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ArtigoDireito Autoral
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- IOC - Artigos de Periódicos [12791]
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DURATION OF POSTDIARRHEAL ENTERIC PATHOGEN CARRIAGE IN YOUNG CHILDREN IN LOW-RESOURCE SETTINGS
Autor(es)
McMurry, Timothy L.
McQuade, Elizabeth T. Rogawski
Liu, Jie
Kang, Gagandeep
Kosek, Margaret N.
LIma, Aldo A. M.
Bessong, Pascal O.
Samie, Amidou
Haque, Rashidul
Mduma, Estomih R.
Leite, José Paulo G.
Bodhidatta, Ladaporn
Iqbal, Najeeha T.
Page, Nicola
Kiwelu, Ireen
Bhutta, Zulfiqar A.
Ahmed, Tahmeed
Houpt, Eric R.
Platts-Mills, James A.
McQuade, Elizabeth T. Rogawski
Liu, Jie
Kang, Gagandeep
Kosek, Margaret N.
LIma, Aldo A. M.
Bessong, Pascal O.
Samie, Amidou
Haque, Rashidul
Mduma, Estomih R.
Leite, José Paulo G.
Bodhidatta, Ladaporn
Iqbal, Najeeha T.
Page, Nicola
Kiwelu, Ireen
Bhutta, Zulfiqar A.
Ahmed, Tahmeed
Houpt, Eric R.
Platts-Mills, James A.
Afiliação
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA,
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA / Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Christian Medical College. Vellore, India.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA / Asociación Benéfica PRISMA. Iquitos, Peru.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
University of Venda. Thohoyandou, South Africa.
University of Venda. Thohoyandou, South Africa.
International Centre for Diarrhoeal Disease Research. Bangladesh, Dhaka, Bangladesh.
8Haydom Global Health Research Centre. Haydom, Tanzania.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Armed Forces Research Institute of Medical Sciences. Bangkok, Thailand.
Aga Khan University. Karachi, Pakistan.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Kilimanjaro Clinical Research Institute. Moshi, Tanzania.
Aga Khan University. Karachi, Pakistan.
International Centre for Diarrhoeal Disease Research. Bangladesh, Dhaka, Bangladesh.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA / Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Christian Medical College. Vellore, India.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA / Asociación Benéfica PRISMA. Iquitos, Peru.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
University of Venda. Thohoyandou, South Africa.
University of Venda. Thohoyandou, South Africa.
International Centre for Diarrhoeal Disease Research. Bangladesh, Dhaka, Bangladesh.
8Haydom Global Health Research Centre. Haydom, Tanzania.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Armed Forces Research Institute of Medical Sciences. Bangkok, Thailand.
Aga Khan University. Karachi, Pakistan.
National Institute for Communicable Diseases. Johannesburg, South Africa.
Kilimanjaro Clinical Research Institute. Moshi, Tanzania.
Aga Khan University. Karachi, Pakistan.
International Centre for Diarrhoeal Disease Research. Bangladesh, Dhaka, Bangladesh.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Division of Infectious Diseases and International Health, University of Virginia. Charlottesville, Virginia. USA.
Resumo em Inglês
Background. Prolonged enteropathogen shedding after diarrhea complicates the identification of etiology in subsequent episodes
and is an important driver of pathogen transmission. A standardized approach has not been applied to estimate the duration
of shedding for a wide range of pathogens.
Methods. We used a multisite birth cohort of children 0–24 months of age from whom diarrheal and monthly nondiarrheal
stools were previously tested by quantitative polymerase chain reaction for 29 enteropathogens. We modeled the probability of detection
of the etiologic pathogen before and after diarrhea using a log-normal accelerated failure time survival model and estimated
the median duration of pathogen carriage as well as differences in subclinical pathogen carriage 60 days after diarrhea onset in comparison
to a prediarrhea baseline.
Results. We analyzed 3247 etiologic episodes of diarrhea for the 9 pathogens with the highest attributable burdens of diarrhea.
The median duration of postdiarrheal carriage varied widely by pathogen, from about 1 week for rotavirus (median, 8.1 days [95%
confidence interval {CI}, 6.2–9.6]) to >1 month for Cryptosporidium (39.5 days [95% CI, 30.6–49.0]). The largest increases in subclinical
pathogen carriage before and after diarrhea were seen for Cryptosporidium (prevalence difference between 30 days prior and
60 days after diarrhea onset, 0.30 [95% CI, .23–.39]) and Shigella (prevalence difference, 0.21 [95% CI, .16–.27]).
Conclusions. Postdiarrheal shedding was widely variable between pathogens, with strikingly prolonged shedding seen for
Cryptosporidium and Shigella. Targeted antimicrobial therapy and vaccination for these pathogens may have a relatively large impact
on transmission.
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