Dataset Information

Etiological, epidemiological, and clinical features of acute diarrhea in China.

ABSTRACT: National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018. Here we report the etiological, epidemiological, and clinical features of the 152,792 eligible patients enrolled in this analysis. Rotavirus A and norovirus are the two leading viral pathogens detected in the patients, followed by adenovirus and astrovirus. Diarrheagenic Escherichia coli and nontyphoidal Salmonella are the two leading bacterial pathogens, followed by Shigella and Vibrio parahaemolyticus. Patients aged <5 years had higher overall positive rate of viral pathogens, while bacterial pathogens were more common in patients aged 18‒45 years. A joinpoint analysis revealed the age-specific positivity rate and how this varied for individual pathogens. Our findings fill crucial gaps of how the distributions of enteropathogens change across China in patients with diarrhea. This allows enhanced identification of the predominant diarrheal pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures.

SUBMITTER: Wang LP

PROVIDER: S-EPMC8085116 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Etiological, epidemiological, and clinical features of acute diarrhea in China.

Wang Li-Ping LP Zhou Shi-Xia SX Wang Xin X Lu Qing-Bin QB Shi Lu-Sha LS Ren Xiang X Zhang Hai-Yang HY Wang Yi-Fei YF Lin Sheng-Hong SH Zhang Cui-Hong CH Geng Meng-Jie MJ Zhang Xiao-Ai XA Li Jun J Zhao Shi-Wen SW Yi Zhi-Gang ZG Chen Xiao X Yang Zuo-Sen ZS Meng Lei L Wang Xin-Hua XH Liu Ying-Le YL Cui Ai-Li AL Lai Sheng-Jie SJ Liu Meng-Yang MY Zhu Yu-Liang YL Xu Wen-Bo WB Chen Yu Y Wu Jian-Guo JG Yuan Zheng-Hong ZH Li Meng-Feng MF Huang Liu-Yu LY Li Zhong-Jie ZJ Liu Wei W Fang Li-Qun LQ Jing Huai-Qi HQ Hay Simon I SI Gao George F GF Yang Wei-Zhong WZ

Nature communications 20210429 1

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 2009‒2018. Here we report the etiological, epidemiological, and clinical features of the 152,792 eligible patients enrolled in this analysis. Rotavirus A and norovirus are the two leading viral pathogens detected in the patients, followed by adenovirus and astrovirus. Diarrheagenic Escherichia coli and nontyphoidal Salmonella are the two leading bacterial pathogens, followed by Shigella ...[more]

PMID: 33927201

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Project description:BackgroundAcute meningitis or encephalitis (AME) results from a neurological infection causing high case fatality and severe sequelae. AME lacked comprehensive surveillance in China.MethodsNation-wide surveillance of all-age patients with AME syndromes was conducted in 144 sentinel hospitals of 29 provinces in China. Eleven AME-causative viral and bacterial pathogens were tested with multiple diagnostic methods.FindingsBetween 2009 and 2018, 20,454 AME patients were recruited for tests. Based on 9,079 patients with all-four-virus tested, 28.43% (95% CI: 27.50%‒29.36%) of them had at least one virus-positive detection. Enterovirus was the most frequently determined virus in children <18 years, herpes simplex virus and Japanese encephalitis virus were the most frequently determined in 18-59 and ≥60 years age groups, respectively. Based on 6,802 patients with all-seven-bacteria tested, 4.43% (95% CI: 3.94%‒4.91%) had at least one bacteria-positive detection, Streptococcus pneumoniae and Neisseria meningitidis were the leading bacterium in children aged <5 years and 5-17 years, respectively. Staphylococcus aureus was the most frequently detected in adults aged 18-59 and ≥60 years. The pathogen spectrum also differed statistically significantly between northern and southern China. Joinpoint analysis revealed age-specific positive rates, with enterovirus, herpes simplex virus and mumps virus peaking at 3-6 years old, while Japanese encephalitis virus peaked in the ≥60 years old. As age increased, the positive rate for Streptococcus pneumoniae and Escherichia coli statistically significantly decreased, while for Staphylococcus aureus and Streptococcus suis it increased.InterpretationThe current findings allow enhanced identification of the predominant AME-related pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures in China, and a possible reassessment of vaccination strategy.FundingChina Mega-Project on Infectious Disease Prevention and the National Natural Science Funds.

Project description:Group A rotavirus infections cause diarrhea in infants and primarily occur in winter. These viruses are characterized by the viral structural proteins VP7 (G subtypes) and VP4 (P subtypes). Current treatments employ vaccines combined with symptomatic treatments. Through a review of published papers from 2003-2013, which included articles, theses, dissertations and academic conference proceedings in PubMed and CNKI (China National Knowledge Infrastructure), we examined the epidemiological and clinical studies conducted in the 7 regional administrative geographical divisions of the People's Republic of China. Binning of the clinical studies provided a quantitative synthesis of the published incidences of rotavirus-positive numbers, the infection rates and the distributions of different subtypes in the provinces. In an investigation of the 32 provincial administrative regions from 1994-2013, the number of positive infections in children, primarily ≤5 years of age, was highest in Guangdong (187,000 cases), Zhejiang (133,000 cases) and Hubei (11,000 cases) Provinces; the provinces that displayed the highest positive rates were Henan (75.20%), Jilin (64.94%) and the Ningxia Hui Autonomous Region (60.16%). Furthermore, the virus, which causes diarrhea, can also infect adults. Statistics regarding the rotavirus subtypes indicated that the top 3 G-subtypes reported were G3 (8,509 cases), G1 (6,490 cases) and G2 (1,601 cases); the top 3 P-subtypes reported were P[8] (8,483 cases), P[4] (2,017 cases) and P[6] (740 cases). The majority of clinical treatments for these infections comprised a combination of Chinese traditional and Western medicines, together with nursing and the administration of a variety of oral liquids to relieve symptoms. The top 3 positive rates were identified in provinces at higher latitude, which confirms increases in humidity and ambient temperature reduce the rotavirus infection rate and the number of rotavirus infections tends to be highest under cool, dry conditions. However, the presence of rotavirus in low-latitude provinces likely indicates living habits, living environments, and education level influencethe precautions and vaccine utilization rate. The traditional subtypes are the rotavirus G- and P-subtypes, thus allowing for the development of vaccines. In China, the treatments that are primarily used to combat the infection are integrative medicines combining a variety of nursing and adjuvant therapies.

Project description:BackgroundHuman adenovirus (HAdV) had been recognized as one of the most common enteric viruses associated with acute diarrhea in children. The present study was carried out to demonstrate the molecular and epidemiological characterization of HAdV Infections among children in Shandong province in China between July 2017 and June 2018.MethodsFecal specimens were collected from children under 5 years old with acute diarrhea. DNA was extracted from the stool specimens and adenovirus DNA was detected by PCR amplification with specific primers. The amplification products were subjected to electrophoresis and visualized on a UV transilluminator. All positive RT-PCR amplification products were sequenced and the obtained sequences analyzed by MEGA (version 7.0). Demographic information and clinical manifestation data were also analyzed.ResultsIn total, 656 fecal specimens were collected and the overall positive rate of HAdV was 7.47%. HAdV infections were detected in all age groups, in which children aged 13-24 months presented the highest positive rate. Seasonal pattern could be observed with a peak in December, January and February. Diarrhea, vomiting, dehydration and fever were the main clinical manifestations, in which vomiting was the most common accompanied symptom. By phylogenetic analysis, four species (A, B, C, and F) were detected and seven different serotypes were identified. HAdV-41 (48.98%, 24/49) was the most common serotype followed by HAdV-3 (18.37%, 9/49), HAdV-31 (14.29%, 7/49), HAdV-7 (8.16%, 4/49), HAdV-40 (4.08%, 2/49), HAdV-1 (4.08%, 2/49) and HAdV-2 (2.04%, 1/49).ConclusionThis study indicated that HAdV infection was an important cause of acute diarrhea among children under 5 years old in Shandong province. The results will contribute to (a) increase understanding of the role of HAdV in diarrheal children and enhance identification of the predominant diarrhea pathogen for diagnosis; (b) avoid abuse of antibiotics; (c) monitor the change of prevalent HAdV serotypes and promote vaccine development and vaccination.

Dataset Information

Etiological, epidemiological, and clinical features of acute diarrhea in China.

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Etiological, epidemiological, and clinical features of acute diarrhea in China.

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