A common, symptom-based case definition for gastroenteritis

Foodborne, Waterborne, and Zoonotic Infections Division, Public Health Agency of Canada, Guelph and Ottawa, ON, Canada.
Epidemiology and Infection (Impact Factor: 2.49). 07/2008; 136(7):886-94. DOI: 10.1017/S0950268807009375
Source: PubMed

ABSTRACT National studies determining the burden of gastroenteritis have defined gastroenteritis by its clinical picture, using symptoms to classify cases and non-cases. The use of different case definitions has complicated inter-country comparisons. We selected four case definitions from the literature, applied these to population data from Australia, Canada, Ireland, Malta and the United States, and evaluated how the epidemiology of illness varied. Based on the results, we developed a standard case definition. The choice of case definition impacted on the observed incidence of gastroenteritis, with a 1.5-2.1 times difference between definitions in a given country. The proportion of cases with bloody diarrhoea, fever, and the proportion who sought medical care and submitted a stool sample also varied. The mean age of cases varied by <5 years under the four definitions. To ensure comparability of results between studies, we recommend a standard symptom-based case definition, and minimum set of results to be reported.

Download full-text


Available from: Shannon Majowicz, May 05, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: 4 OzFoodNet (Queensland), Communicable In 2000, Australia improved national surveillance of gastro- intestinal and foodborne illness by adapting the Centers for Disease Control and Prevention's (CDC's) FoodNet model of active surveillance. The OzFoodNet surveillance network ap- plied concentrated effort at the national and local levels to investigate and understand foodborne disease, to describe more effectively its epidemiology, and to provide better evidence for minimizing the number of cases of foodborne illness in Aus- tralia. The Australian government funded each of Australia's 6 states and 2 territories to employ 1 epidemiologist to enhance surveillance of foodborne disease, with a coordinating team based at the federal Department of Health and Ageing. Oz- FoodNet estimated that there are ∼5.4 million cases of food- borne disease per year, costing A$1.2 billion annually. In Aus- tralia, contaminated food results in ∼100 outbreaks of illness each year, with the incidence of outbreaks of illness caused by
    Clinical Infectious Diseases 09/2008; 47(3):392-400. DOI:10.1086/589861 · 9.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute gastrointestinal illness is an important public-health issue worldwide. Burden-of-illness studies have not previously been conducted in Cuba. The objective of the study was to determine the magnitude, distribution, and burden of self-reported acute gastrointestinal illness in Cuba. A retrospective, cross-sectional survey was conducted in three sentinel sites during June-July 2005 (rainy season) and during November 2005-January 2006 (dry season). Households were randomly selected from a list maintained by the medical offices in each site. One individual per household was selected to complete a questionnaire in a face-to-face interview. The case definition was three or more bouts of loose stools in a 24-hour period within the last 30 days. In total, 97.3% of 6,576 interviews were completed. The overall prevalence of acute gastrointestinal illness was 10.6%. The risk of acute gastrointestinal illness was higher during the rainy season (odds ratio [OR]=3.85, 95% confidence interval [CI] 3.18-4.66) in children (OR=3.12, 95% CI 2.24-4.36) and teens (OR=2.27, 95% CI 1.51-3.41) compared to people aged 25-54 years, in males (OR=1.24, 95% CI 1.04-1.47), and in the municipality of Santiago de Cuba (OR=1.33, 95% CI 1.11-1.61). Of 680 cases, 17.1-38.1% visited a physician, depending on sentinel site. Of the cases who visited a physician, 33.3-53.9% were requested to submit a stool sample, and of those, 72.7-100.0% complied. Of the cases who sought medical care, 16.7-61.5% and 0-31.6% were treated with antidiarrhoeals and antibiotics respectively. Acute gastrointestinal illness represented a substantial burden of health compared to developed countries. Targeting the identified risk factors when allocating resources for education, food safety, and infrastructure might lower the morbidity associated with acute gastrointestinal illness.
    Journal of Health Population and Nutrition 07/2009; 27(3):345-57. DOI:10.3329/jhpn.v27i3.3377 · 1.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A population-based telephone survey of acute gastroenteritis (AG) was conducted in Hong Kong from August 2006 to July 2007. Study subjects were recruited through random digit-dialing with recruitments evenly distributed weekly over the 1-year period. In total, 3743 completed questionnaires were obtained. An AG episode is defined as diarrhoea >or=3 times or any vomiting in a 24-h period during the 4 weeks prior to interview, in the absence of known non-infectious causes. The prevalence of AG reporting was 7%. An overall rate of 0.91 (95% CI 0.81-1.01) episodes per person-year was observed with women having a slightly higher rate (0.94, 95% CI 0.79-1.08) than men (0.88, 95% CI 0.73-1.04). The mean duration of illness was 3.6 days (S.D.=5.52). Thirty-nine percent consulted a physician, 1.9% submitted a stool sample for testing, and 2.6% were admitted to hospital. Of the subjects aged >or=15 years, significantly more of those with AG reported eating raw oysters (OR 2.4, 95% CI 1.3-4.4), buffet meals (OR 1.8, 95% CI 1.3-2.5), and partially cooked beef (OR 1.8, 95% CI 1.2-2.7) in the previous 4 weeks compared to the subjects who did not report AG. AG subjects were also more likely to have had hot pot, salad, partially cooked or raw egg or fish, sushi, sashimi, and 'snacks bought at roadside' in the previous 4 weeks. This first population-based study on the disease burden of AG in Asia showed that the prevalence of AG in Hong Kong is comparable to that experienced in the West. The study also revealed some 'risky' eating practices that are more prevalent in those affected with AG.
    Epidemiology and Infection 11/2009; 138(7):982-91. DOI:10.1017/S0950268809991087 · 2.49 Impact Factor
Show more