Etiology of acute diarrhea in the elderly in China: A six-year observational study.
Acute diarrhea leads to a substantial disease burden among the elderly worldwide. However, in the context of increasingly aging trend in China, the prevalence of etiological agents among elderly diarrheal patients was undetermined. This study aimed to explore the major enteropathogens of acute diarrhea among outpatients older than 65 years in China, and also the epidemiological features of the pathogens. Demographic and clinical data for acute diarrhea among outpatients older than 65 years were collected from 213 participating hospitals from 2009 to 2014. Stool specimens were collected and tested for 13 enteric viruses and bacteria. The proportion of outpatients positive for targeted pathogens was analyzed by residential areas and seasonal patterns. Among the 7,725 patients enrolled, 1,617 (20.9%)were positive for any one of the 13 study pathogens. The predominant pathogen was norovirus (9.0%), followed by diarrheagenic Escherichia coli (DEC) (5.5%), rotavirus (3.9%), non-typhoidal Salmonella (NTS) (2.9%), and Shigella spp. (2.5%). The prevalence of Shigella spp. among rural patients (6.9%) was higher than that among urban patients (1.6%) (p < 0.001), with opposite trend for DEC (3.6% versus 5.9%, p = 0.007). An obvious seasonal pattern was observed for major pathogens, with peak for norovirus in autumn, rotavirus in winter and DEC, NTS, and Shigella spp. in summer. A wide variety of enteropathogens were detected among the elderly with acute diarrhea in China, with norovirus and DEC being the most commonly isolated pathogens. A strong seasonal pattern was observed for major pathogens of acute diarrhea among the elderly.
Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.|Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.|Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Zike
Z
Zhang
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.|Worldpop, Department of Geography and Environment, University of Southampton, Southampton, United Kingdom.
Shengjie
S
Lai
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.|Institute of Pathogen Biology, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, China.
Jianxing
J
Yu
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.|State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
Qibin
Q
Geng
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.|State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
Wanqi
W
Yang
Department of Laboratory Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.|Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.
Yu
Y
Chen
State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan, China.
Jianguo
J
Wu
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.
Weizhong
W
Yang
Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
Zhongjie
Z
Li
D000208:Acute Disease; D000368:Aged; D017250:Caliciviridae Infections / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D004405:Dysentery, Bacillary / Q000453:epidemiology; D004927:Escherichia coli Infections / Q000453:epidemiology; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology; D006801:Humans; D008297:Male; D029322:Norovirus; D015995:Prevalence; D012400:Rotavirus Infections / Q000453:epidemiology; D012424:Rural Population; D012480:Salmonella Infections / Q000453:epidemiology; D012621:Seasons; D012760:Shigella; D013997:Time Factors; D014505:Urban Population