Back to Search Start Over

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).

Authors :
Sow SO
Muhsen K
Nasrin D
Blackwelder WC
Wu Y
Farag TH
Panchalingam S
Sur D
Zaidi AK
Faruque AS
Saha D
Adegbola R
Alonso PL
Breiman RF
Bassat Q
Tamboura B
Sanogo D
Onwuchekwa U
Manna B
Ramamurthy T
Kanungo S
Ahmed S
Qureshi S
Quadri F
Hossain A
Das SK
Antonio M
Hossain MJ
Mandomando I
Nhampossa T
Acácio S
Omore R
Oundo JO
Ochieng JB
Mintz ED
O'Reilly CE
Berkeley LY
Livio S
Tennant SM
Sommerfelt H
Nataro JP
Ziv-Baran T
Robins-Browne RM
Mishcherkin V
Zhang J
Liu J
Houpt ER
Kotloff KL
Levine MM
Source :
PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2016 May 24; Vol. 10 (5), pp. e0004729. Date of Electronic Publication: 2016 May 24 (Print Publication: 2016).
Publication Year :
2016

Abstract

Background: The importance of Cryptosporidium as a pediatric enteropathogen in developing countries is recognized.&lt;br /&gt;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 &lt;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 &lt;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.&lt;br /&gt;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 &lt;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.&lt;br /&gt;Conclusions: The enormous African/Asian Cryptosporidium disease burden warrants investments to develop vaccines, diagnostics and therapies.

Details

Language :
English
ISSN :
1935-2735
Volume :
10
Issue :
5
Database :
MEDLINE
Journal :
PLoS neglected tropical diseases
Publication Type :
Academic Journal
Accession number :
27219054
Full Text :
https://doi.org/10.1371/journal.pntd.0004729