Aetiology-Specific Estimates of the Global and Regional Incidence and Mortality of Diarrhoeal Diseases Commonly Transmitted through Food

PLoS One. 2015 Dec 3;10(12):e0142927. doi: 10.1371/journal.pone.0142927. eCollection 2015.


Background: Diarrhoeal diseases are major contributors to the global burden of disease, particularly in children. However, comprehensive estimates of the incidence and mortality due to specific aetiologies of diarrhoeal diseases are not available. The objective of this study is to provide estimates of the global and regional incidence and mortality of diarrhoeal diseases caused by nine pathogens that are commonly transmitted through foods.

Methods and findings: We abstracted data from systematic reviews and, depending on the overall mortality rates of the country, applied either a national incidence estimate approach or a modified Child Health Epidemiology Reference Group (CHERG) approach to estimate the aetiology-specific incidence and mortality of diarrhoeal diseases, by age and region. The nine diarrhoeal diseases assessed caused an estimated 1.8 billion (95% uncertainty interval [UI] 1.1-3.3 billion) cases and 599,000 (95% UI 472,000-802,000) deaths worldwide in 2010. The largest number of cases were caused by norovirus (677 million; 95% UI 468-1,153 million), enterotoxigenic Escherichia coli (ETEC) (233 million; 95% UI 154-380 million), Shigella spp. (188 million; 95% UI 94-379 million) and Giardia lamblia (179 million; 95% UI 125-263); the largest number of deaths were caused by norovirus (213,515; 95% UI 171,783-266,561), enteropathogenic E. coli (121,455; 95% UI 103,657-143,348), ETEC (73,041; 95% UI 55,474-96,984) and Shigella (64,993; 95% UI 48,966-92,357). There were marked regional differences in incidence and mortality for these nine diseases. Nearly 40% of cases and 43% of deaths caused by these nine diarrhoeal diseases occurred in children under five years of age.

Conclusions: Diarrhoeal diseases caused by these nine pathogens are responsible for a large disease burden, particularly in children. These aetiology-specific burden estimates can inform efforts to reduce diarrhoeal diseases caused by these nine pathogens commonly transmitted through foods.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Caliciviridae Infections / epidemiology*
  • Caliciviridae Infections / mortality
  • Child
  • Child, Preschool
  • Cost of Illness
  • Diarrhea / epidemiology*
  • Diarrhea / etiology
  • Diarrhea / mortality
  • Dysentery, Bacillary / epidemiology*
  • Dysentery, Bacillary / mortality
  • Enterotoxigenic Escherichia coli
  • Escherichia coli Infections / epidemiology*
  • Escherichia coli Infections / mortality
  • Female
  • Foodborne Diseases / epidemiology*
  • Foodborne Diseases / etiology
  • Foodborne Diseases / mortality
  • Gastroenteritis / epidemiology*
  • Gastroenteritis / mortality
  • Giardia lamblia
  • Giardiasis / epidemiology*
  • Giardiasis / mortality
  • Global Health
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Norovirus
  • Shigella
  • Young Adult

Grant support

The World Health Organization funded this study under the Foodborne Disease Burden Epidemiology Reference Group through contributions from member states and international agencies. The authors would also like to acknowledge the support from the Bill and Melinda Gates Foundation, who funded Dr. Claudio E. Lanata, Dr. Christa Fisher-Walker and Dr. Robert E. Black through the Child Health Epidemiology Reference Group (CHERG). Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the US Centers for Disease Control, the Department of the Navy, Department of Defense, the U.S. Government or other institutions listed. CFL, AJH, and FJA are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.