Title
Duration of Postdiarrheal Enteric Pathogen Carriage in Young Children in Low-resource Settings
Date Issued
01 June 2021
Access level
open access
Resource Type
journal article
Author(s)
Mcmurry T.L.
Mcquade E.T.R.
Liu J.
Kang G.
Lima A.A.M.
Bessong P.O.
Samie A.
Haque R.
Mduma E.R.
Leite J.P.
Bodhidatta L.
Iqbal N.T.
Page N.
Kiwelu I.
Bhutta Z.A.
Ahmed T.
Houpt E.R.
Platts-Mills J.A.
Publisher(s)
Oxford University Press
Abstract
Background: Prolonged enteropathogen shedding after diarrhea complicates the identification of etiology in subsequent episodes and is an important driver of pathogen transmission. A standardized approach has not been applied to estimate the duration of shedding for a wide range of pathogens. Methods: We used a multisite birth cohort of children 0-24 months of age from whom diarrheal and monthly nondiarrheal stools were previously tested by quantitative polymerase chain reaction for 29 enteropathogens. We modeled the probability of detection of the etiologic pathogen before and after diarrhea using a log-normal accelerated failure time survival model and estimated the median duration of pathogen carriage as well as differences in subclinical pathogen carriage 60 days after diarrhea onset in comparison to a prediarrhea baseline. Results: We analyzed 3247 etiologic episodes of diarrhea for the 9 pathogens with the highest attributable burdens of diarrhea. The median duration of postdiarrheal carriage varied widely by pathogen, from about 1 week for rotavirus (median, 8.1 days [95% confidence interval {CI}, 6.2-9.6]) to >1 month for Cryptosporidium (39.5 days [95% CI, 30.6-49.0]). The largest increases in subclinical pathogen carriage before and after diarrhea were seen for Cryptosporidium (prevalence difference between 30 days prior and 60 days after diarrhea onset, 0.30 [95% CI,. 23-.39]) and Shigella (prevalence difference, 0.21 [95% CI,. 16-.27]). Conclusions: Postdiarrheal shedding was widely variable between pathogens, with strikingly prolonged shedding seen for Cryptosporidium and Shigella. Targeted antimicrobial therapy and vaccination for these pathogens may have a relatively large impact on transmission.
Start page
E806
End page
E814
Volume
72
Issue
11
Language
English
OCDE Knowledge area
PediatrÃa
Ciencias socio biomédicas (planificación familiar, salud sexual, efectos polÃticos y sociales de la investigación biomédica)
GastroenterologÃa, HepatologÃa
Subjects
Scopus EID
2-s2.0-85102532417
PubMed ID
Source
Clinical Infectious Diseases
ISSN of the container
10584838
Sponsor(s)
This work was supported by the Bill & Melinda Gates Foundation (award numbers OPP1131125 and OPP1131114); and the NIH (grant numbers K23 AI114888 to J. P. M. and K01AI130326 to E. T. R. M.).
Sources of information:
Directorio de Producción CientÃfica
Scopus