The Global Burden of Shigella and Enterotoxigenic E. coli: Results from the Global Burden of Disease Study 2016

BACKGROUND: Diarrhea is the seventh leading cause of death globally, responsible for more than 1,600,000 deaths in 2016 and nearly 90% of these deaths occurred in sub-Saharan Africa and South Asia. The Global Burden of Disease Study (GBD) is an annual effort to produce and refine estimates of diarrheal disease burden attributable to Shigella spp., enterotoxigenic Escherichia coli (ETEC), and other enteric pathogens. METHODS: We used a counter-factual approach to estimate deaths, incidence, years of life lost (YLLs), years living with disability (YLDs), and total disability adjusted life years (DALYs) attributable to diarrhea and its etiologies, including Shigella and ETEC. To estimate the burden of diarrhea etiologies, we conducted a systematic review of the proportion of diarrheal cases positive for each pathogen and modeled these data using a Bayesian meta-regression tool called DisMod-MR. This tool generates estimates of the pathogen distribution for national and some subnational geographies, all age groups, and for both sexes from 1990 to 2016. We used these estimates, in conjunction with odds ratios for diarrhea given pathogen detection from the Global Enteric Multicenter Study, to calculate the population attributable fraction for each pathogen. RESULTS: In 2016, Shigella was responsible for 75,000 deaths among children under-5 and 270,000 deaths among all ages and ETEC was responsible for 22,000 deaths among children under-5 and 60,000 deaths among all ages. Shigella and ETEC ranked second and fourth with regard to pathogen contributions to global diarrheal deaths. CONCLUSION: The global burden of disease attributable to Shigella and ETEC is substantial. GBD 2016 estimates on the age- and location-specific impact of Shigella and ETEC enable evidence-based decision making regarding interventions to reduce the burden of these pathogens. Our findings call for accelerated efforts for the development of vaccines against ETEC and Shigella. DISCLOSURES: All authors: No reported disclosures.