The Roles of Clostridium difficile and Norovirus Among Gastroenteritis-Associated Deaths in the United States, 1999-2007

• Published in: Clinical infectious diseases Vol. 55; no. 2; pp. 216 - 223
• Main Authors: Hall, Aron J., Curns, Aaron T., McDonald, L. Clifford, Parashar, Umesh D., Lopman, Ben A.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 15.07.2012
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; ARTICLES AND COMMENTARIES; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Caliciviridae Infections - mortality; Caliciviridae Infections - virology; Child; Child, Preschool; Children; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium Infections - microbiology; Clostridium Infections - mortality; Death; Disease outbreaks; Epidemiology; Female; Gastroenteritis; Gastroenteritis - etiology; Gastroenteritis - microbiology; Gastroenteritis - mortality; Gastroenteritis - virology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal diseases; Gram-positive bacteria; Human bacterial diseases; Human viral diseases; Humans; Incidence; Infant; Infant, Newborn; Infectious diseases; Male; Mathematical models; Medical sciences; Middle Aged; Mortality; Norovirus; Norovirus - isolation & purification; Older adults; Other diseases. Semiology; Pathogens; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Analysis; United States - epidemiology; Viral diseases; Viral diseases of the digestive system; Viruses; Young Adult; United States; North America; America; United States > US; Infection; Viral gastroenteritis; Prognosis; Norovirus; Mortality; Clostridiaceae; Clostridium difficile; Clostridiales; Diarrhea; Bacteria; Digestive diseases; Intestinal disease
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/cis386

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 39/1 000 000 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 (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.