Duration of postdiarrheal enteric pathogen carriage in young children in low-resource settings
Document Type
Article
Department
Women and Child Health; Paediatrics and Child Health; Centre of Excellence in Women and Child Health
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 multi-site birth cohort of children 0-24 months of age from whom diarrheal and monthly non-diarrheal stools were previously tested by qPCR 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 sub-clinical pathogen carriage 60 days after diarrhea onset in comparison to a pre-diarrhea baseline.
Results: We analyzed 3247 etiologic episodes of diarrhea for the nine pathogens with the highest attributable burdens of diarrhea. The median duration of post-diarrheal carriage varied widely by pathogen, from about one week for rotavirus (median 8.1 days; 95% confidence interval: 6.2, 9.6) to more than one month for Cryptosporidium (39.5 days; 95% CI: 30.6, 49.0). The largest increases in sub-clinical pathogen carriage before and after diarrhea were seen for Cryptosporidium (prevalence difference between 30 days prior and 60 days after diarrhea onset of 0.30; 95% confidence interval: 0.23, 0.39) and Shigella (prevalence difference 0.21; 95% CI: 0.16, 0.27).
Conclusions: Post-diarrheal 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.
Publication (Name of Journal)
Clinical Infectious Diseases
Recommended Citation
McMurry, T. L.,
McQuade, E. R.,
Liu, J.,
Kang, G.,
Kosek, M. N.,
Lima, A. M.,
Bessong, P. O.,
Samie, A.,
Iqbal, N.,
Bhutta, Z. A.
(2021). Duration of postdiarrheal enteric pathogen carriage in young children in low-resource settings. Clinical Infectious Diseases, 72(11), e806-e814.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/951