Lucien R. Swetschinski’s research while affiliated with Institute for Health Metrics and Evaluation and other places

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Publications (31)


Supplementary appendix.pdf
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December 2024

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73 Reads

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Authia P. Gray

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Nicole Davis Weaver

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Mohsen Naghavi
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Figure 1: Diarrhoeal mortality rates per 100 000 and counts by broad age categories (A) and under-5 age groups (B), from 1990 to 2021 Shaded areas represent 95% uncertainty intervals. Early neonatal represents newborns aged 0-6 days. Late neonatal represents newborns aged 7-27 days.
Figure 2: Years of life lost due to diarrhoeal diseases by broad age categories (A) and under-5 age groups (B), from 1990 to 2021 Years of life lost are shown in millions with each colour representing one age group. Early neonatal represents newborns aged 0-6 days. Late neonatal represents newborns aged 7-27 days.
Figure 5: Number of diarrhoeal deaths (A) and DALYs (B) in specific age groups in children younger than 5 years attributable to 13 pathogens in 2021 Early neonatal represents newborns aged 0-6 days. Late neonatal represents newborns aged 7-27 days. DALY=disability-adjusted life-year. PAF=population attributable fraction. ST-ETEC=enterotoxigenic Escherichia coli producing heat-stable toxin. tEPEC=typical enteropathogenic E coli.
Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

December 2024

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766 Reads

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2 Citations

The Lancet Infectious Diseases

Summary Background Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021. Methods We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, populationbased surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age–sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework. Findings In 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793–1·62) deaths globally, representing a 60·3% (50·6–69·0) decrease since 1990 (2·93 million [2·31–3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4–84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147–221) in 1990 to 51·4 million (39·9–65·9) in 2021. In 2021, an estimated 59·0 million (47·2–73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1–42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1–5 months and 2–4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2–73·2) to 4·99 million (1·99–10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4–20·1), followed by norovirus at 10·6% (2·3–17·0) and Cryptosporidium spp at 10·2% (7·03–14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7–43·0), followed by Shigella spp at 24·0% (15·2–37·9) and adenovirus at 23·8% (14·8–36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenic Escherichia coli, and enterotoxigenic E coli producing heat-stable toxin. Interpretation The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial.


Diagram displaying the creation of the composite indicator (referenced here as metaranks) based on human disability adjusted life-years (DALYs) attributable to AMR, livestock AMU (mg/kg), livestock biomass (population correction units), and a global correlation assessment between livestock and human proportion of resistant isolates (represented as significance levels of Spearman correlation estimates) by antimicrobial class, pathogen, and livestock species (also represented here as a cell). Values displayed, from initial input values, to ranks, and final composite indicators, are taken from the example of fluoroquinolones, E. coli and pigs, with country-specific examples referencing the Philippines
Livestock AMR data coverage for all countries extracted (n = 109) aggregated by livestock species, antimicrobial classes and pathogen species. Antimicrobials are ordered top to bottom by shared human and animal relevance. Dark brown shows the most number of countries that have AMR data for the specific antimicrobial class, pathogen, and livestock species. Lighter brown and peach indicate less number of countries with AMR data for the specific antimicrobial class, pathogen, and livestock species, and white shows there are no countries from data extracted that have AMR data for the specific antimicrobial class, pathogen, and livestock species
Global metaranks (n = 194) accounting for livestock antimicrobial usage (AMU), livestock biomass (population correction units), human DALYs attributable to AMR, and significance levels of correlations between human and livestock proportion of resistance. Global metaranks were calculated for a particular livestock species, antimicrobial classes and pathogen species combination. Antimicrobials are ordered top to bottom by shared human and animal relevance. Dark purple shows the highest metaranks calculated for the specific antimicrobial class, pathogen, and livestock species. Lighter purple and blue indicate a lower metarank for the specific antimicrobial class, pathogen, and livestock species
Global percentage of countries (n = 194) with data for a particular livestock species, antimicrobial classes and pathogen species combination if it was prioritized. Antimicrobials are ordered top to bottom by shared human and animal relevance. White and lighter colors relay a low percentage of countries with data, and darker colors indicate a higher percentage of countries with data. Cells for which no countries have prioritized the category are grey, and have no numbers stated. Numbers in each cell correspond to the number of countries that have prioritized that particular category
Map showing the percentage of priorities that have recorded livestock AMR data for a particular category of antimicrobial class, pathogen, and livestock species per country. Darker colors (more blue-grey) show a higher percentage of countries with livestock AMR data for prioritized categories, lighter colors (lighter blue and yellow) shows a lower percentage. White represents countries without livestock AMR data for prioritized categories, and locations without any prioritized categories are colored light grey
Using priorities between human and livestock bacterial antimicrobial resistance (AMR) to identify data gaps in livestock AMR surveillance

September 2024

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195 Reads

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1 Citation

BMC Infectious Diseases

Background Bacterial antimicrobial resistance (AMR) is a global threat to both humans and livestock. Despite this, there is limited global consensus on data-informed, priority areas for intervention in both sectors. We compare current livestock AMR data collection efforts with other variables pertinent to human and livestock AMR to identify critical data gaps and mutual priorities. Methods We globally synthesized livestock AMR data from open-source surveillance reports and point prevalence surveys stratified for six pathogens (Escherichia coli, Staphylococcus aureus, non-typhoidal Salmonella, Campylobacter spp., Enterococcus faecalis, Enterococcus faecium) and eleven antimicrobial classes important in human and veterinary use, published between 2000 and 2020. We also included all livestock species represented in the data: cattle, chickens, pigs, sheep, turkeys, ducks, horses, buffaloes, and goats. We compared this data with intended priorities calculated from: disability-adjusted life years (DALYs), livestock antimicrobial usage (AMU), livestock biomass, and a global correlation exercise between livestock and human proportion of resistant isolates. Results Resistance to fluoroquinolones and macrolides in Staphylococcus aureus were identified as priorities in many countries but, less than 10% of these reported livestock AMR data. Resistance data for Escherichia coli specific to cattle, chickens, and pigs, which we prioritized, were also well collected. AMR data collection on non-typhoidal Salmonella and other livestock species were often not prioritized. Of 232 categories prioritized by at least one country, data were only collected for 48% (n = 112). Conclusions The lack of livestock AMR data globally for broad resistance in Staphylococcus aureus could underplay their zoonotic threat. Countries can bolster livestock AMR data collection, reporting, and intervention setting for Staphylococcus aureus as done for Escherichia coli. This framework can provide guidance on areas to strengthen AMR surveillance and decision-making for humans and livestock, and if done routinely, can adapt to resistance trends and priorities.





Citations (18)


... Rotavirus causes severe and fatal diarrhea in young patients worldwide and accounts for half of all hospitalizations for this condition in children under 5 years of age in developed countries. It is also responsible for approximately 25% of all hospital-acquired viral infections, particularly in immunocompromised children [65]. SARS-CoV-2 coronavirus was detected in two studies [45,49]. ...

Reference:

Pathogens of Medical Importance Identified in Hospital-Collected Cockroaches: A Systematic Review
Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

The Lancet Infectious Diseases

... Of note, these states cover South, North, and Central Mexico. A total of 59 Newport strains (14.7%) and 50 Anatum strains (12.4%) were isolated from meat samples, aligning with previous reports showing that Salmonella serotypes are frequently associated with meat products, especially in urban areas with interconnected food supply chains [9,[54][55][56]. ...

Using priorities between human and livestock bacterial antimicrobial resistance (AMR) to identify data gaps in livestock AMR surveillance

BMC Infectious Diseases

... The rise in antimicrobial resistance (AMR) threatens to cause a significant number of unnecessary deaths (O'Neill, 2016;Naghavi et al., 2024). To address this growing threat, policies have targeted antibiotic usage (ABU) reduction in the human, animal and environmental sectors (Chua et al., 2021). ...

Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050

... Com a RAM, essas infecções se tornam mais difíceis de tratar, aumentando o risco de mortalidade, internações prolongadas e custos elevados para o sistema de saúde. Em nível econômico, a RAM é associada a além da promoção de boas práticas de higiene e saneamento (Naghavi et al., 2024). Contudo, a implementação de políticas eficazes enfrenta desafios, como a variabilidade das regulamentações e o uso indiscriminado de antimicrobianos na agricultura. ...

Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050

... To reduce your chances of exposure to these bacteria, don't drink lake or pond water, wash your hands often, avoid unsecured foods, and beware of cross-contaminants between foods. [9]. Several studies have been conducted on contamination of well water with intestinal bacteria and sewage, especially the spread IOP Publishing doi:10.1088/1755-1315/1183/1/012068 ...

Increasing air pollution and its impact on human health
  • Citing Data
  • September 2024

... This study reveals a high prevalence of tetra-, penta-, and hepta-resistant patterns in environmental and pork isolates, which poses a significant public health threat due to potential treatment failures after simple infections caused by MDR isolates. These findings were consistent with various global investigations demonstrating a high incidence of MDR patterns among Salmonella strains isolated from different sources [19,30]. The extensive use of antibiotics in the medical and veterinary sectors that resulted in a high AMR by exerting a selection pressure against the used antimicrobials. ...

Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050

The Lancet

... In 2019, an estimated 309 million disability-adjusted life-years (DALYs) were linked to 85 different parasites in children under the age of five, with Plasmodium spp., the causative agent of malaria, accounting for 12.0% of the total [186]. Another parasite, Toxoplasma gondii, is associated with various infections including congenital toxoplasmosis, which is transmitted from the mother to the foetus. ...

Global burden associated with 85 pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
  • Citing Article
  • April 2024

The Lancet Infectious Diseases

... However, the epidemic cycle typically spans approximately 3 to 7 years, and may last for 1 to 2 years [3]. In 2021, MP caused approximately 25.3 million infections [4], and was identified as a principal pathogen responsible for 10-40% of community-acquired pneumonia cases among school-aged children (5-14 years) and young adults [5]. The infection rate in school-age children reached as high as 49.9% [6]. ...

Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

The Lancet Infectious Diseases

... Pharmaceutical companies must be held accountable for proper waste management, ensuring that antibiotic residues are not discharged into water bodies or the environment. Governments can regulate waste disposal practices and implement stricter controls on pharmaceutical manufacturers to reduce contamination [1][2][3][4][5][6][7]9]. ...

The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis

The Lancet Global Health

... Environmental antibiotic pollution creates a complex challenge due to the development of microbial antibiotic resistance from prolonged exposure in the environment [88]. Almost 5 million deaths were associated with antimicrobial resistance (AMR) in 2019, with AMR being directly responsible for 1.27 million deaths [89]. To effectively address this issue, the sorption of four antibiotics, namely chlortetracycline (CTC), oxytetracycline (OTC), ofloxacin (OFL), and enrofloxacin (ENR), on natural zeolite was investigated. ...

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

Croatian Medical Journal