Gastroenteritis Burden in the Adult Community: Prospects for Vaccines

Abstract

The Global Burden of Diseases collaborators reported in 2016 that among the 30 leading causes of death over the last decade, diarrhoeal disease (GE) is the ninth cause of death overall worldwide. The specific causes of GE in adults and the elderly are poorly identified, but severe GE leading to hospitalization and death is more frequently observed in the elderly. Age is thus clearly a very important risk factor. The aetiology of transmission modes as reported by the US surveillance systems shows that around 60% are person-to-person environmental transmissions and only about 30% are food- and water-borne. The most common settings are long-term care facilities, schools, child care facilities and hospitals. The total economic burden of GE is greatest in young children, but the highest cost per illness is observed among older age groups, largely due to productivity losses resulting from acute illness. In the hospital setting, Clostridium difficile is a common cause of antibiotic-associated diarrhoea, and infection may lead to sepsis or even death. The majority of infections with C. difficile occur among persons aged over 65 years and in those in healthcare facilities, such as hospitals and long-term care facilities. Vaccination programmes against GE-causing pathogens need to take into account the fact that some groups have higher risk of infection and clinical complications (elderly, nursing home residents, travellers), while others have higher risk of transmitting infection to other groups (healthcare workers, food handlers) and some can have both (young children, immunocompromised patients). Vaccine development is at different stages for these various infectious agents. The potential population-level effects and the cost-effectiveness of vaccination also warrant further investigation.