title: Changes in causes of acute gastroenteritis in the United Kingdom over 15 years: microbiologic findings from 2 prospective, population-based studies of infectious intestinal disease.
abstract: BACKGROUND
  Large-scale, prospective studies of infectious intestinal disease (IID) in developed countries are uncommon. Two studies of IID incidence and etiology have been conducted in the United Kingdom: the Infectious Intestinal Disease Study in England (IID1) in 1993-1996 and the Second Study of Infectious Intestinal Disease in the Community (IID2) in 2008-2009. We examined changes in etiology and diagnostic yield of IID cases over 15 years.
  
  
  METHODS
  Fecal samples submitted by IID cases were examined for a range of bacterial, viral, and protozoal pathogens using traditional and molecular microbiological methods. We calculated the percentage of specimens positive for each organism based on traditional methods and on traditional and molecular methods combined. We compared the distributions of organisms in the 2 studies.
  
  
  RESULTS
  For pathogens investigated in both studies, 40% of fecal samples submitted by cases in IID2 were positive compared with 28% in IID1. Viruses were most frequent among community cases in IID2. Campylobacter was the most common bacterial pathogen among cases presenting to healthcare. Major differences between the 2 studies were increases in the detection of norovirus and sapovirus and a decline Salmonella.
  
  
  CONCLUSIONS
  Most fecal specimens were negative for the pathogens tested in both studies, so new strategies are needed to close the diagnostic gap. Among known pathogens, effective control of norovirus, rotavirus, and Campylobacter remain high priorities. The reduction in nontyphoidal salmonellosis demonstrates the success of Europe-wide control strategies, notably an industry-led Salmonella control program in poultry in the United Kingdom.
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Clarence C
authors.initials: CC
authors.lastname: Tam
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
authors.forename: David S
authors.initials: DS
authors.lastname: Tompkins
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Bolton
authors.forename: Lisa
authors.initials: L
authors.lastname: Berry
authors.forename: Julie
authors.initials: J
authors.lastname: Dodds
authors.forename: Dalia
authors.initials: D
authors.lastname: Choudhury
authors.forename: Fenella
authors.initials: F
authors.lastname: Halstead
authors.forename: Miren
authors.initials: M
authors.lastname: Iturriza-Gómara
authors.forename: Katherine
authors.initials: K
authors.lastname: Mather
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.forename: Alan
authors.initials: A
authors.lastname: Ridge
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.forename: John
authors.initials: J
authors.lastname: Wain
authors.forename: Bernard
authors.initials: B
authors.lastname: Wood
authors.forename: James J
authors.initials: JJ
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017250:Caliciviridae Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D060085:Coinfection; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005759:Gastroenteritis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D029322:Norovirus / Q000302:isolation & purification; D011446:Prospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012480:Salmonella Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D029341:Sapovirus / Q000302:isolation & purification; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult