Etiology of diarrhea among children under the age five in China: Results from a five-year surveillance.
OBJECTIVE
Diarrhea is a leading cause of morbidity and mortality for children, although sparse data is available on the etiology of diarrhea in China. This study was conducted to determine main causes that underlie childhood diarrhea and related diseases.


METHODS
Surveillance data for diarrhea was collected from 213 participating hospitals between 2009 and 2013. These stool specimens, from children aged 0-59 months, were then analyzed for a panel of etiological agents consisting of 5 viruses, 8 bacteria and 3 protozoa. The proportion of children who tested positive for each pathogen was calculated and seasonal patterns for major organisms were determined.


RESULTS
Pathogens were identified in 44.6% of the 32,189 samples from children with diarrhea. The most commonly detected pathogens were rotavirus (29.7% of cases), norovirus (11.8%), Diarrheagenic Escherichia coli (DEC; 5.0%), adenovirus (4.8%), non-typhoidal Salmonella (NTS; 4.3%), and Shigella spp. (3.6%). A strong seasonal pattern was observed for these organisms, including rotavirus (winter), norovirus (autumn), and DEC, NTS, and Shigella (summer).


CONCLUSIONS
A wide range of enteropathogens were detected in this five-year surveillance study; rotavirus and norovirus were most common among children under the age five. These findings should serve as robust evidence for public health entities when planning and developing national intervention programs in China.
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Jianxing
J
Yu
National Institute for Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Huaiqi
H
Jing
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Shengjie
S
Lai
National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Wenbo
W
Xu
Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, China.
Mengfeng
M
Li
State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
Jianguo
J
Wu
Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China.
Wei
W
Liu
Shanghai Public Health Clinical Center, Shanghai, China.
Zhenghong
Z
Yuan
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Yu
Y
Chen
Yunnan Provincial Center for Disease Control and Prevention, Kunming, China.
Shiwen
S
Zhao
Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China.
Xinhua
X
Wang
Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China.
Zhuo
Z
Zhao
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Lu
L
Ran
International Emerging Infections Program, US Centers for Disease Control and Prevention, Beijing, China; Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
Shuyu
S
Wu
International Emerging Infections Program, US Centers for Disease Control and Prevention, Beijing, China; Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
John D
JD
Klena
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Luzhao
L
Feng
State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
Fu
F
Li
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Xianfei
X
Ye
State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
Yanzi
Y
Qiu
National Institute for Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Xin
X
Wang
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Hongjie
H
Yu
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: lizj@chinacdc.cn.
Zhongjie
Z
Li
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Electronic address: yangwz@chinacdc.cn.
Weizhong
W
Yang
D001424:Bacterial Infections / Q000453:epidemiology* / Q000821:virology; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology*; D062665:Epidemiological Monitoring; D005243:Feces / Q000382:microbiology / Q000469:parasitology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010272:Parasitic Diseases / Q000453:epidemiology* / Q000469:parasitology; D015995:Prevalence; D014777:Virus Diseases / Q000453:epidemiology* / Q000821:virology
Children; China; Diarrhea; Etiology; Outpatients; Sentinel surveillance