Case fatality risk of diarrhoeal pathogens: a systematic review and meta-analysis

Author:

Asare Ernest O1ORCID,Hergott Dianna2,Seiler Jessica2,Morgan Brooks2,Archer Helena2,Wiyeh Alison B2,Guo Boya2,Driver Matt2,Giersing Birgitte3,Hasso-Agopsowicz Mateusz3,Lingappa Jairam4,Lopman Benjamin A5,Pitzer Virginia E1

Affiliation:

1. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University , New Haven, CT, USA

2. Department of Epidemiology, University of Washington , Seattle, WA, USA

3. Vaccine Product Delivery Research, Immunization, Vaccines and Biologicals, World Health Organization , Geneva, Switzerland

4. Departments of Global Health, Medicine, and Pediatrics, University of Washington , Seattle, WA, USA

5. Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, GA, USA

Abstract

Abstract Background Estimates of the relative contribution of different pathogens to all-cause diarrhoea mortality are needed to inform global diarrhoea burden models and prioritize interventions. We aimed to investigate and estimate heterogeneity in the case fatality risk (CFR) of different diarrhoeal pathogens. Methods We conducted a systematic review and meta-analysis of studies that reported cases and deaths for 15 enteric pathogens published between 1990 and 2019. The primary outcome was the pathogen-specific CFR stratified by age group, country-specific under-5 mortality rate, setting, study year and rotavirus vaccine introduction status. We developed fixed-effects and multilevel mixed-effects logistic regression models to estimate the pooled CFR overall and for each pathogen, controlling for potential predictors of heterogeneity. Results A total of 416 studies met review criteria and were included in the analysis. The overall crude CFR for all pathogens was 0.65%, but there was considerable heterogeneity between and within studies. The overall CFR estimated from a random-effects model was 0.04% (95% CI: 0.026%–0.062%), whereas the pathogen-specific CFR estimates ranged from 0% to 2.7%. When pathogens were included as predictors of the CFR in the overall model, the highest and lowest odds ratios were found for enteropathogenic Escherichia coli (EPEC) [odds ratio (OR) = 3.0, 95% CI: 1.28–7.07] and rotavirus (OR = 0.23, 95% CI: 0.13–0.39), respectively. Conclusion We provide comprehensive estimates of the CFR across different diarrhoeal pathogens and highlight pathogens for which more studies are needed. The results motivate the need for diarrhoeal interventions and could help prioritize pathogens for vaccine development.

Funder

World Health Organization

National Institutes of Health/National Institute of Allergy and Infectious Diseases

Publisher

Oxford University Press (OUP)

Subject

General Medicine,Epidemiology

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