The cascading burden of diarrheal disease
Revealing the hidden costs of ETEC and Shigella diarrhea

Leading causes of childhood diarrhea

Enterotoxigenic E. coli (ETEC) and Shigella are the leading bacterial causes of severe and fatal childhood diarrheal disease worldwide.

In addition to causing more than 15 percent of the approximately 500,000 child deaths due to diarrhea each year, repeated infections with ETEC and Shigella can have long-term consequences on a child’s growth and development.

Cascading impact of infections

Diarrhea Deaths The good news:Of the children whose lives are sidetracked by diarrhea, fewer are dying. 0 200 400 600 800 1000 1200 1.2M 2000 Childhood deathsfrom diarrhea 2015 500K DiarrheaInfections

Cascading impact of infections

but...Many of the survivors suffer long-term consequences. DiarrheaInfections Stunting &Malnutrition reduce a child’s chances of reaching their full potential and increase the life-long risk of chronic diseases. Both physical stunting... and cognitive deficiencies...

Cascading impact of infections

HouseholdImpoverishment MetabolicDisorders Diabetes Heart Disease Obesity DiarrheaInfections Stunting &Malnutrition Reduced long-term learning and earning potential contribute to poverty and susceptibility to infectious disease. Infectious Diseases

Cascading impact of infections

HouseholdImpoverishment MetabolicDisorders Diabetes Heart Disease Obesity DiarrheaInfections Stunting &Malnutrition Infectious Diseases All of these follow-on effects perpetuate exposureto diarrheal disease...

Cascading impact of infections

HouseholdImpoverishment MetabolicDisorders Diabetes Heart Disease Obesity DiarrheaInfections Stunting &Malnutrition Infectious Diseases ...and the cycle continues. All of these follow-on effects perpetuate exposureto diarrheal disease...

Disease burden in DALYs

To estimate the comprehensive toll that ETEC and Shigella take on communities, researchers measure the overall burden in disability-adjusted life-years (DALYs). DALYs account for lost years of productive life due not only to early death but also to illness, stunting, and other long-term impacts.

Birth = 1 year of healthy life Health Life expectancy for a healthy child averages 84 years. Life expectancy 84

Disease burden in DALYs

To estimate the comprehensive toll that ETEC and Shigella take on communities, researchers measure the overall burden in disability-adjusted life-years (DALYs). DALYs account for lost years of productive life due not only to early death but also to illness, stunting, and other long-term impacts.

In this example, a child infected at age 4 whodies at age 11 has lost77.2 DALYs to ETEC. YLD = 4.2 years(Years Lost to Disability = Years Disabled x Disabled %) YLL = 73 years(Years of Life Lost) 4.2 YLD + 73 YLL = 77.2 DALYs ETECInfection Death Birth Life expectancyat time of death Age 4 Age 11 Health Disability 84 disability premature death = 1 lost year of life (DALY) = 1 year of healthy life

The disease burden on a particular population is measured by totaling all the DALYs for the number of cases in that population. A population with 18 cases like the one in our example would have a total burden of...

1,389.6 DALYs which are equivalent to 17 lifetimes.

Global burden of ETEC and Shigella among children

These estimates are for the 96 countries with the highest rates of diarrheal death.

Disparity of the burden of ETEC and Shigella

The burden of ETEC and Shigella among young children is unevenly distributed, as regional-level estimates from 11 African countries show.

SELECT A COUNTRY TO SEE DETAIL

The potential for interventions

Vaccines against ETEC and Shigella are currently in development. If they become available and are introduced in an integrated approach with oral rehydration solution, zinc, and improvements in water, hygiene, sanitation, and nutrition, they would have the potential to not only prevent deaths but also alleviate the burden due to long-term consequences of infections...

turning DALYs... back into healthy lives. French Polynesia

Learn more about the development of ETEC and Shigella vaccines and join the movement to defeat diarrheal disease!

SOURCES

Rheingans R, Bagamian KH, Muhib F, Amaya MP, Laytner LA, Anderson IV JD. Global burden and distribution of ETEC and Shigella infections in 96 low- and middle-income countries. In prep.

Bagamian, K., Anderson, J., Laytner, L., Cumming, O. & Rheingans, R. Spatial heterogeneity and disparities in enteric disease risk (ETEC and Shigella infection) in East and Central Africa: Implications for new enteric vaccines. In prep.

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