title: Respiratory symptoms and the case definition of gastroenteritis: an international analysis of the potential impact on burden estimates.
abstract: Estimates of the burden of foodborne disease rely on attributing a proportion of syndromic gastroenteritis to foodborne transmission. Persons with syndromic diarrhoea/vomiting can also present with concurrent respiratory symptoms that could be due to respiratory infections, gastrointestinal infections, or both. This distinction is important when estimating the foodborne disease burden but has rarely been considered. Using data from population surveys from Australia, Canada and the USA we describe the effect of excluding persons with respiratory and associated symptoms from the case definition of gastroenteritis. Excluding persons first with respiratory symptoms, or second with respiratory symptoms plus fever and headache, resulted in a decrease in the weighted estimates of acute gastroenteritis of about 10-50% depending on the exclusion criteria. This has the potential to have a very significant impact on estimates of the burden of foodborne infections using syndromic case definitions of acute gastroenteritis.
authors.affiliation: National Centre for Epidemiology and Population Health and Medical School, Australian National University, Canberra Australian Capital Territory 0200 , Australia. gillian.hall@anu.edu.au
authors.forename: G
authors.initials: G
authors.lastname: Hall
authors.forename: L
authors.initials: L
authors.lastname: McDonald
authors.forename: S E
authors.initials: SE
authors.lastname: Majowicz
authors.forename: E
authors.initials: E
authors.lastname: Scallan
authors.forename: M
authors.initials: M
authors.lastname: Kirk
authors.forename: P
authors.initials: P
authors.lastname: Sockett
authors.forename: F J
authors.initials: FJ
authors.lastname: Angulo
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005517:Foodborne Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005759:Gastroenteritis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult