Effect of biannual azithromycin distribution on antibody responses to malaria, bacterial, and protozoan pathogens in Niger.

The MORDOR trial in Niger, Malawi, and Tanzania found that biannual mass distribution of azithromycin to children younger than 5 years led to a 13.5% reduction in all-cause mortality (NCT02048007). To help elucidate the mechanism for mortality reduction, we report IgG responses to 11 malaria, bacterial, and protozoan pathogens using a multiplex bead assay in pre-specified substudy of 30 communities in the rural Niger placebo-controlled trial over a three-year period (n = 5642 blood specimens, n = 3814 children ages 1-59 months). Mass azithromycin reduces Campylobacter spp. force of infection by 29% (hazard ratio = 0.71, 95% CI: 0.56, 0.89; P = 0.004) but serological measures show no significant differences between groups for other pathogens against a backdrop of high transmission. Results align with a recent microbiome study in the communities. Given significant sequelae of Campylobacter infection among preschool aged children, our results support an important mechanism through which biannual mass distribution of azithromycin likely reduces mortality in Niger.

Report of fatal mixed infection with Cryptosporidium parvum and Giardia intestinalis in neonatal calves.

In the production and management of beef and dairy cattle, controlling diarrhea is one of the important concerns. Pathogenic agents of the disease, protozoan parasites including Cryptosporidium spp., are difficult to control, making prevention, diagnoses, and treatment of diarrhea. In the present study, we investigated a farm with a history of calf deaths over a period of 10 years in order to determine the cause of disease and to clarify the detailed distribution of the pathogens. In four examined calves that were reared in calf pens, all were positive with Cryptosporidium and/or Giardia, while the other breeding stock and adult cattle were negative. Molecular analyses revealed that the isolates from calves were C. parvum subtype IIaA15G2R1 as a zoonotic and G. intestinalis assemblage E. Other pathogenic bacteria and diarrhea-causing viruses were not detected. After treating the calf pens with boiling water and milk of lime (Ca[OH]2), oocysts of C. parvum and cysts of G. intestinalis were not found and no additional calves died. This is the first report to describe the mixed infection of both parasites in Japan.

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

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.

Disease burden of selected gastrointestinal pathogens in Australia, 2010.

OBJECTIVE: To estimate and compare disease burden attributable to six gastrointestinal pathogens (norovirus, rotavirus, Campylobacter, non-typhoidal Salmonella, Giardia, and Cryptosporidium) in Australia, 2010. METHODS: We estimated the number of acute gastroenteritis (AGE) cases and deaths, disability-adjusted life years (DALYs), and DALY/case for each pathogen. We included AGE cases that did not require medical care. Sequelae were included for Campylobacter (Guillain-Barré syndrome, reactive arthritis (ReA), irritable bowel syndrome (IBS)) and Salmonella (ReA, IBS). RESULTS: We estimated 16626069 AGE cases in Australia in 2010 (population 22 million). Of the pathogens studied, most AGE cases were attributed to norovirus (2180145), Campylobacter (774003), and Giardia (614740). Salmonella caused the fewest AGE cases (71255) but the most AGE deaths (90). The DALY burden was greatest for Campylobacter (18222 DALYs) and Salmonella (3856 DALYs), followed by the viral and protozoal pathogens. The average DALY/case was greatest for Salmonella (54.1 DALY/1000 cases), followed by Campylobacter (23.5 DALY/1000 cases). CONCLUSIONS: The pathogen causing the greatest disease burden varied according to the metric used, however DALYs are considered most useful given the incorporation of morbidity, mortality, and sequelae. These results can be used to prioritize public health interventions toward Salmonella and Campylobacter infections and to measure the impact of these interventions.

Risk assessment of Giardia in rivers of southern China based on continuous monitoring.

The occurrence and risks of Giardia in China have been unclear to date, which has made it difficult to properly manage source water as well as to create reasonable drinking water standards. The levels of Giardia in river networks of several cities in Zhejiang Province, China were found to be in the range of 0-5 oocysts/10 L in the rainy season in 2008. The mortality due to Giardia infection for people in this region was calculated to be from 0 to 1.95 x 10(-8) persons using a conditional probability equation. Based on multiple unboiled water intake routes, the disability-adjusted life years (DALYs) due to Giardia infection for people who consumed conventionally treated water was 0.625 (95% CI: 0.137-2.05) per 10(5) persons, with the symptom of hospitalization making the highest contribution to total DALYs (0.56 per 10(5) persons; 95% CI: 0.122-1.84). The DALYs decreased to 0.425 (95% CI: 0.137-2.05) per 10(5) persons per year for those consuming water treated with advanced technology. These values were lower than the acceptable risk (1.97 x 10(-5) DALYs per year). This study revealed the risk of Giardia infection to the people in river networks of Zhejiang Province for the first time, and provides a method to evaluate the risk of Giardia infection. The results are useful for the modification of drinking water quality standards based on cost-benefit analysis.

Partial breastfeeding protects Bedouin infants from infection and morbidity: prospective cohort study.

The benefits of exclusive breastfeeding for health in infants have been widely described. The goal of this study was to determine whether partial breastfeeding has protective effects against enteric infection and associated morbidity in population where early addition of supplementation is common. In this prospective study 238 Bedouin infants were followed from birth to age 18 months. Exclusive breastfeeding was protective against infection and morbidity at ages 0 to 3 months. In the age range of 4 to 6 months, partial versus non breastfeeding was associated with lower rates of infection with Cryptosporidium spp (Odds Ratio OR 0.34, 95% confidence interval CI 0.18; 0.65), and Campylobacter spp (OR 0.58, CI 0.35; 0.98), lower rates of ear infections (OR 0.47, CI 0.24; 0.90) and of asthma (OR 0.33, CI 0.13; 0.81). In older children (10-12 month age range) partial breastfeeding as compared to none, protected against infections with Cryptosporidium spp (OR 0.57, CI 0.36; 0.91) and Giardia lamblia (OR 0.92, CI 0.85; 0.99). In Bedouins, and possibly in other populations, even partial breastfeeding, especially at ages 4 to 6 months offers protection against infection. Thus, encouraging mothers to continue to at least partially breastfeed past age 3 months may help reduce infections and morbidity in infants.

Morbidity and mortality in pups from pet stores and private sources: 968 cases (1987-1988).

Morbidity (greater than or equal to 1 disease condition) for pups sold from 3 pet stores from January 1987 through December 1988 ranged from 54 to 68%. In 1 store, morbidity was higher for store pups, compared with pups originating from private parties, for such disease conditions as "kennel cough," diarrhea, and several species of gastrointestinal parasites. In-store mortality ranged from 5 to 9.5% of pups arriving for sale.