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The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007.
Clin Infect Dis. 2012 Jul; 55(2):216-23.CI

Abstract

BACKGROUND

Globally, gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus.

METHODS

Gastroenteritis-associated deaths in the United States during 1999-2007 were identified from the National Center for Health Statistics multiple-cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed gastroenteritis were included. Time-series regression models were used to identify cause-unspecified gastroenteritis deaths that were probably due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths.

RESULTS

Gastroenteritis mortality averaged 39/1000000 person-years (11 255 deaths per year) during the study period, increasing from 25/1 000 000 person-years in 1999-2000 to 57/1 000 000 person-years in 2006-2007 (P < .001). Adults aged ≥ 65 years accounted for 83% of gastroenteritis deaths (258/1 000 000 person-years). C. difficile mortality increased 5-fold from 10/1 000 000 person-years in 1999-2000 to 48/1 000 000 person-years in 2006-2007 (P < .001). Norovirus contributed to an estimated 797 deaths annually (3/1 000 000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains.

CONCLUSIONS

Gastroenteritis-associated mortality has more than doubled during the past decade, primarily affecting the elderly. C. difficile is the main contributor to gastroenteritis-associated deaths, largely accounting for the increasing trend, and norovirus is probably the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development.

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Authors+Show Affiliations

Hall AJ
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA. ajhall@cdc.gov
Curns AT
No affiliation info available
McDonald LC
No affiliation info available
Parashar UD
No affiliation info available
Lopman BA
No affiliation info available

MeSH

AdolescentAdultAge FactorsAgedAged, 80 and overCaliciviridae InfectionsChildChild, PreschoolClostridioides difficileClostridium InfectionsFemaleGastroenteritisHumansIncidenceInfantInfant, NewbornMaleMiddle AgedNorovirusSurvival AnalysisUnited StatesYoung Adult

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

22491338

Clinical Trial Links

Probiotics to Promote Intestinal Health

Citation

Hall, Aron J., et al. "The Roles of Clostridium Difficile and Norovirus Among Gastroenteritis-associated Deaths in the United States, 1999-2007." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 55, no. 2, 2012, pp. 216-23.
Hall AJ, Curns AT, McDonald LC, et al. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clin Infect Dis. 2012;55(2):216-23.
Hall, A. J., Curns, A. T., McDonald, L. C., Parashar, U. D., & Lopman, B. A. (2012). The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 55(2), 216-23. https://doi.org/10.1093/cid/cis386
Hall AJ, et al. The Roles of Clostridium Difficile and Norovirus Among Gastroenteritis-associated Deaths in the United States, 1999-2007. Clin Infect Dis. 2012;55(2):216-23. PubMed PMID: 22491338.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. AU - Hall,Aron J, AU - Curns,Aaron T, AU - McDonald,L Clifford, AU - Parashar,Umesh D, AU - Lopman,Ben A, Y1 - 2012/04/04/ PY - 2012/4/12/entrez PY - 2012/4/12/pubmed PY - 2013/1/23/medline SP - 216 EP - 23 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 55 IS - 2 N2 - BACKGROUND: Globally, gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus. METHODS: Gastroenteritis-associated deaths in the United States during 1999-2007 were identified from the National Center for Health Statistics multiple-cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed gastroenteritis were included. Time-series regression models were used to identify cause-unspecified gastroenteritis deaths that were probably due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths. RESULTS: Gastroenteritis mortality averaged 39/1000000 person-years (11 255 deaths per year) during the study period, increasing from 25/1 000 000 person-years in 1999-2000 to 57/1 000 000 person-years in 2006-2007 (P < .001). Adults aged ≥ 65 years accounted for 83% of gastroenteritis deaths (258/1 000 000 person-years). C. difficile mortality increased 5-fold from 10/1 000 000 person-years in 1999-2000 to 48/1 000 000 person-years in 2006-2007 (P < .001). Norovirus contributed to an estimated 797 deaths annually (3/1 000 000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains. CONCLUSIONS: Gastroenteritis-associated mortality has more than doubled during the past decade, primarily affecting the elderly. C. difficile is the main contributor to gastroenteritis-associated deaths, largely accounting for the increasing trend, and norovirus is probably the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22491338/The_roles_of_Clostridium_difficile_and_norovirus_among_gastroenteritis_associated_deaths_in_the_United_States_1999_2007_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis386 DB - PRIME DP - Unbound Medicine ER -