Etiological, epidemiological, and clinical features of acute diarrhea in China

National-based prospective surveillance of all-age patients with acute diarrhea was conducted in China between 20092018. Here we report the etiological, epidemiological, and clinical features of the 152,792 eligible patients enrolled in this analysis. Rotavirus A and norovirus are the two leading viral pathogens detected in the patients, followed by adenovirus and astrovirus. Diarrheagenic Escherichia coli and nontyphoidal Salmonella are the two leading bacterial pathogens, followed by Shigella and Vibrio parahaemolyticus. Patients aged <5 years had higher overall positive rate of viral pathogens, while bacterial pathogens were more common in patients aged 1845 years. A joinpoint analysis revealed the age-specific positivity rate and how this varied for individual pathogens. Our findings fill crucial gaps of how the distributions of enteropathogens change across China in patients with diarrhea. This allows enhanced identification of the predominant diarrheal pathogen candidates for diagnosis in clinical practice and more targeted application of prevention and control measures. Diarrhoea is a major cause of morbidity and mortality in China. Here, the authors present results from a large sentinel surveillance scheme from 217 hospitals in all 31 provinces in mainland China, including similar to 150,000 patients with acute diarrhoea and covering years 2009-2018.

Automated summary

A national-based prospective surveillance of acute diarrhea patients in China between 2009 and 2018 revealed that patients aged <5 years mainly had viral infections, while patients aged 18-45 years were more likely to be infected by bacteria. This study provides key insights into the distribution of enteropathogens in China and highlights the importance of identifying predominant diarrheal pathogens for clinical diagnosis and targeted prevention measures.