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The Burden of Cryptosporidium Diarrheal Disease among Children < 24 Months of Age in Moderate/High Mortality Regions of Sub-Saharan Africa and South Asia, Utilizing Data from the Global Enteric Multicenter Study (GEMS).


ABSTRACT: BACKGROUND:The importance of Cryptosporidium as a pediatric enteropathogen in developing countries is recognized. METHODS:Data from the Global Enteric Multicenter Study (GEMS), a 3-year, 7-site, case-control study of moderate-to-severe diarrhea (MSD) and GEMS-1A (1-year study of MSD and less-severe diarrhea [LSD]) were analyzed. Stools from 12,110 MSD and 3,174 LSD cases among children aged <60 months and from 21,527 randomly-selected controls matched by age, sex and community were immunoassay-tested for Cryptosporidium. Species of a subset of Cryptosporidium-positive specimens were identified by PCR; GP60 sequencing identified anthroponotic C. parvum. Combined annual Cryptosporidium-attributable diarrhea incidences among children aged <24 months for African and Asian GEMS sites were extrapolated to sub-Saharan Africa and South Asian regions to estimate region-wide MSD and LSD burdens. Attributable and excess mortality due to Cryptosporidium diarrhea were estimated. FINDINGS:Cryptosporidium was significantly associated with MSD and LSD below age 24 months. Among Cryptosporidium-positive MSD cases, C. hominis was detected in 77.8% (95% CI, 73.0%-81.9%) and C. parvum in 9.9% (95% CI, 7.1%-13.6%); 92% of C. parvum tested were anthroponotic genotypes. Annual Cryptosporidium-attributable MSD incidence was 3.48 (95% CI, 2.27-4.67) and 3.18 (95% CI, 1.85-4.52) per 100 child-years in African and Asian infants, respectively, and 1.41 (95% CI, 0.73-2.08) and 1.36 (95% CI, 0.66-2.05) per 100 child-years in toddlers. Corresponding Cryptosporidium-attributable LSD incidences per 100 child-years were 2.52 (95% CI, 0.33-5.01) and 4.88 (95% CI, 0.82-8.92) in infants and 4.04 (95% CI, 0.56-7.51) and 4.71 (95% CI, 0.24-9.18) in toddlers. We estimate 2.9 and 4.7 million Cryptosporidium-attributable cases annually in children aged <24 months in the sub-Saharan Africa and India/Pakistan/Bangladesh/Nepal/Afghanistan regions, respectively, and ~202,000 Cryptosporidium-attributable deaths (regions combined). ~59,000 excess deaths occurred among Cryptosporidium-attributable diarrhea cases over expected if cases had been Cryptosporidium-negative. CONCLUSIONS:The enormous African/Asian Cryptosporidium disease burden warrants investments to develop vaccines, diagnostics and therapies.

SUBMITTER: Sow SO 

PROVIDER: S-EPMC4878811 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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The Burden of Cryptosporidium Diarrheal Disease among Children < 24 Months of Age in Moderate/High Mortality Regions of Sub-Saharan Africa and South Asia, Utilizing Data from the Global Enteric Multicenter Study (GEMS).

Sow Samba O SO   Muhsen Khitam K   Nasrin Dilruba D   Blackwelder William C WC   Wu Yukun Y   Farag Tamer H TH   Panchalingam Sandra S   Sur Dipika D   Zaidi Anita K M AK   Faruque Abu S G AS   Saha Debasish D   Adegbola Richard R   Alonso Pedro L PL   Breiman Robert F RF   Bassat Quique Q   Tamboura Boubou B   Sanogo Doh D   Onwuchekwa Uma U   Manna Byomkesh B   Ramamurthy Thandavarayan T   Kanungo Suman S   Ahmed Shahnawaz S   Qureshi Shahida S   Quadri Farheen F   Hossain Anowar A   Das Sumon K SK   Antonio Martin M   Hossain M Jahangir MJ   Mandomando Inacio I   Nhampossa Tacilta T   Acácio Sozinho S   Omore Richard R   Oundo Joseph O JO   Ochieng John B JB   Mintz Eric D ED   O'Reilly Ciara E CE   Berkeley Lynette Y LY   Livio Sofie S   Tennant Sharon M SM   Sommerfelt Halvor H   Nataro James P JP   Ziv-Baran Tomer T   Robins-Browne Roy M RM   Mishcherkin Vladimir V   Zhang Jixian J   Liu Jie J   Houpt Eric R ER   Kotloff Karen L KL   Levine Myron M MM  

PLoS neglected tropical diseases 20160524 5


<h4>Background</h4>The importance of Cryptosporidium as a pediatric enteropathogen in developing countries is recognized.<h4>Methods</h4>Data from the Global Enteric Multicenter Study (GEMS), a 3-year, 7-site, case-control study of moderate-to-severe diarrhea (MSD) and GEMS-1A (1-year study of MSD and less-severe diarrhea [LSD]) were analyzed. Stools from 12,110 MSD and 3,174 LSD cases among children aged <60 months and from 21,527 randomly-selected controls matched by age, sex and community wer  ...[more]

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