morbidity and mortality.