Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis
Identifieur interne : 002E96 ( Pmc/Corpus ); précédent : 002E95; suivant : 002E97Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis
Auteurs : Stephanie M. Fletcher ; Mary-Louise Mclaws ; John T. EllisSource :
- Journal of Public Health Research [ 2279-9028 ] ; 2013.
Abstract
Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.
Url:
DOI: 10.4081/jphr.2013.e9
PubMed: 25170480
PubMed Central: 4140330
Links to Exploration step
PMC:4140330Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis</title><author><name sortKey="Fletcher, Stephanie M" sort="Fletcher, Stephanie M" uniqKey="Fletcher S" first="Stephanie M." last="Fletcher">Stephanie M. Fletcher</name><affiliation><nlm:aff id="aff001"><institution>The iThree Institute and School of Medical and Molecular Biosciences, University of Technology</institution>,<addr-line>Sydney</addr-line>;</nlm:aff></affiliation></author><author><name sortKey="Mclaws, Mary Louise" sort="Mclaws, Mary Louise" uniqKey="Mclaws M" first="Mary-Louise" last="Mclaws">Mary-Louise Mclaws</name></author><author><name sortKey="Ellis, John T" sort="Ellis, John T" uniqKey="Ellis J" first="John T." last="Ellis">John T. Ellis</name><affiliation><nlm:aff id="aff001"><institution>The iThree Institute and School of Medical and Molecular Biosciences, University of Technology</institution>,<addr-line>Sydney</addr-line>;</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25170480</idno><idno type="pmc">4140330</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140330</idno><idno type="RBID">PMC:4140330</idno><idno type="doi">10.4081/jphr.2013.e9</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">002E96</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002E96</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis</title><author><name sortKey="Fletcher, Stephanie M" sort="Fletcher, Stephanie M" uniqKey="Fletcher S" first="Stephanie M." last="Fletcher">Stephanie M. Fletcher</name><affiliation><nlm:aff id="aff001"><institution>The iThree Institute and School of Medical and Molecular Biosciences, University of Technology</institution>,<addr-line>Sydney</addr-line>;</nlm:aff></affiliation></author><author><name sortKey="Mclaws, Mary Louise" sort="Mclaws, Mary Louise" uniqKey="Mclaws M" first="Mary-Louise" last="Mclaws">Mary-Louise Mclaws</name></author><author><name sortKey="Ellis, John T" sort="Ellis, John T" uniqKey="Ellis J" first="John T." last="Ellis">John T. Ellis</name><affiliation><nlm:aff id="aff001"><institution>The iThree Institute and School of Medical and Molecular Biosciences, University of Technology</institution>,<addr-line>Sydney</addr-line>;</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Public Health Research</title><idno type="ISSN">2279-9028</idno><idno type="eISSN">2279-9036</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kosek, M" uniqKey="Kosek M">M Kosek</name></author><author><name sortKey="Bern, C" uniqKey="Bern C">C Bern</name></author><author><name sortKey="Guerrant, R" uniqKey="Guerrant R">R Guerrant</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Johnson, Hl" uniqKey="Johnson H">HL Johnson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wardlaw, T" uniqKey="Wardlaw T">T Wardlaw</name></author><author><name sortKey="Salama, P" uniqKey="Salama P">P Salama</name></author><author><name sortKey="Brocklehurst, C" uniqKey="Brocklehurst C">C Brocklehurst</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Keusch, G" uniqKey="Keusch G">G Keusch</name></author><author><name sortKey="Fontaine, O" uniqKey="Fontaine O">O Fontaine</name></author><author><name sortKey="Bhargava, A" uniqKey="Bhargava A">A Bhargava</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schmidt, Rh" uniqKey="Schmidt R">RH Schmidt</name></author><author><name sortKey="Goodrich, Rm" uniqKey="Goodrich R">RM Goodrich</name></author><author><name sortKey="Archer, Dl" uniqKey="Archer D">DL Archer</name></author><author><name sortKey="Schneider, Kr" uniqKey="Schneider K">KR Schneider</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Georges, Mc" uniqKey="Georges M">MC Georges</name></author><author><name sortKey="Wachsmuth, Ik" uniqKey="Wachsmuth I">IK Wachsmuth</name></author><author><name sortKey="Meunier, Dmv" uniqKey="Meunier D">DMV Meunier</name></author><author><name sortKey="Nebout, N" uniqKey="Nebout N">N Nebout</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dutta, P" uniqKey="Dutta P">P Dutta</name></author><author><name sortKey="Lahiri, M" uniqKey="Lahiri M">M Lahiri</name></author><author><name sortKey="Sen, D" uniqKey="Sen D">D Sen</name></author><author><name sortKey="Pal, S" uniqKey="Pal S">S Pal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boga, Ja" uniqKey="Boga J">JA Boga</name></author><author><name sortKey="Melon, S" uniqKey="Melon S">S Melon</name></author><author><name sortKey="Nicieza, I" uniqKey="Nicieza I">I Nicieza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abba, K" uniqKey="Abba K">K Abba</name></author><author><name sortKey="Sinfield, R" uniqKey="Sinfield R">R Sinfield</name></author><author><name sortKey="Hart, Ca" uniqKey="Hart C">CA Hart</name></author><author><name sortKey="Garner, P" uniqKey="Garner P">P Garner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boschi Pinto, C" uniqKey="Boschi Pinto C">C Boschi-Pinto</name></author><author><name sortKey="Velebit, L" uniqKey="Velebit L">L Velebit</name></author><author><name sortKey="Shibuya, K" uniqKey="Shibuya K">K Shibuya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Green, St" uniqKey="Green S">ST Green</name></author><author><name sortKey="Small, Mj" uniqKey="Small M">MJ Small</name></author><author><name sortKey="Casman, Ea" uniqKey="Casman E">EA Casman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Savarino, Sj" uniqKey="Savarino S">SJ Savarino</name></author><author><name sortKey="Bourgeois, Al" uniqKey="Bourgeois A">AL Bourgeois</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Greenwood, Z" uniqKey="Greenwood Z">Z Greenwood</name></author><author><name sortKey="James, Black" uniqKey="James B">Black James</name></author><author><name sortKey="Leisa, Weld" uniqKey="Leisa W">Weld Leisa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fletcher, Sm" uniqKey="Fletcher S">SM Fletcher</name></author><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Harkness, J" uniqKey="Harkness J">J Harkness</name></author><author><name sortKey="Ellis, J" uniqKey="Ellis J">J Ellis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gilbert, Gl" uniqKey="Gilbert G">GL Gilbert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roy, Sl" uniqKey="Roy S">SL Roy</name></author><author><name sortKey="Scallan, E" uniqKey="Scallan E">E Scallan</name></author><author><name sortKey="J, Bm" uniqKey="J B">BM J</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Heymann, Dl" uniqKey="Heymann D">DL Heymann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lamps, Lw" uniqKey="Lamps L">LW Lamps</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pinter, M" uniqKey="Pinter M">M Pintér</name></author><author><name sortKey="Kolesarova, M" uniqKey="Kolesarova M">M Kolesárová</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ferrell, Ld" uniqKey="Ferrell L">LD Ferrell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fletcher, Sm" uniqKey="Fletcher S">SM Fletcher</name></author><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Ellis, J" uniqKey="Ellis J">J Ellis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mead, P" uniqKey="Mead P">P Mead</name></author><author><name sortKey="Slutsker, L" uniqKey="Slutsker L">L Slutsker</name></author><author><name sortKey="Dietz, V" uniqKey="Dietz V">V Dietz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Flint, Ja" uniqKey="Flint J">JA Flint</name></author><author><name sortKey="Van, Duynhoven Yt" uniqKey="Van D">Duynhoven YT Van</name></author><author><name sortKey="Angulo, Fj" uniqKey="Angulo F">FJ Angulo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scallan, E" uniqKey="Scallan E">E Scallan</name></author><author><name sortKey="Hoekstra, Rm" uniqKey="Hoekstra R">RM Hoekstra</name></author><author><name sortKey="Angulo, Fj" uniqKey="Angulo F">FJ Angulo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hall, G" uniqKey="Hall G">G Hall</name></author><author><name sortKey="Martyn, D" uniqKey="Martyn D">D. Martyn</name></author><author><name sortKey="Niels Becker, K" uniqKey="Niels Becker K">K Niels Becker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kirk Martyn, D" uniqKey="Kirk Martyn D">D Kirk Martyn</name></author><author><name sortKey="Mckay, I" uniqKey="Mckay I">I McKay</name></author><author><name sortKey="Hall Gill, V" uniqKey="Hall Gill V">V Hall Gill</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Leung, A" uniqKey="Leung A">A Leung</name></author><author><name sortKey="Robson, W" uniqKey="Robson W">W Robson</name></author><author><name sortKey="Davies, H" uniqKey="Davies H">H Davies</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marcos, La" uniqKey="Marcos L">LA Marcos</name></author><author><name sortKey="Dupont, Hl" uniqKey="Dupont H">HL DuPont</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Swaminathan, A" uniqKey="Swaminathan A">A Swaminathan</name></author><author><name sortKey="Torresi, J" uniqKey="Torresi J">J Torresi</name></author><author><name sortKey="Schlagenhauf, P" uniqKey="Schlagenhauf P">P Schlagenhauf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steffen, R" uniqKey="Steffen R">R Steffen</name></author><author><name sortKey="Tornieporth, N" uniqKey="Tornieporth N">N Tornieporth</name></author><author><name sortKey="Clemens, S Ac" uniqKey="Clemens S">S-AC Clemens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jiang, Z D" uniqKey="Jiang Z">Z-D Jiang</name></author><author><name sortKey="Brett, L" uniqKey="Brett L">L Brett</name></author><author><name sortKey="Verenkar, M P" uniqKey="Verenkar M">M P Verenkar</name></author><author><name sortKey="Ashley, D" uniqKey="Ashley D">D Ashley</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Jackson, D" uniqKey="Jackson D">D Jackson</name></author><author><name sortKey="Bowden, J" uniqKey="Bowden J">J Bowden</name></author><author><name sortKey="Baker, R" uniqKey="Baker R">R Baker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Borenstein, M" uniqKey="Borenstein M">M Borenstein</name></author><author><name sortKey="Hedges, L" uniqKey="Hedges L">L Hedges</name></author><author><name sortKey="Higgins, J" uniqKey="Higgins J">J Higgins</name></author><author><name sortKey="Rothstein, H" uniqKey="Rothstein H">H Rothstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tin, A" uniqKey="Tin A">A Tin</name></author><author><name sortKey="Mar, N" uniqKey="Mar N">N Mar</name></author><author><name sortKey="Kyi, K" uniqKey="Kyi K">K Kyi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Huilan, S" uniqKey="Huilan S">S Huilan</name></author><author><name sortKey="Zhen, Lg" uniqKey="Zhen L">LG Zhen</name></author><author><name sortKey="Mathan, Mm" uniqKey="Mathan M">MM Mathan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kain, Kc" uniqKey="Kain K">KC Kain</name></author><author><name sortKey="Barteluk, Rl" uniqKey="Barteluk R">RL Barteluk</name></author><author><name sortKey="Kelly, Mt" uniqKey="Kelly M">MT Kelly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yu, J M" uniqKey="Yu J">J-M Yu</name></author><author><name sortKey="Li, D D" uniqKey="Li D">D-D Li</name></author><author><name sortKey="Xu, Z Q" uniqKey="Xu Z">Z-Q Xu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Soenarto, Y" uniqKey="Soenarto Y">Y Soenarto</name></author><author><name sortKey="Sebodo, T" uniqKey="Sebodo T">T Sebodo</name></author><author><name sortKey="Suryantoro, P" uniqKey="Suryantoro P">P Suryantoro</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yamashiro, T" uniqKey="Yamashiro T">T Yamashiro</name></author><author><name sortKey="Nakasone, N" uniqKey="Nakasone N">N Nakasone</name></author><author><name sortKey="Higa, N" uniqKey="Higa N">N Higa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liu, Lj" uniqKey="Liu L">LJ Liu</name></author><author><name sortKey="Yang, Yj" uniqKey="Yang Y">YJ Yang</name></author><author><name sortKey="Kuo, Ph" uniqKey="Kuo P">PH Kuo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lu, C Y" uniqKey="Lu C">C-Y Lu</name></author><author><name sortKey="Tsai Ling, L" uniqKey="Tsai Ling L">L Tsai-Ling</name></author><author><name sortKey="Fang, Y H" uniqKey="Fang Y">Y-H Fang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Isenbarger, D" uniqKey="Isenbarger D">D Isenbarger</name></author><author><name sortKey="Hien, B" uniqKey="Hien B">B Hien</name></author><author><name sortKey="Ha, H" uniqKey="Ha H">H Ha</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bodhidatta, L" uniqKey="Bodhidatta L">L Bodhidatta</name></author><author><name sortKey="Vithayasai, N" uniqKey="Vithayasai N">N Vithayasai</name></author><author><name sortKey="Eimpokalarp, B" uniqKey="Eimpokalarp B">B Eimpokalarp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nguyen, Tv" uniqKey="Nguyen T">TV Nguyen</name></author><author><name sortKey="Le, Van P" uniqKey="Le V">Van P Le</name></author><author><name sortKey="Le, Huy C" uniqKey="Le H">Huy C Le</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hien, Btt" uniqKey="Hien B">BTT Hien</name></author><author><name sortKey="Trang, Dt" uniqKey="Trang D">DT Trang</name></author><author><name sortKey="Scheutz, F" uniqKey="Scheutz F">F Scheutz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seigel, Rr" uniqKey="Seigel R">RR Seigel</name></author><author><name sortKey="Santana E Sant Nna, C" uniqKey="Santana E Sant Nna C">C Santana e Sant’anna</name></author><author><name sortKey="Salgado, K" uniqKey="Salgado K">K Salgado</name></author><author><name sortKey="De Jesus, P" uniqKey="De Jesus P">P de-Jesus</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barreto, Ml" uniqKey="Barreto M">ML Barreto</name></author><author><name sortKey="Milroy, Ca" uniqKey="Milroy C">CA Milroy</name></author><author><name sortKey="Strina, A" uniqKey="Strina A">A Strina</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Flores Abuxapqui, Jj" uniqKey="Flores Abuxapqui J">JJ Flores-Abuxapqui</name></author><author><name sortKey="Suarez Hoil, Gdj" uniqKey="Suarez Hoil G">GdJ Suárez-Hoil</name></author><author><name sortKey="Puc Franco, Ma" uniqKey="Puc Franco M">MA Puc-Franco</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ochoa, Tj" uniqKey="Ochoa T">TJ Ochoa</name></author><author><name sortKey="Ecker, L" uniqKey="Ecker L">L Ecker</name></author><author><name sortKey="Barletta, F" uniqKey="Barletta F">F Barletta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paniagua, G" uniqKey="Paniagua G">G Paniagua</name></author><author><name sortKey="Monroy, E" uniqKey="Monroy E">E Monroy</name></author><author><name sortKey="Garcia Gonzalez, O" uniqKey="Garcia Gonzalez O">O García-González</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pazzaglia, G" uniqKey="Pazzaglia G">G Pazzaglia</name></author><author><name sortKey="Sack, Rb" uniqKey="Sack R">RB Sack</name></author><author><name sortKey="Salazar, E" uniqKey="Salazar E">E Salazar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Torres, Me" uniqKey="Torres M">ME Torres</name></author><author><name sortKey="Pirez, Mc" uniqKey="Pirez M">MC Pírez</name></author><author><name sortKey="Schelotto, F" uniqKey="Schelotto F">F Schelotto</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="El Mohamady, H" uniqKey="El Mohamady H">H El-Mohamady</name></author><author><name sortKey="Abdel Messih, Ia" uniqKey="Abdel Messih I">IA Abdel-Messih</name></author><author><name sortKey="Youssef, Fg" uniqKey="Youssef F">FG Youssef</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Elamreen, Fha" uniqKey="Elamreen F">FHA Elamreen</name></author><author><name sortKey="Abed, Aa" uniqKey="Abed A">AA Abed</name></author><author><name sortKey="Sharif, Fa" uniqKey="Sharif F">FA Sharif</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="El Sheikh, Sm" uniqKey="El Sheikh S">SM El-Sheikh</name></author><author><name sortKey="El Assouli, Sm" uniqKey="El Assouli S">SM El-Assouli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Youssef, M" uniqKey="Youssef M">M Youssef</name></author><author><name sortKey="Shurman, A" uniqKey="Shurman A">A Shurman</name></author><author><name sortKey="Bougnoux, M E" uniqKey="Bougnoux M">M-E Bougnoux</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Gallas, N" uniqKey="Al Gallas N">N Al-Gallas</name></author><author><name sortKey="Bahri, O" uniqKey="Bahri O">O Bahri</name></author><author><name sortKey="Bouratbeen, A" uniqKey="Bouratbeen A">A Bouratbeen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barnes, Gl" uniqKey="Barnes G">GL Barnes</name></author><author><name sortKey="Uren, E" uniqKey="Uren E">E Uren</name></author><author><name sortKey="Stevens, Kb" uniqKey="Stevens K">KB Stevens</name></author><author><name sortKey="Bishop, Rf" uniqKey="Bishop R">RF Bishop</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mciver, Cj" uniqKey="Mciver C">CJ McIver</name></author><author><name sortKey="Hansman, G" uniqKey="Hansman G">G Hansman</name></author><author><name sortKey="White, P" uniqKey="White P">P White</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olesen, B" uniqKey="Olesen B">B Olesen</name></author><author><name sortKey="Neimann, J" uniqKey="Neimann J">J Neimann</name></author><author><name sortKey="Bottiger, B" uniqKey="Bottiger B">B Böttiger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rautelin, Hi" uniqKey="Rautelin H">HI Rautelin</name></author><author><name sortKey="Renkonen, Ov" uniqKey="Renkonen O">OV Renkonen</name></author><author><name sortKey="Von, Bonsdorff C H" uniqKey="Von B">Bonsdorff C-H Von</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Levidiotou, S" uniqKey="Levidiotou S">S Levidiotou</name></author><author><name sortKey="Gartzonika, C" uniqKey="Gartzonika C">C Gartzonika</name></author><author><name sortKey="Papaventsis, D" uniqKey="Papaventsis D">D Papaventsis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Colomba, C" uniqKey="Colomba C">C Colomba</name></author><author><name sortKey="De, Grazia S" uniqKey="De G">Grazia S De</name></author><author><name sortKey="Giammanco, Gm" uniqKey="Giammanco G">GM Giammanco</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Albert, Mj" uniqKey="Albert M">MJ Albert</name></author><author><name sortKey="Faruque, Asg" uniqKey="Faruque A">ASG Faruque</name></author><author><name sortKey="Faruque, Sm" uniqKey="Faruque S">SM Faruque</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ghosh, Ar" uniqKey="Ghosh A">AR Ghosh</name></author><author><name sortKey="Nair, Gb" uniqKey="Nair G">GB Nair</name></author><author><name sortKey="Dutta, P" uniqKey="Dutta P">P Dutta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Haque, R" uniqKey="Haque R">R Haque</name></author><author><name sortKey="Mondal, D" uniqKey="Mondal D">D Mondal</name></author><author><name sortKey="Kirkpatrick, Bd" uniqKey="Kirkpatrick B">BD Kirkpatrick</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Klein, E" uniqKey="Klein E">E Klein</name></author><author><name sortKey="Boster, Dr" uniqKey="Boster D">DR Boster</name></author><author><name sortKey="Stapp, Jr" uniqKey="Stapp J">JR Stapp</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kyung Hee, K" uniqKey="Kyung Hee K">K Kyung-Hee</name></author><author><name sortKey="Inn Soo, Suh" uniqKey="Inn Soo S">Suh Inn-Soo</name></author><author><name sortKey="Jung, Mogg Kim" uniqKey="Jung M">Mogg Kim Jung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neuwelt, P" uniqKey="Neuwelt P">P Neuwelt</name></author><author><name sortKey="Simmons, G" uniqKey="Simmons G">G Simmons</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Uysal, G" uniqKey="Uysal G">G Uysal</name></author><author><name sortKey="Do Ru, U" uniqKey="Do Ru U">Ü Do ru</name></author><author><name sortKey="Aysev, D" uniqKey="Aysev D">D Aysev</name></author><author><name sortKey="Karabiber, N" uniqKey="Karabiber N">N Karabiber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Djeneba, O" uniqKey="Djeneba O">O Djeneba</name></author><author><name sortKey="Damintoti, K" uniqKey="Damintoti K">K Damintoti</name></author><author><name sortKey="Denise, I" uniqKey="Denise I">I Denise</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Germani, Y" uniqKey="Germani Y">Y Germani</name></author><author><name sortKey="Minssart, P" uniqKey="Minssart P">P Minssart</name></author><author><name sortKey="Vohito, M" uniqKey="Vohito M">M Vohito</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hoge, Cw" uniqKey="Hoge C">CW Hoge</name></author><author><name sortKey="Echeverria, P" uniqKey="Echeverria P">P Echeverria</name></author><author><name sortKey="Rajah, R" uniqKey="Rajah R">R Rajah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reither, K" uniqKey="Reither K">K Reither</name></author><author><name sortKey="Ignatius, R" uniqKey="Ignatius R">R Ignatius</name></author><author><name sortKey="Weitzel, T" uniqKey="Weitzel T">T Weitzel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yongsi, Hbn" uniqKey="Yongsi H">HBN Yongsi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anyanwu, Bn" uniqKey="Anyanwu B">BN Anyanwu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ogbu, O" uniqKey="Ogbu O">O Ogbu</name></author><author><name sortKey="Agumadu, N" uniqKey="Agumadu N">N Agumadu</name></author><author><name sortKey="Uneke, Cj" uniqKey="Uneke C">CJ Uneke</name></author><author><name sortKey="Amadi, Es" uniqKey="Amadi E">ES Amadi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ogunsanya, Ti" uniqKey="Ogunsanya T">TI Ogunsanya</name></author><author><name sortKey="Rotimi, Vo" uniqKey="Rotimi V">VO Rotimi</name></author><author><name sortKey="Adenuga, A" uniqKey="Adenuga A">A Adenuga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olowe, Oa" uniqKey="Olowe O">OA Olowe</name></author><author><name sortKey="Olayemi, Ab" uniqKey="Olayemi A">AB Olayemi</name></author><author><name sortKey="Eniola, Kit" uniqKey="Eniola K">KIT Eniola</name></author><author><name sortKey="Adeyeba, Oa" uniqKey="Adeyeba O">OA Adeyeba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Eijk, Am" uniqKey="Van Eijk A">AM van Eijk</name></author><author><name sortKey="Brooks, Jt" uniqKey="Brooks J">JT Brooks</name></author><author><name sortKey="Adcock, Pm" uniqKey="Adcock P">PM Adcock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brink, Ak" uniqKey="Brink A">AK Brink</name></author><author><name sortKey="Mahe, C" uniqKey="Mahe C">C Mahé</name></author><author><name sortKey="Watera, C" uniqKey="Watera C">C Watera</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cajetan, Ici" uniqKey="Cajetan I">ICI Cajetan</name></author><author><name sortKey="Nnennaya, Ir" uniqKey="Nnennaya I">IR Nnennaya</name></author><author><name sortKey="Casmir, Aa" uniqKey="Casmir A">AA Casmir</name></author><author><name sortKey="Florence, In" uniqKey="Florence I">IN Florence</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Musiime, V" uniqKey="Musiime V">V Musiime</name></author><author><name sortKey="Kalyesubula, I" uniqKey="Kalyesubula I">I Kalyesubula</name></author><author><name sortKey="Kaddu Mulindwa, D" uniqKey="Kaddu Mulindwa D">D Kaddu-Mulindwa</name></author><author><name sortKey="Byarugaba, J" uniqKey="Byarugaba J">J Byarugaba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vargas, M" uniqKey="Vargas M">M Vargas</name></author><author><name sortKey="Gascon, J" uniqKey="Gascon J">J Gascon</name></author><author><name sortKey="Casals, C" uniqKey="Casals C">C Casals</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Mol, P" uniqKey="De Mol P">P De Mol</name></author><author><name sortKey="Hemelhof, W" uniqKey="Hemelhof W">W Hemelhof</name></author><author><name sortKey="Butzler, J P" uniqKey="Butzler J">J P Butzler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Henry, M C" uniqKey="Henry M">M-C Henry</name></author><author><name sortKey="Alary, M" uniqKey="Alary M">M Alary</name></author><author><name sortKey="Desmet, P" uniqKey="Desmet P">P Desmet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kelly, P" uniqKey="Kelly P">P Kelly</name></author><author><name sortKey="Baboo, K" uniqKey="Baboo K">K Baboo</name></author><author><name sortKey="Wolff, M" uniqKey="Wolff M">M Wolff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nakano, T" uniqKey="Nakano T">T Nakano</name></author><author><name sortKey="Kamiya, H" uniqKey="Kamiya H">H Kamiya</name></author><author><name sortKey="Matsubayashi, N" uniqKey="Matsubayashi N">N Matsubayashi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Podkolzin, At" uniqKey="Podkolzin A">AT Podkolzin</name></author><author><name sortKey="Fenske, Eb" uniqKey="Fenske E">EB Fenske</name></author><author><name sortKey="Yu Abramycheva, N" uniqKey="Yu Abramycheva N">N Yu Abramycheva</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Eill, Hj" uniqKey="O Eill H">HJ O’Neill</name></author><author><name sortKey="Mccaughey, C" uniqKey="Mccaughey C">C McCaughey</name></author><author><name sortKey="Coyle, Pv" uniqKey="Coyle P">PV Coyle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jansen, A" uniqKey="Jansen A">A Jansen</name></author><author><name sortKey="Stark, K" uniqKey="Stark K">K Stark</name></author><author><name sortKey="Kunkel, J" uniqKey="Kunkel J">J Kunkel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olsen, Je" uniqKey="Olsen J">JE Olsen</name></author><author><name sortKey="Aabo, S" uniqKey="Aabo S">S Aabo</name></author><author><name sortKey="Hill, W" uniqKey="Hill W">W Hill</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ashley, Dvm" uniqKey="Ashley D">DVM Ashley</name></author><author><name sortKey="Walters, C" uniqKey="Walters C">C Walters</name></author><author><name sortKey="Dockery Brown, C" uniqKey="Dockery Brown C">C Dockery-Brown</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fletcher, Sm" uniqKey="Fletcher S">SM Fletcher</name></author><author><name sortKey="Maharaj, Sr" uniqKey="Maharaj S">SR Maharaj</name></author><author><name sortKey="James, K" uniqKey="James K">K James</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Steffen, R" uniqKey="Steffen R">R Steffen</name></author><author><name sortKey="Collard, F" uniqKey="Collard F">F Collard</name></author><author><name sortKey="Tornieporth, N" uniqKey="Tornieporth N">N Tornieporth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sanchez Padilla, E" uniqKey="Sanchez Padilla E">E Sanchez-Padilla</name></author><author><name sortKey="Grais, Rf" uniqKey="Grais R">RF Grais</name></author><author><name sortKey="Guerin, Pj" uniqKey="Guerin P">PJ Guerin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Genser, B" uniqKey="Genser B">B Genser</name></author><author><name sortKey="Strina, A" uniqKey="Strina A">A Strina</name></author><author><name sortKey="Dos Santos, La" uniqKey="Dos Santos L">LA Dos Santos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Robins Browne, Rm" uniqKey="Robins Browne R">RM Robins-Browne</name></author><author><name sortKey="Levine, Mm" uniqKey="Levine M">MM Levine</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Richardson, S" uniqKey="Richardson S">S Richardson</name></author><author><name sortKey="Grimwood, K" uniqKey="Grimwood K">K Grimwood</name></author><author><name sortKey="Gorrell, R" uniqKey="Gorrell R">R Gorrell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Van Hal, S" uniqKey="Van Hal S">S van Hal</name></author><author><name sortKey="Fotedar, R" uniqKey="Fotedar R">R Fotedar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bruijnesteijn Van Coppenraet, Les" uniqKey="Bruijnesteijn Van Coppenraet L">LES Bruijnesteijn van Coppenraet</name></author><author><name sortKey="Wallinga, Ja" uniqKey="Wallinga J">JA Wallinga</name></author><author><name sortKey="Ruijs, Gjhm" uniqKey="Ruijs G">GJHM Ruijs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Al Qassab, Se" uniqKey="Al Qassab S">SE Al-Qassab</name></author><author><name sortKey="Barratt, Jln" uniqKey="Barratt J">JLN Barratt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Barratt, J" uniqKey="Barratt J">J Barratt</name></author><author><name sortKey="Roberts, T" uniqKey="Roberts T">T Roberts</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Barratt, J" uniqKey="Barratt J">J Barratt</name></author><author><name sortKey="Roberts, T" uniqKey="Roberts T">T Roberts</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fotedar, R" uniqKey="Fotedar R">R Fotedar</name></author><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Beebe, N" uniqKey="Beebe N">N Beebe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Putignani, L" uniqKey="Putignani L">L Putignani</name></author><author><name sortKey="Menichella, D" uniqKey="Menichella D">D Menichella</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thapar, N" uniqKey="Thapar N">N Thapar</name></author><author><name sortKey="Sanderson, Pir" uniqKey="Sanderson P">PIR Sanderson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glass, R" uniqKey="Glass R">R. Glass</name></author><author><name sortKey="Parashar, Ud" uniqKey="Parashar U">UD Parashar</name></author><author><name sortKey="Estes, M" uniqKey="Estes M">M Estes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fletcher, Sm" uniqKey="Fletcher S">SM Fletcher</name></author><author><name sortKey="Van Hal, S" uniqKey="Van Hal S">S Van Hal</name></author><author><name sortKey="Andresen, D" uniqKey="Andresen D">D Andresen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cook, Sm" uniqKey="Cook S">SM Cook</name></author><author><name sortKey="Glass, Ri" uniqKey="Glass R">RI Glass</name></author><author><name sortKey="Lebaron, Cw" uniqKey="Lebaron C">CW LeBaron</name></author><author><name sortKey="Ho, M S" uniqKey="Ho M">M-S Ho</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Curns, At" uniqKey="Curns A">AT Curns</name></author><author><name sortKey="Steiner, Ca" uniqKey="Steiner C">CA Steiner</name></author><author><name sortKey="Barrett, M" uniqKey="Barrett M">M Barrett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chiu, C" uniqKey="Chiu C">C Chiu</name></author><author><name sortKey="Dey, A" uniqKey="Dey A">A Dey</name></author><author><name sortKey="Wang, H" uniqKey="Wang H">H Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brotherton, J" uniqKey="Brotherton J">J Brotherton</name></author><author><name sortKey="Wang, H" uniqKey="Wang H">H Wang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hull, B P" uniqKey="Hull B">B P Hull</name></author><author><name sortKey="Mahajan, D" uniqKey="Mahajan D">D Mahajan</name></author><author><name sortKey="Dey, A" uniqKey="Dey A">A Dey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Madhi, Sa" uniqKey="Madhi S">SA Madhi</name></author><author><name sortKey="Cunliffe, Na" uniqKey="Cunliffe N">NA Cunliffe</name></author><author><name sortKey="Steele, D" uniqKey="Steele D">D Steele</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Santosham, M" uniqKey="Santosham M">M Santosham</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Svraka, S" uniqKey="Svraka S">S Svraka</name></author><author><name sortKey="Duizer, E" uniqKey="Duizer E">E Duizer</name></author><author><name sortKey="Vennema, H" uniqKey="Vennema H">H Vennema</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fischer Walker, Cl" uniqKey="Fischer Walker C">CL Fischer Walker</name></author><author><name sortKey="Sack, D" uniqKey="Sack D">D Sack</name></author><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Voetsch, Ac" uniqKey="Voetsch A">AC Voetsch</name></author><author><name sortKey="Van Gilder, Tj" uniqKey="Van Gilder T">TJ Van Gilder</name></author><author><name sortKey="Angulo, Fj" uniqKey="Angulo F">FJ Angulo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rabsch, W" uniqKey="Rabsch W">W Rabsch</name></author><author><name sortKey="Tsch Pe, H" uniqKey="Tsch Pe H">H Tschäpe</name></author><author><name sortKey="B Umler, Aj" uniqKey="B Umler A">AJ Bäumler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bambrick, H" uniqKey="Bambrick H">H Bambrick</name></author><author><name sortKey="Dear, K" uniqKey="Dear K">K Dear</name></author><author><name sortKey="Woodruff, R" uniqKey="Woodruff R">R Woodruff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Yan, M" uniqKey="O Yan M">M O’Ryan</name></author><author><name sortKey="Prado, V" uniqKey="Prado V">V Prado</name></author><author><name sortKey="Pickering, Lk" uniqKey="Pickering L">LK Pickering</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Raso, G" uniqKey="Raso G">G Raso</name></author><author><name sortKey="Luginbuhl, A" uniqKey="Luginbuhl A">A Luginbuhl</name></author><author><name sortKey="Adjoua, Ca" uniqKey="Adjoua C">CA Adjoua</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mor Siobhan, M" uniqKey="Mor Siobhan M">M Mor Siobhan</name></author><author><name sortKey="Tzipori, S" uniqKey="Tzipori S">S Tzipori</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Barratt, Jln" uniqKey="Barratt J">JLN Barratt</name></author><author><name sortKey="Van Hal, S" uniqKey="Van Hal S">S van Hal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jones, M" uniqKey="Jones M">M Jones</name></author><author><name sortKey="Whipps, C" uniqKey="Whipps C">C Whipps</name></author><author><name sortKey="Ganac, R" uniqKey="Ganac R">R Ganac</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boorom, K" uniqKey="Boorom K">K Boorom</name></author><author><name sortKey="Smith, H" uniqKey="Smith H">H Smith</name></author><author><name sortKey="Nimri, L" uniqKey="Nimri L">L Nimri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dogruman Al, F" uniqKey="Dogruman Al F">F Dogruman-Al</name></author><author><name sortKey="Kustimur, S" uniqKey="Kustimur S">S Kustimur</name></author><author><name sortKey="Yoshikawa, H" uniqKey="Yoshikawa H">H Yoshikawa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Van Hal, S" uniqKey="Van Hal S">S van Hal</name></author><author><name sortKey="Marriott, D" uniqKey="Marriott D">D Marriott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jimenez Gonzalez, D" uniqKey="Jimenez Gonzalez D">D Jimenez-Gonzalez</name></author><author><name sortKey="Martinez Flores, W" uniqKey="Martinez Flores W">W Martinez-Flores</name></author><author><name sortKey="Reyes Gordillo, J" uniqKey="Reyes Gordillo J">J Reyes-Gordillo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roberts, T" uniqKey="Roberts T">T Roberts</name></author><author><name sortKey="Stark, D" uniqKey="Stark D">D Stark</name></author><author><name sortKey="Harkness, J" uniqKey="Harkness J">J Harkness</name></author><author><name sortKey="Ellis, J" uniqKey="Ellis J">J Ellis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kotloff, Kl" uniqKey="Kotloff K">KL Kotloff</name></author><author><name sortKey="Blackwelder, Wc" uniqKey="Blackwelder W">WC Blackwelder</name></author><author><name sortKey="Nasrin, D" uniqKey="Nasrin D">D Nasrin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Panchalingam, S" uniqKey="Panchalingam S">S Panchalingam</name></author><author><name sortKey="Antonio, M" uniqKey="Antonio M">M Antonio</name></author><author><name sortKey="Hossain, A" uniqKey="Hossain A">A Hossain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fletcher, Sm" uniqKey="Fletcher S">SM Fletcher</name></author><author><name sortKey="Van Hal, S" uniqKey="Van Hal S">S Van Hal</name></author><author><name sortKey="Andresen, D" uniqKey="Andresen D">D Andresen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grimwood, K" uniqKey="Grimwood K">K Grimwood</name></author><author><name sortKey="Huang, Qs" uniqKey="Huang Q">QS Huang</name></author><author><name sortKey="Cohet, C" uniqKey="Cohet C">C Cohet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mounts, Aw" uniqKey="Mounts A">AW Mounts</name></author><author><name sortKey="Ando, T" uniqKey="Ando T">T Ando</name></author><author><name sortKey="Koopmans, M" uniqKey="Koopmans M">M Koopmans</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lal, A" uniqKey="Lal A">A Lal</name></author><author><name sortKey="Hales, S" uniqKey="Hales S">S Hales</name></author><author><name sortKey="French, N" uniqKey="French N">N French</name></author><author><name sortKey="Baker, Mg" uniqKey="Baker M">MG Baker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Ssw" uniqKey="Chan S">SSW Chan</name></author><author><name sortKey="Ng, Kc" uniqKey="Ng K">KC Ng</name></author><author><name sortKey="Lam, Pk W" uniqKey="Lam P">PK-W Lam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ekdahl, K" uniqKey="Ekdahl K">K Ekdahl</name></author><author><name sortKey="De, Jong B" uniqKey="De J">Jong B De</name></author><author><name sortKey="Wollin, R" uniqKey="Wollin R">R Wollin</name></author><author><name sortKey="Andersson, Y" uniqKey="Andersson Y">Y Andersson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ekdahl, L" uniqKey="Ekdahl L">L Ekdahl</name></author><author><name sortKey="Andersson, Y" uniqKey="Andersson Y">Y Andersson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gauci, C" uniqKey="Gauci C">C Gauci</name></author><author><name sortKey="Gilles, H" uniqKey="Gilles H">H Gilles</name></author><author><name sortKey="O Rien, S" uniqKey="O Rien S">S O’Brien</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hall, G" uniqKey="Hall G">G Hall</name></author><author><name sortKey="Kirk, M" uniqKey="Kirk M">M Kirk</name></author><author><name sortKey="Ashbolt, R" uniqKey="Ashbolt R">R Ashbolt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kovats, Rs" uniqKey="Kovats R">RS Kovats</name></author><author><name sortKey="Edwards, Sj" uniqKey="Edwards S">SJ Edwards</name></author><author><name sortKey="Charron, D" uniqKey="Charron D">D Charron</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pardhan Ali, A" uniqKey="Pardhan Ali A">A Pardhan-Ali</name></author><author><name sortKey="Wilson, J" uniqKey="Wilson J">J Wilson</name></author><author><name sortKey="Edge, Vl" uniqKey="Edge V">VL Edge</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Public Health Res</journal-id><journal-id journal-id-type="iso-abbrev">J Public Health Res</journal-id><journal-id journal-id-type="publisher-id">JPHR</journal-id><journal-title-group><journal-title>Journal of Public Health Research</journal-title></journal-title-group><issn pub-type="ppub">2279-9028</issn><issn pub-type="epub">2279-9036</issn><publisher><publisher-name>PAGEPress Publications</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25170480</article-id><article-id pub-id-type="pmc">4140330</article-id><article-id pub-id-type="doi">10.4081/jphr.2013.e9</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review and Meta-analysis</subject></subj-group></article-categories><title-group><article-title>Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Fletcher</surname><given-names>Stephanie M.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>McLaws</surname><given-names>Mary-Louise</given-names></name><xref ref-type="aff" rid="aff001 aff002"><sup>1, 2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ellis</surname><given-names>John T.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><institution>The iThree Institute and School of Medical and Molecular Biosciences, University of Technology</institution>,<addr-line>Sydney</addr-line>;</aff><aff id="aff002"><label>2</label><institution>School of Public Health and Community Medicine, The University of New South Wales</institution>,<addr-line>Sydney, Australia</addr-line></aff><author-notes><corresp id="cor1">Correspondence: Stephanie M. Fletcher, The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney P.O. Box 123, Broadway, NSW, Australia. <email>stephanie.fletcher@uts.edu.au</email></corresp><fn fn-type="conflict"><p>Conflicts of interest: the authors declare no potential conflict of interests.</p></fn></author-notes><pub-date pub-type="epub"><day>16</day><month>7</month><year>2013</year></pub-date><pub-date pub-type="collection"><day>28</day><month>4</month><year>2013</year></pub-date><volume>2</volume><issue>1</issue><fpage>42</fpage><lpage>53</lpage><history><date date-type="received"><day>08</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>14</day><month>5</month><year>2013</year></date></history><permissions><copyright-statement>©Copyright S.M. Fletcher et al., 2013</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Licensee PAGEPress, Italy</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:type="simple" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.</p></abstract><kwd-group><title>Key words</title><kwd>adults</kwd><kwd>bacteria</kwd><kwd>children</kwd><kwd>developing country</kwd><kwd>diarrhoea</kwd><kwd>enteric pathogens</kwd><kwd>vaccines</kwd><kwd>viruses</kwd><kwd>parasites</kwd></kwd-group><counts><fig-count count="0"></fig-count><table-count count="4"></table-count><equation-count count="0"></equation-count><ref-count count="149"></ref-count><page-count count="12"></page-count></counts></article-meta></front><body><boxed-text position="float" orientation="portrait"><sec><title>Significance for public health</title><p>This research is significant in that it provides an evidence base for the advancement in understanding global disease burden and the development of public health and research priorities. Understanding that people in both developed and developing settings are affected by similar pathogens to different degrees and requires cross border sharing and learning for their control. The prevalence of rotavirus underscores the need for improved access to rotavirus vaccines in both settings. Rotavirus vaccines have efficaciously reduced gastroenteritis burden where they have been introduced and hence likely to do so in developing settings. The global public health community should support efforts to make rotavirus vaccines available at affordable costs to the poorest people of the world, where disease burden and mortality is highest. Developed countries should support developing regions to implementation effective programs for the prevention and control of gastrointestinal infections, since infectious pathogens know no boundaries.</p></sec></boxed-text><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Gastrointestinal (GIT) illnesses contribute significantly to the burden of illness from infectious diseases worldwide. Diarrhoea is the second leading cause of preventable illness in children under age five.<sup><xref rid="ref1" ref-type="bibr">1-3</xref></sup> Despite the strong association between gastrointestinal illnesses and factors such as poor sanitation, inadequate access to safe drinking water and other risk factors, both resource-rich and less developed countries alike are impacted by gastrointestinal illness.<sup><xref rid="ref3" ref-type="bibr">3</xref>,<xref rid="ref4" ref-type="bibr">4</xref></sup> The risk factors however appear to be distributed differently between developed and developing countries and as a result, the incidence of specific pathogens may differ between each setting.<sup><xref rid="ref5" ref-type="bibr">5</xref></sup> Several studies have described the pathogens, associated risk factors and the costs and burden of illness on health care. However, there are few studies that estimate the prevalence of pathogens affecting populations in different regions worldwide. Developing countries world often experience similar sanitation and poverty related risk factors, which predisposes their population to diarrhoeal illnesses. However, the incidence of illness in developed countries tend to be less generic and more related to seasonality, travel and food borne transmission.<sup><xref rid="ref4" ref-type="bibr">4</xref></sup></p><p>Several enteric micro-organisms are responsible for GIT illnesses and are bacterial, viral or parasitic in nature.<sup><xref rid="ref6" ref-type="bibr">6</xref></sup> A review of the literature world-wide indicates that a causative organism is identified in about 50% of symptomatic cases.<sup><xref rid="ref7" ref-type="bibr">7-10</xref></sup> In resource-limited settings under-reporting is possible, with the data biased towards certain pathogens and relate mainly to specific age groups.<sup><xref rid="ref1" ref-type="bibr">1</xref>,<xref rid="ref11" ref-type="bibr">11</xref>,<xref rid="ref12" ref-type="bibr">12</xref></sup></p><p>There are few estimates of the prevalence and distribution of pathogens that cause GIT illnesses, which indicate there may be significant differences in the prevalence of certain pathogens in circulation in developing and developed settings.<sup><xref rid="ref13" ref-type="bibr">13-15</xref></sup> Determining the prevalence of pathogens on a regional basis will assist in the development of appropriately targeted prevention and control strategies, identify gaps in surveillance and provide support for the strengthening of laboratory diagnostic capacity at the regional level. It can also assist in the management of the health needs of travelers to different regions.</p><p>This paper provides an overview of gastrointestinal illnesses and a systematic review of the literature to provide region-specific GIT pathogen detection rates associated with cases in developed countries and developing regions. Firstly, an overview of gastrointestinal illnesses including definitions, and disease transmission and risk factors are presented. Then an estimate of the detection of enteric pathogens is provided based on studies worldwide.</p><sec id="sec2-1"><title>Definition of gastrointestinal illness</title><p>The term <italic>gastrointestinal illness</italic> refers to several conditions affecting the gastrointestinal system that exhibits watery or unformed stools and are usually caused by infections or intoxications with a biological agent.<sup><xref rid="ref16" ref-type="bibr">16</xref></sup> Because of the various causes, variable symptomology, and numerous different terms used to describe disease of the gastrointestinal tract, no standard definition of <italic>gastrointestinal diseases</italic> has been presented in the medical literature.<sup><xref rid="ref17" ref-type="bibr">17</xref></sup> For the purposes of this study, gastrointestinal illness refers to any illness of the gastrointestinal tract caused by a microbe causing chronic or acute diarrhea, whether or not accompanied by nausea, or vomiting, combined with abdominal pain, or systemic symptoms such as fever. A suspected case is any case having met the criteria for a clinical diagnosis (see below). A confirmed case is any suspect case that has a laboratory confirmation of an enteric disease pathogen isolated from a clinical specimen.</p><p>Diarrhoeal illness is usually divided into three main categories based on its clinical presentation:<sup><xref rid="ref18" ref-type="bibr">18</xref></sup></p><list list-type="simple"><list-item><p><italic>- Acute watery diarrhoea</italic> associated with several pathogens such as <italic>Vibrio cholera</italic> and rotavirus, usually last for several days, and poses a high risk for dehydration which can be fatal especially in young children, the elderly and immuo-compromised persons.<sup><xref rid="ref18" ref-type="bibr">18</xref></sup></p></list-item><list-item><p><italic>- Acute bloody diarrhoea</italic> or dysentery is usually evidence of infection with <italic>Campylobacter, Salmonella, Shigella,</italic> enterohaemorrhagic <italic>E. coli</italic> pathotypes<italic>, Entamoeba histolytica</italic> and other organisms, and can lead to dehydration. The major risks associated with this presentation include intestinal damage, sepsis and malnutrition.<sup><xref rid="ref18" ref-type="bibr">18</xref></sup></p></list-item><list-item><p><italic>- Persistent diarrhoea</italic> lasts for 14 or more days and is usually associated with parasitic aetiology but can be due to non-infectious causes such as inflammatory bowel disease. Due to the prolonged duration of persistent diarrhoea there is a risk of nutrient deficiency, extra intestinal infection and dehydration especially in children, the elderly and immuno-compromised.<sup><xref rid="ref18" ref-type="bibr">18</xref></sup></p></list-item></list></sec></sec><sec id="sec1-2"><title>Overview of gastrointestinal illness</title><p>Gastrointestinal illnesses can be either acute self-limiting infections or chronic idiopathies.<sup><xref rid="ref19" ref-type="bibr">19</xref></sup> Both acute and chronic infections can be caused by pathogenic bacteria, viruses and parasites. Diarrhoea can also be caused by idiopathic diseases arising from internal dysfunctions of gastrointestinal tract include diseases such as Idiopathic bowel disease, Crohn’s disease and ulcerative colitis.<sup><xref rid="ref19" ref-type="bibr">19</xref>,<xref rid="ref20" ref-type="bibr">20</xref></sup> The majority of gastrointestinal illnesses are self-limited,<sup><xref rid="ref19" ref-type="bibr">19</xref></sup> however, certain risk factors such as malnutrition, immunosuppression, and young age predisposes the development of persistent diarrhea.<sup><xref rid="ref18" ref-type="bibr">18</xref></sup> Patients with immune deficiencies (congenital, iatrogenic or acquired) are unusually more susceptible to infections and are at an increased risk for malignancy.<sup><xref rid="ref21" ref-type="bibr">21</xref></sup></p><sec id="sec2-2"><title>Disease transmission and risk factors</title><p>Infectious gastrointestinal illnesses are transmitted through a variety of routes including contaminated food or water borne, the faecal oral route, and person-to-person.<sup><xref rid="ref16" ref-type="bibr">16</xref>,<xref rid="ref22" ref-type="bibr">22</xref></sup> A significant proportion, about 36%, of gastrointestinal illnesses is attributable to food borne transmission.<sup><xref rid="ref23" ref-type="bibr">23</xref>,<xref rid="ref24" ref-type="bibr">24</xref></sup> Among all illnesses attributable to food borne transmission, 30% are caused by bacteria, 3% by parasites, and 67% by viruses.<sup><xref rid="ref23" ref-type="bibr">23</xref></sup> In the USA for example, nontyphoidal Salmonella spp. (35%), norovirus (26%), Campylobacter spp. (15%), and Toxoplasma gondii (8%) were the leading causes of hospitalization in 2000-2008.<sup><xref rid="ref23" ref-type="bibr">23</xref>,<xref rid="ref25" ref-type="bibr">25</xref></sup><italic>Salmonella</italic>, <italic>Listeria</italic>, <italic>Toxoplasma</italic>, and norovirus are responsible for more than 75% of deaths related to known causes of food borne illness each year.<sup><xref rid="ref6" ref-type="bibr">6</xref>,<xref rid="ref23" ref-type="bibr">23</xref>,<xref rid="ref25" ref-type="bibr">25</xref></sup> In Australia about 32% of all gastroenteritis are foodborne, and <italic>Campylobacter,</italic> non-typhoid <italic>Salmonella,</italic> pathogenic <italic>E. coli</italic> and norovirus are responsible for over 80% of foodborne illness from <italic>known</italic> pathogens.<sup><xref rid="ref26" ref-type="bibr">26</xref>,<xref rid="ref27" ref-type="bibr">27</xref></sup> In Australia the highest rates of gastroenteritis in the general population has been reported among young children and their adult carers.<sup><xref rid="ref28" ref-type="bibr">28</xref></sup></p><p>The majority of gastrointestinal illnesses can be transmitted through the faecal-oral route. Infections with pathogenic <italic>E. coli</italic> strains are usually considered an indication of poor hygiene. Up to 63% of children with persistent diarrhoea in low and middle income countries have tested positive for <italic>E. coli</italic> strains.<sup><xref rid="ref10" ref-type="bibr">10</xref></sup> Travel-associated diarrhoea has been described and travel to a developing region is a risk factor among patients presenting with diarrhoea in developed settings.<sup><xref rid="ref29" ref-type="bibr">29</xref>,<xref rid="ref30" ref-type="bibr">30</xref></sup> Studies have reported that travellers to low and middle income countries are between 9 and 151 times more likely to develop diarrhoeal illness,<sup><xref rid="ref14" ref-type="bibr">14</xref>,<xref rid="ref31" ref-type="bibr">31</xref></sup> with the highest risk associated with travel to areas in South America, Africa and South Asia.<sup><xref rid="ref14" ref-type="bibr">14</xref>,<xref rid="ref32" ref-type="bibr">32</xref>,<xref rid="ref33" ref-type="bibr">33</xref></sup></p></sec></sec><sec id="sec1-3"><title>Methodology for estimating pathogen detection rates</title><sec id="sec2-3"><title>Search strategy</title><p>Studies reporting the aetiology of diarrhoeal illness were identified from a search of databases including Science Direct, PubMed, PubMed Central, and Google scholar for articles published from 1980 and 2010. The search was not restricted to publications in the English Language, only to studies that had abstracts in English. The key subject terms included one or combinations of the following: <italic>infectious intestinal pathogen AND humans, diarrhea (or diarrhoea) and pathogen, aetiology (etiology) of acute gastroenteritis OR diarrhoea, enteric infectious pathogens.</italic> Boolean operators (<italic>not</italic>, <italic>and</italic>, <italic>or</italic>) were also used in succession to narrow and widen the searches. Other articles were identified by using the PubMed option of <italic>related articles</italic> and checked the reference lists of the original and review articles.</p></sec><sec id="sec2-4"><title>Eligibility and study selection criteria</title><p>Eligibility of studies for inclusion includes the following criteria:</p><list list-type="simple"><list-item><p>- Detailed results of microbiological analysis of stool samples and the number of samples tested;</p></list-item><list-item><p>- Subjects defined as clinically symptomatic or asymptomatic;</p></list-item><list-item><p>- Number of study subjects and positive results for both cases/controls;</p></list-item><list-item><p>- Definition of symptomatic subjects (case) as persons who had diarrhoea (defined as three or more loose/watery stools in a 24 hour period), or loose stools associated with gastrointestinal symptoms including: vomiting, abdominal pain or cramps, and blood or mucus in stool.<sup><xref rid="ref34" ref-type="bibr">34</xref></sup></p></list-item></list><p>Detection rates for adults and children were provided as age-specific.</p></sec><sec id="sec2-5"><title>Excluded studies</title><p>Studies were excluded where data were provided without adequate information for the detection and age-specific rates to be calculated, where the focus was on a single pathogen, or data were presented as the number of diarrhoeal episodes rather than samples tested.</p></sec><sec id="sec2-6"><title>Data abstraction and analysis</title><p>Selected studies were summarised in tabular format to include data on study design, study population, source of sample and sample size, methods to detect enteric pathogens, and detection rates. Where studies included combined age-groups that provided adequate data for children and adults separately, the data for children and adults were recorded separately. Countries were categorised into developing regions categories, based on the World Bank List of Economies published in July 2009,<sup><xref rid="ref35" ref-type="bibr">35</xref></sup> including: East Asia Pacific (EAP), Latin America and Caribbean (LAC), Middle East and Northern Africa (MENA), Sub-Saharan Africa (SSA), and South Asia and the Pacific (SAP). Developed countries were categorised based on the Organisation for Economic Co-operation and Development (OECD) category of countries.<sup><xref rid="ref35" ref-type="bibr">35</xref>,<xref rid="ref36" ref-type="bibr">36</xref></sup> Two non-OECD developed countries [Republic of (South) Korea and Turkey] were also included in this category (Supplementary Table S1).</p></sec><sec id="sec2-7"><title>Analysis and synthesis of results</title><p>Estimates of the prevalence of diarrhoeal pathogens were calculated by region. As studies were conducted in different regions using different methods and approaches the pooled prevalence of pathogens was estimated using the DerSimonian-Laird random-effect (RE) method.<sup><xref rid="ref37" ref-type="bibr">37</xref></sup> The pooled or weighted RE estimate of pathogen prevalence was calculated using the Comprehensive Meta-analysis (CMA) programme.<sup><xref rid="ref38" ref-type="bibr">38</xref></sup> The estimated mean prevalence was reported with 95% Confidence Intervals (95% CI).</p></sec></sec><sec id="sec1-4"><title>Estimating the prevalence of gastrointestinal pathogens</title><sec id="sec2-8"><title>Description of studies</title><p>The search produced 10,288 papers and the abstracts of 121 were included in our critical review. Data from 60 studies (from 47 developing and 13 developed countries) met the inclusion criteria for analysis.<sup><xref rid="ref7" ref-type="bibr">7</xref>,<xref rid="ref8" ref-type="bibr">8</xref>,<xref rid="ref39" ref-type="bibr">39-97</xref></sup> The studies included are summarised in <xref ref-type="table" rid="table001">Table 1</xref>. Of the studies reviewed, one presented multi-country data (two in EAP, one in LAC, two in SAP) which was tabulated and analysed under individual country/region.<sup><xref rid="ref40" ref-type="bibr">40</xref></sup> Three studies had sufficient data to allow the tabulation and analysis of findings for children and adults separately.<sup><xref rid="ref62" ref-type="bibr">62</xref>,<xref rid="ref94" ref-type="bibr">94</xref>,<xref rid="ref95" ref-type="bibr">95</xref></sup> These brought the total number of studies reviewed to 67. Most studies (73%, 44/60) recruited subjects from hospital settings and the remainder (17%, 16/60) were recruited from community or mixed settings. Studies were classified into six groups: five developing regions and OECD (developed) countries.</p><p>The summary of the laboratory procedures employed in each study is presented in Table S1. For the detection of bacteria, standard culture methods often coupled with serological tests, DNA hybridization, enzyme immunoassays (EIA) and polymerase chain reaction (PCR) were employed for the detection of different pathotypes of pathogenic <italic>E. coli.</italic> In some cases antibiotic susceptibility testing was performed by the disk diffusion or plate dilution methods. The majority of viral studies focused on rotavirus, employing mainly enzyme linked immunosorbent assay (ELISA), EIA, and less frequently, latex slide agglutination test and PCRs. Microscopic examination of permanently stained films have been generally used for the detection of ova cyst and parasites along with a modified Ziehl-Neelsen stain for coccidian parasites.</p></sec><sec id="sec2-9"><title>Overall detection of pathogens</title><sec id="sec3-1"><title>Source of cases</title><p>There was no significant difference in the detection of total number of pathogens in community or hospital settings (P>0.05). In 13 community based studies from four regions, enteric pathogens were detected in an average of 57.8% (95% CI, 49.2-65.9%) of cases, ranging from 52.4% in the EAP region to 62.6% in the SSA region. There was a significant difference in detection rates from 44 hospital based studies across the six regions, (P=0.001). The average detection of enteric pathogens was 58.1% (95% CI, 54.0-62.0%) of hospitalised cases, with a range of 36.9% (95% CI, 31.7-56.2%) in the MENA region to 66.7% (95% CI, 58.9-72.4%) in the SAP region (<xref ref-type="table" rid="table002">Table 2</xref>).</p></sec><sec id="sec3-2"><title>Age groups</title><p>In children, a pathogen was detected on average 56.7% (95% CI, 53.0-60.4%) with the lowest detection rate of 43.6% (95% CI, 31.7-56.2%) in the MENA region and the highest detection rate of 64.4% (95% CI, 57.6-70.7%) in the SAP region. Conversely, the detection rate of pathogens in adults on average was 74.8% (95% CI, 63.1-83.8%). The highest rate was among adults from the MENA region (90.4%; 95% CI, 81.2-95.4%) and the lowest rates of detection was among adults from OECD countries (32.5%; 95% CI, 14.7-57.3%) (<xref ref-type="table" rid="table002">Table 2</xref>).</p></sec></sec><sec id="sec2-10"><title>Regional distribution of enteric pathogens</title><sec id="sec3-3"><title>Children</title><p>The weighted average detection rate for enteric organisms in children for each region identified rotavirus as the most frequently detected pathogen in children (<xref ref-type="table" rid="table003">Table 3</xref>). The rates ranged from a low of 4.8% (95% CI, 2.6-8.7%) in SSA region to as high as 24.8% (95% CI, 18.0-33.1%) in OECD countries. The detection of rotavirus from diarrhoeal cases was up to five times more in OECD countries than in developing regions. Adenovirus 4.5% (95% CI 3.3-6.1%) and norovirus 3.3% (95% CI, 1.9-5.7%) were also most frequently detected in OECD countries when compared with developing regions. On average, <italic>E. coli</italic> pathotypes [Enterotoxigenic <italic>E</italic>. <italic>coli</italic> (ETEC), Enteropathogenic <italic>E. coli</italic> (EPEC)] and other pathogenic <italic>E. coli</italic> spp. were prevalent across all developing regions. The highest rates of EPEC were detected in the SAP region (8.5%; 95% CI, 5.4-13.1%) followed by the LAC region (5.6%; 95% CI, 2.3-12.6%); while ETEC was most prevalent in the SAP region and other <italic>E. coli</italic> pathotypes were also common in the MENA region (10.6%; 95% CI, 4.2-24.3%). <italic>Campylobacter</italic> spp., was also frequently detected in developing regions with the highest rate of detection in the SAP (6.6%; 95% CI, 3.9-10.9) and LAC (5.5%; 95% CI, 2.8-10.4) regions. <italic>Salmonella</italic> spp and <italic>Shigella</italic> spp were frequently detected among children in developing regions with <italic>Salmonella</italic> (4.1%; 95% CI, 2.8-5.9%) and <italic>Campylobacter</italic> spp (3.4%; 95% CI, 2.3-4.9%) the most frequently detected bacterial pathogens in children in developed countries.</p><p>Parasites were less frequently detected; yet <italic>Giardia intestinalis</italic> was the most frequently detected protozoa in developing regions, with the highest prevalence found in SAP (3.0%; 95% CI, 1.5-5.9%) and SSA (2.7%; 95% CI, 1.8-4.3%) regions. <italic>Entamoeba</italic> spp were frequently detected in MENA (1.5%; 95% CI, 0.6-4.2%) and SSA (1.5%; 95% CI, 0.9-2.5%) regions while <italic>Cryptosporidium</italic> was more prevalent in in the MENA (1.0%; 95% CI, 0.2-4.9%) and SAP (1.7; 95% CI, 0.8-3.1%) regions. Another protozoa, <italic>Dientamoeba fragilis,</italic> was found in <1% of cases in each region.</p><p>Adult patients were assessed for only three regions: MENA, SSA and the OECD countries (<xref ref-type="table" rid="table004">Table 4</xref>). Amongst adult patients <italic>Cryptosporidium</italic> sp. (9.4%; 95% CI, 1.0-50.2%), <italic>Salmonella</italic> spp (4.0%; 95% CI, 0.2-43.5%), other pathogenic <italic>E. coli</italic> (3.6%; 95% CI 0.3-36.2%), and <italic>Shigella</italic> sp. (2.2%; 95% CI, 1.1-4.5%) were quite common in the SSA region. Frequent viral pathogens detected in stools of adults from OECD countries were norovirus (10.5%; 95% CI, 7.5-14.7%), rotavirus (3.6%; 95% CI, 1.4-9.2%) and <italic>Campylobacter</italic> (3.3%; 95% CI, 0.9-12.0%).</p></sec></sec></sec><sec sec-type="discussion" id="sec1-5"><title>Discussion</title><p>The paucity of information concerning the prevalence of diarrhoeal pathogens in different world regions has resulted in the conduct of this systematic review. This is the first study that has attempted to provide an estimate of the prevalence of enteric pathogens in both developed and developing settings. Several fundamental conclusions can be drawn from these findings. This review found i) developing regions have significantly more pathogens isolated than the OECD countries, ii) the identification of pathogens from community based studies was similar to those in hospital based studies, iii) the overall detection of enteric pathogens is higher amongst adults than in children in developing settings, iv) enteric viruses (rotavirus, adenovirus and norovirus) were more frequently detected in paediatric cases in developed countries than in developing countries, and v) bacterial pathogens are frequently detected amongst children and adults in developing regions.</p><p>This review found that developing regions had significantly more pathogens isolated than the OECD countries. A WHO report indicated that in 2008 the SSA and SAP regions accounted for more than three quarters of the deaths in children from diarrhoeal disease.<sup><xref rid="ref11" ref-type="bibr">11</xref></sup> Several travel based studies suggest that travel to South America, Africa, and South Asia poses the greatest risk for travelers’ diarrhoea.<sup><xref rid="ref14" ref-type="bibr">14</xref>,<xref rid="ref32" ref-type="bibr">32</xref>,<xref rid="ref33" ref-type="bibr">33</xref></sup> South Asia continues to be affected by a disproportionately higher incidence of diarrhoeal illness in countries such as India and Bangladesh. Support to developing regions for the development of targeted interventions such as food safety programs that can successfully reduce the rates of travelers’ diarrhoea amongst tourists,<sup><xref rid="ref98" ref-type="bibr">98-100</xref></sup> and provide evidence for vaccine development should be a priority for developed countries.<sup><xref rid="ref101" ref-type="bibr">101</xref></sup> While the source of difference in pathogen prevalence between both settings cannot be determined from the information provided in the studies, we suggest that it is likely to be related, in part, to factors such as socioeconomic status, access to potable water and sanitation solutions. These factors were not explicitly described in many studies but are known important predictors of diarrhoea incidence in developing settings.<sup><xref rid="ref102" ref-type="bibr">102</xref></sup></p><p>The identification of pathogens from community based studies was similar to those in hospital based studies; however regional differences may exist between the settings. Even though there were no significant differences in the overall detection of pathogens between community and hospital based studies, differences were observed within hospital based studies between regions. One explanation for this may be hospital setting cases have severe clinical symptoms and were more likely to be tested compared with cases from the community setting.</p><p>The overall detection of enteric pathogens was higher amongst adults than in children in developing settings. The contrary is true for developed settings. Whilst this may be due to underlying sample sizes and testing methodologies employed, there is some evidence to suggest that several new and emerging pathogens are not routinely detected in clinical laboratories. Considering the majority of the studies involving children were from developing regions, limited laboratory capacity may have precluded the identification of organisms that require very sensitive diagnostic techniques, such as viral pathogens and some enteric protozoa.<sup><xref rid="ref103" ref-type="bibr">103-106</xref></sup> There is a need for the development of inexpensive sensitive and specific diagnostic methods to improve pathogen detection in clinical laboratories.<sup><xref rid="ref15" ref-type="bibr">15</xref>,<xref rid="ref107" ref-type="bibr">107-110</xref></sup> Some exposures increase the risk for infections in older children and adults, that could influence the types of pathogens that infect them including poor hygiene practices, foodborne infections and different environmental risk factors.<sup><xref rid="ref111" ref-type="bibr">111</xref></sup></p><p>Enteric viruses were more frequently detected in paediatric cases in developed countries than in developing countries. This finding is not unusual since rotavirus is considered to be the most common cause of childhood diarrhoea in both developed and developing countries.<sup><xref rid="ref112" ref-type="bibr">112</xref></sup> Infections with enteric viruses have a strong relationship with seasons and may be the reason for the higher incidence in OECD countries. This relationship is particularly evident in OECD countries with a temperate climate where rotavirus and norovirus infections often peak in the cooler months.<sup><xref rid="ref113" ref-type="bibr">113</xref>,<xref rid="ref114" ref-type="bibr">114</xref></sup> There is a less obvious seasonal distribution in tropical countries.<sup><xref rid="ref115" ref-type="bibr">115</xref></sup> The burden of rotaviral diarrhoea worldwide has resulted in the World Health Organization (WHO) placing priority on the development and distribution of rotavirus vaccines globally.<sup><xref rid="ref3" ref-type="bibr">3</xref></sup> More recently, a gradually decrease in the number of hospitalizations from severe dehydrating diarrhoea in children has been observed since the introduction of the rotavirus vaccine in the USA, in 2006,<sup><xref rid="ref116" ref-type="bibr">116</xref></sup> and in Australia in 2007.<sup><xref rid="ref117" ref-type="bibr">117-119</xref></sup> Efficacy trials conducted in Africa,<sup><xref rid="ref120" ref-type="bibr">120</xref></sup> and a post-marketing study conducted in Mexico, support the use of rotavirus vaccines in the developing countries.<sup><xref rid="ref121" ref-type="bibr">121</xref></sup></p><p>Norovirus infection in developed settings was prevalent in adults and nearly three times more common compared with children. Norovirus is recognized as a leading cause of epidemic gastroenteritis affecting all age groups, with sporadic cases occurring all year round with increased incidence observed in colder months.<sup><xref rid="ref113" ref-type="bibr">113</xref></sup> In contrast to rotavirus, norovirus is the principal cause of healthcare associated viral diarrhoea.<sup><xref rid="ref122" ref-type="bibr">122</xref></sup> Enteric adenoviruses types 40 and 41 and astrovirus are less frequently implicated but are also important causes of acute diarrhoeal illnesses in sporadic and outbreak settings.<sup><xref rid="ref114" ref-type="bibr">114</xref>,<xref rid="ref122" ref-type="bibr">122</xref></sup></p><p><italic>Campylobacter</italic> spp, <italic>E. coli</italic> pathotypes and <italic>Shigella</italic> spp are frequently detected in children from developing regions while adults are predominantly affected by <italic>Cryptosporidium</italic> spp, <italic>Salmonella</italic> and pathogenic <italic>E. coli</italic>. Bacterial diarrhoea can be spread through various routes including contaminated food, water and the faecal-oral route; providing multiple sources of infections among the exposed.<sup><xref rid="ref6" ref-type="bibr">6</xref>,<xref rid="ref28" ref-type="bibr">28</xref></sup> The relatively high prevalence of different strains of pathogenic <italic>E. coli</italic> found in both adults and children in developing settings has been previously described.<sup><xref rid="ref10" ref-type="bibr">10</xref></sup> One recent estimate of multiple diarrhoea pathogens in older children and adults in outpatient and inpatient settings, found ETEC and <italic>Vibrio cholera</italic> as the leading causes of hospitalization and <italic>Salmonella</italic> sp, <italic>Shigella sp</italic>, and <italic>E. hystolitica</italic> as the leading causes in out-patients.<sup><xref rid="ref123" ref-type="bibr">123</xref></sup> The prevalence of pathogenic <italic>E. coli</italic> in developed countries is usually sporadic and more closely associated with travel to a developing regions.<sup><xref rid="ref29" ref-type="bibr">29</xref>,<xref rid="ref30" ref-type="bibr">30</xref>,<xref rid="ref112" ref-type="bibr">112</xref></sup><italic>Campylobacter</italic> spp and <italic>Salmonell</italic>a spp were the most common bacteria isolated in patients from OECD countries. Evidence from the USA, New Zealand and Australia suggest that <italic>Salmonella</italic> infections are a major cause of hospitalizations and deaths annually, and are frequently associated with foodborne illnesses in industrialized countries.<sup><xref rid="ref124" ref-type="bibr">124-126</xref></sup></p><p>Enteric protozoa, mainly <italic>Giardia intestinalis</italic> and <italic>Entamoeba</italic> spp were common in children from developing regions compared with children from developed settings. A recent meta-analysis found that <italic>Giardia intestinalis</italic> was not associated with acute paediatric diarrhoea but was associated with persistent diarrhoea in developing countries. Adults, predominantly those in the SSA region, were mainly affected by <italic>Cryptosporidium</italic> spp and <italic>Blastocystis</italic> spp., which has been previously described in the SSA region.<sup><xref rid="ref22" ref-type="bibr">22</xref></sup> The prevalence of parasitic infections is consistent with findings from other developing settings, where sanitation and access to clean water is compromised.<sup><xref rid="ref127" ref-type="bibr">127-129</xref></sup> There are conflicting interpretations about the role of <italic>Blastocystis</italic> spp as a pathogen, and as a result some laboratories may not place priority on looking for or reporting the presence of this parasite.<sup><xref rid="ref130" ref-type="bibr">130-132</xref></sup> However, several reports have established its association with abdominal pain, persistent diarrhoea and irritable bowel syndrome,<sup><xref rid="ref133" ref-type="bibr">133-135</xref></sup> and other reports hypothesize that pathogenicity may be sub-type dependent.<sup><xref rid="ref136" ref-type="bibr">136</xref></sup></p></sec><sec id="sec1-6"><title>Limitations</title><p>In systematically reviewing the literature, it became apparent that only some studies utilised high level study design and analytical techniques that could identify a broad range of enteric pathogens. Accordingly, we limited our analysis to include only those studies that utilised a rigorous methodology and clearly defined the patient group (diarrhea cases) and the enteric pathogens detected. This study found a higher prevalence of enteric viruses in developed countries compared with developing countries. This difference however, might be due to the different methods used to identify viral pathogens in the different geographical areas, since some diagnostic methods are more sensitive than others. Similar findings however have been found by the recently completed GEMS study that employed a standardised protocol for several countries in sub-Saharan Africa and Asia.<sup><xref rid="ref103" ref-type="bibr">103</xref>,<xref rid="ref137" ref-type="bibr">137</xref>,<xref rid="ref138" ref-type="bibr">138</xref></sup> Additionally, OECD countries are likely to have better testing regimes than many developing countries, and as such they are more likely to identify pathogens from infected persons. As such, care should be taken in making comparisons across developed and developing regions. Another limitation of this study was the lack of data to analyse the correlation between the prevalence of enteric pathogens and seasons in different countries. However, previous studies have shown correlations between the prevalence of some pathogens and specific seasons. For example, studies have described distinct seasonal patterns of increased prevalence of viral enteric infections in cooler months.<sup><xref rid="ref50" ref-type="bibr">50</xref>,<xref rid="ref139" ref-type="bibr">139-141</xref></sup> Despite regional variations, consistent summer peak in the incidence of bacterial diseases has been observed across transnational boundaries, for campylobacteriosis, salmonellosis and verotoxin producing <italic>E. coli</italic> (VTEC).<sup><xref rid="ref142" ref-type="bibr">142</xref></sup> This consistent summer peak in bacterial diseases has been widely described for both developing and developed suggesting possible direct effects of large-scale environmental influences on a shared exposure routes.<sup><xref rid="ref143" ref-type="bibr">143-147</xref></sup> For example increased incidence of infection with common foodborne bacteria (<italic>e.g</italic>. <italic>Campylobacter</italic>, <italic>Salmonella</italic> spp) has been reported in warmer months.<sup><xref rid="ref148" ref-type="bibr">148</xref>,<xref rid="ref149" ref-type="bibr">149</xref></sup> Understanding disease specific seasonal patterns is important for improving existing disease surveillance methods and developing appropriate prevention strategies.</p></sec><sec sec-type="conclusions" id="sec1-7"><title>Conclusions</title><p>This systematic review of the literature has attempted to provide an estimation of the types and prevalence of gastrointestinal pathogens associated with diarrhoeal illness in both developing and developed settings. To our knowledge this systematic review is the first to provide an estimate of the region specific prevalence of enteric pathogens associated with diarrhoeal illnesses in both developed and developing countries. Similar studies to provide a comparison were not found as this was the first study to employ a broad definition of diarrhoeal illness, for adults and children. The current study addresses the gap in the literature by providing region specific estimates of pathogen prevalence for adults and children worldwide. It concludes that pathogens are consistently detected in persons seeking medical attention for diarrhoeal illnesses in secondary or primary care settings. This review highlights the need for the development of inexpensive sensitive and specific diagnostic methods to improve pathogen detection in clinical laboratories. Global support is necessary for equitable access to rotavirus vaccines in developing settings and for continued research and development of cost effective interventions to prevent and control diarrhoeal illnesses worldwide.</p></sec></body><back><ref-list><title>References</title><ref id="ref1"><label>1.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kosek</surname><given-names>M</given-names></name><name><surname>Bern</surname><given-names>C</given-names></name><name><surname>Guerrant</surname><given-names>R</given-names></name></person-group><article-title>The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000</article-title>. <source>Bull World Health Organ</source><year>2003</year>;<volume>81</volume>:<fpage>197</fpage>-<lpage>204</lpage><pub-id pub-id-type="pmid">12764516</pub-id></mixed-citation></ref><ref id="ref2"><label>2.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Black</surname><given-names>RE</given-names></name><name><surname>Cousens</surname><given-names>S</given-names></name><name><surname>Johnson</surname><given-names>HL</given-names></name><etal></etal></person-group><article-title>Global, regional, and national causes of child mortality in 2008: a systematic analysis</article-title>. <source>Lancet</source><year>2010</year>;<volume>375</volume>:<fpage>1969</fpage>-<lpage>87</lpage><pub-id pub-id-type="pmid">20466419</pub-id></mixed-citation></ref><ref id="ref3"><label>3.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wardlaw</surname><given-names>T</given-names></name><name><surname>Salama</surname><given-names>P</given-names></name><name><surname>Brocklehurst</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Diarrhoea: why children are still dying and what can be done</article-title>. <source>Lancet</source><year>2010</year>;<volume>375</volume>:<fpage>870</fpage>-<lpage>2</lpage><pub-id pub-id-type="pmid">19833382</pub-id></mixed-citation></ref><ref id="ref4"><label>4.</label><mixed-citation publication-type="web"><collab>UNICEF/WHO</collab>. <article-title>Diarrhoea: why children are still dying and what can be done. UNICEF/WHO joint report on preventing and treating the second leading killer of children</article-title>. <year>2009</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://www.unicef.org/health/index_51412.html">http://www.unicef.org/health/index_51412.html</ext-link><comment>Accessed on May 2013</comment></mixed-citation></ref><ref id="ref5"><label>5.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Keusch</surname><given-names>G</given-names></name><name><surname>Fontaine</surname><given-names>O</given-names></name><name><surname>Bhargava</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Diarrhoeal Diseases</article-title><year>2006</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://files.dcp2.org/pdf/DCP/DCP19.pdf">http://files.dcp2.org/pdf/DCP/DCP19.pdf</ext-link></mixed-citation></ref><ref id="ref6"><label>6.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Schmidt</surname><given-names>RH</given-names></name><name><surname>Goodrich</surname><given-names>RM</given-names></name><name><surname>Archer</surname><given-names>DL</given-names></name><name><surname>Schneider</surname><given-names>KR</given-names></name></person-group><article-title>General overview of the causative agents of foodborne illness</article-title>. <year>2003</year><source>Food Science and Human Nutrition Department, Florida Cooperative Extension Service, IFAS</source>, <comment>University of Florida. Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://edis.ifas.ufl.edu/pdffiles/FS/FS09900.pdf">http://edis.ifas.ufl.edu/pdffiles/FS/FS09900.pdf</ext-link></mixed-citation></ref><ref id="ref7"><label>7.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Georges</surname><given-names>MC</given-names></name><name><surname>Wachsmuth</surname><given-names>IK</given-names></name><name><surname>Meunier</surname><given-names>DMV</given-names></name><name><surname>Nebout</surname><given-names>N</given-names></name></person-group><article-title>Parasitic, bacterial and viral enteric pathogens associated with diarrhoea in Central African Republic</article-title>. <source>J Clin Microbiol</source><year>1984</year>;<volume>19</volume>:<fpage>571</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">6330161</pub-id></mixed-citation></ref><ref id="ref8"><label>8.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dutta</surname><given-names>P</given-names></name><name><surname>Lahiri</surname><given-names>M</given-names></name><name><surname>Sen</surname><given-names>D</given-names></name><name><surname>Pal</surname><given-names>S</given-names></name></person-group><article-title>Prospective hospital based study on persistent diarhoea</article-title>. <source>Gut</source><year>1991</year>;<volume>32</volume>:<fpage>787</fpage>-<lpage>90</lpage><pub-id pub-id-type="pmid">1855686</pub-id></mixed-citation></ref><ref id="ref9"><label>9.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Boga</surname><given-names>JA</given-names></name><name><surname>Melon</surname><given-names>S</given-names></name><name><surname>Nicieza</surname><given-names>I</given-names></name><etal></etal></person-group><article-title>Etiology of sporadic cases of pediatric acute gastroenteritis in Asturia, Spain, and genotyping and characterization of norovirus strains involved</article-title>. <source>J Clin Microbiol</source><year>2004</year>;<volume>42</volume>:<fpage>2668</fpage>-<lpage>74</lpage><pub-id pub-id-type="pmid">15184450</pub-id></mixed-citation></ref><ref id="ref10"><label>10.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Abba</surname><given-names>K</given-names></name><name><surname>Sinfield</surname><given-names>R</given-names></name><name><surname>Hart</surname><given-names>CA</given-names></name><name><surname>Garner</surname><given-names>P</given-names></name></person-group><article-title>Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review</article-title>. <source>BMC Infect Dis</source><year>2009</year>;<volume>9</volume>:<fpage>88</fpage>-<lpage>103</lpage><pub-id pub-id-type="pmid">19515227</pub-id></mixed-citation></ref><ref id="ref11"><label>11.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Boschi-Pinto</surname><given-names>C</given-names></name><name><surname>Velebit</surname><given-names>L</given-names></name><name><surname>Shibuya</surname><given-names>K</given-names></name></person-group><article-title>Estimating mortality due to diarrhoea indeveloping countries</article-title>. <source>Bull World Health Organ</source><year>2008</year>;<volume>86</volume>:<fpage>710</fpage>-<lpage>7</lpage><pub-id pub-id-type="pmid">18797647</pub-id></mixed-citation></ref><ref id="ref12"><label>12.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Green</surname><given-names>ST</given-names></name><name><surname>Small</surname><given-names>MJ</given-names></name><name><surname>Casman</surname><given-names>EA</given-names></name></person-group><article-title>Determinants of national diarrheal disease burden</article-title>. <source>Environ Sci Technol</source><year>2009</year>;<volume>43</volume>:<fpage>993</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">19320148</pub-id></mixed-citation></ref><ref id="ref13"><label>13.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Savarino</surname><given-names>SJ</given-names></name><name><surname>Bourgeois</surname><given-names>AL</given-names></name></person-group><article-title>Epidemiology of diarrhoeal diseases in developed countries</article-title>. <source>Trans R Soc Trop Med Hyg</source><year>1993</year>;<volume>87</volume><issue>Suppl 3</issue>:<fpage>7</fpage>-<lpage>11</lpage><pub-id pub-id-type="pmid">8108853</pub-id></mixed-citation></ref><ref id="ref14"><label>14.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Greenwood</surname><given-names>Z</given-names></name><name><surname>James</surname><given-names>Black</given-names></name><name><surname>Leisa</surname><given-names>Weld</given-names></name><etal></etal></person-group><article-title>Gastrointestinal Infection Among International Travelers Globally</article-title>. <source>J Travel Med</source><year>2008</year>;<volume>15</volume>:<fpage>221</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">18666921</pub-id></mixed-citation></ref><ref id="ref15"><label>15.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fletcher</surname><given-names>SM</given-names></name><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Harkness</surname><given-names>J</given-names></name><name><surname>Ellis</surname><given-names>J</given-names></name></person-group><article-title>Enteric protozoa in the developed world: a public health perspective</article-title>. <source>Clin Microbiol Rev</source><year>2012</year>;<volume>25</volume>:<fpage>420</fpage>-<lpage>49</lpage><pub-id pub-id-type="pmid">22763633</pub-id></mixed-citation></ref><ref id="ref16"><label>16.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gilbert</surname><given-names>GL</given-names></name></person-group><article-title>Improving foodborne disease surveillance in NSW</article-title>. <source>NSW Public Health Bull</source><year>2008</year>;<volume>19</volume>:<fpage>1</fpage>-<lpage>2</lpage></mixed-citation></ref><ref id="ref17"><label>17.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Roy</surname><given-names>SL</given-names></name><name><surname>Scallan</surname><given-names>E</given-names></name><name><surname>J</surname><given-names>BM</given-names></name></person-group><article-title>The rate acute gastrointestinal illness in developed countries</article-title>. <source>J Water Health</source><year>2006</year>;<volume>4</volume><issue>Suppl 2</issue>:<fpage>31</fpage>-<lpage>69</lpage><pub-id pub-id-type="pmid">16895085</pub-id></mixed-citation></ref><ref id="ref18"><label>18.</label><mixed-citation publication-type="book"><person-group person-group-type="editor"><name><surname>Heymann</surname><given-names>DL</given-names></name></person-group>, ed. <source>Control of communicable diseases manual</source>. <edition>19</edition> ed. <publisher-loc>Washington DC</publisher-loc>: <publisher-name>American Public Health Association</publisher-name>; <year>2008</year></mixed-citation></ref><ref id="ref19"><label>19.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lamps</surname><given-names>LW</given-names></name></person-group><article-title>Infective disorders of the gastrointestinal tract</article-title>. <source>Histopathology</source><year>2007</year>;<volume>50</volume>:<fpage>55</fpage>-<lpage>63</lpage><pub-id pub-id-type="pmid">17204021</pub-id></mixed-citation></ref><ref id="ref20"><label>20.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pintér</surname><given-names>M</given-names></name><name><surname>Kolesárová</surname><given-names>M</given-names></name></person-group><article-title>Genetic aspects of idiopatic inflammatory bowel disease Acta medica (Hradec Králové) Supplementum Universitas Carolina</article-title>, <source>Facultas Medica Hradec Králové</source><year>2004</year>;<volume>47</volume>:<fpage>83</fpage>-<lpage>7</lpage></mixed-citation></ref><ref id="ref21"><label>21.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ferrell</surname><given-names>LD</given-names></name></person-group><article-title>Sexually Transmitted Gastrointestinal Tract Diseases</article-title>. <source>West J Med</source><year>1984</year>;<volume>141</volume>:<fpage>96</fpage><pub-id pub-id-type="pmid">18749590</pub-id></mixed-citation></ref><ref id="ref22"><label>22.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fletcher</surname><given-names>SM</given-names></name><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Ellis</surname><given-names>J</given-names></name></person-group><article-title>Prevalence of gastrointestinal pathogens in Sub-Saharan Africa; systematic review and metaanalysis</article-title>. <source>J Pub Health Africa</source><year>2011</year>;<volume>2</volume>:<fpage>127</fpage>-<lpage>37</lpage></mixed-citation></ref><ref id="ref23"><label>23.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mead</surname><given-names>P</given-names></name><name><surname>Slutsker</surname><given-names>L</given-names></name><name><surname>Dietz</surname><given-names>V</given-names></name><etal></etal></person-group><article-title>Food-related illness and death in the United States</article-title>. <source>Emerg Infect Dis</source><year>1999</year>;<volume>5</volume>:<fpage>607</fpage>-<lpage>25</lpage><pub-id pub-id-type="pmid">10511517</pub-id></mixed-citation></ref><ref id="ref24"><label>24.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Flint</surname><given-names>JA</given-names></name><name><surname>Van</surname><given-names>Duynhoven YT</given-names></name><name><surname>Angulo</surname><given-names>FJ</given-names></name><etal></etal></person-group><article-title>Estimating the burden of acute gastroenteritis, foodborne disease, and pathogens commonly transmitted by food: an international review</article-title>. <source>Clin Infect Dis</source><year>2005</year>;<volume>41</volume>:<fpage>698</fpage>-<lpage>704</lpage><pub-id pub-id-type="pmid">16080093</pub-id></mixed-citation></ref><ref id="ref25"><label>25.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Scallan</surname><given-names>E</given-names></name><name><surname>Hoekstra</surname><given-names>RM</given-names></name><name><surname>Angulo</surname><given-names>FJ</given-names></name><etal></etal></person-group><article-title>Foodborne illness acquired in the United States - major pathogens</article-title>. <source>Emerg Infect Dis</source><year>2011</year>;<volume>17</volume>:<fpage>7</fpage>-<lpage>15</lpage><pub-id pub-id-type="pmid">21192848</pub-id></mixed-citation></ref><ref id="ref26"><label>26.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hall</surname><given-names>G</given-names></name><name><surname>Martyn</surname><given-names>D.</given-names></name><name><surname>Niels Becker</surname><given-names>K</given-names></name><etal></etal></person-group><article-title>Estimating foodborne gastroenteritis, Australia</article-title>. <source>Emerg Infect Dis</source><year>2005</year>;<volume>11</volume>:<fpage>1257</fpage>-<lpage>64</lpage><pub-id pub-id-type="pmid">16102316</pub-id></mixed-citation></ref><ref id="ref27"><label>27.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kirk Martyn</surname><given-names>D</given-names></name><name><surname>McKay</surname><given-names>I</given-names></name><name><surname>Hall Gill</surname><given-names>V</given-names></name><etal></etal></person-group><article-title>Food safety: foodborne disease in Australia: the OzFoodNet experience</article-title>. <source>Clin Infect Dis</source><year>2008</year>;<volume>47</volume>:<fpage>392</fpage>-<lpage>400</lpage><pub-id pub-id-type="pmid">18558879</pub-id></mixed-citation></ref><ref id="ref28"><label>28.</label><mixed-citation publication-type="web"><collab>Australian Government Department of Health and Ageing</collab>. <article-title>Foodborne illness in Australia. Annual incidence circa 2000</article-title>. <year>2005</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://www.ozfoodnet.gov.au/internet/ozfoodnet/publishing.nsf/Content/7BDEF9F8EC3835D9CA257165001AB31D/$File/foodborne_report.pdf">http://www.ozfoodnet.gov.au/internet/ozfoodnet/publishing.nsf/Content/7BDEF9F8EC3835D9CA257165001AB31D/$File/foodborne_report.pdf</ext-link></mixed-citation></ref><ref id="ref29"><label>29.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Leung</surname><given-names>A</given-names></name><name><surname>Robson</surname><given-names>W</given-names></name><name><surname>Davies</surname><given-names>H</given-names></name></person-group><article-title>Travelers’ diarrhea</article-title>. <source>Adv Ther</source><year>2006</year>;<volume>23</volume>:<fpage>519</fpage>-<lpage>27</lpage><pub-id pub-id-type="pmid">17050494</pub-id></mixed-citation></ref><ref id="ref30"><label>30.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marcos</surname><given-names>LA</given-names></name><name><surname>DuPont</surname><given-names>HL</given-names></name></person-group><article-title>Advances in defining etiology and new therapeutic approaches in acute diarrhea</article-title>. <source>J Infect</source><year>2007</year>;<volume>55</volume>:<fpage>385</fpage>-<lpage>93</lpage><pub-id pub-id-type="pmid">17825422</pub-id></mixed-citation></ref><ref id="ref31"><label>31.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Swaminathan</surname><given-names>A</given-names></name><name><surname>Torresi</surname><given-names>J</given-names></name><name><surname>Schlagenhauf</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>A global study of pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travellers</article-title>. <source>J Infect</source><year>2009</year>;<volume>59</volume>:<fpage>19</fpage>-<lpage>27</lpage><pub-id pub-id-type="pmid">19552961</pub-id></mixed-citation></ref><ref id="ref32"><label>32.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steffen</surname><given-names>R</given-names></name><name><surname>Tornieporth</surname><given-names>N</given-names></name><name><surname>Clemens</surname><given-names>S-AC</given-names></name><etal></etal></person-group><article-title>Epidemiology of travelers’ diarrhea: details of a global survey</article-title>. <source>J Travel Med</source><year>2004</year>;<volume>11</volume>:<fpage>231</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">15541226</pub-id></mixed-citation></ref><ref id="ref33"><label>33.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jiang</surname><given-names>Z-D</given-names></name><name><surname>Brett</surname><given-names>L</given-names></name><name><surname>Verenkar</surname><given-names>M P</given-names></name><name><surname>Ashley</surname><given-names>D</given-names></name></person-group><article-title>Prevalence of enteric pathogens among international travelers with diarrhea acquired in Kenya (Mombasa), India (Goa), or Jamaica (Montego Bay)</article-title>. <source>J Infect Dis</source><year>2002</year>;<volume>185</volume>:<fpage>497</fpage><pub-id pub-id-type="pmid">11865402</pub-id></mixed-citation></ref><ref id="ref34"><label>34.</label><mixed-citation publication-type="web"><collab>WHO</collab>. <article-title>Health topics: diarrhoea</article-title>. <comment>World Health Organization</comment>; <year>2010</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/topics/diarrhoea/en/">http://www.who.int/topics/diarrhoea/en/</ext-link></mixed-citation></ref><ref id="ref35"><label>35.</label><mixed-citation publication-type="web"><collab>The World Bank Group</collab>. <article-title>World Bank Country Classifcation</article-title>. <comment>July</comment><year>2009</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://go.worldbank.org/D7SN0B8YU0">http://go.worldbank.org/D7SN0B8YU0</ext-link></mixed-citation></ref><ref id="ref36"><label>36.</label><mixed-citation publication-type="web"><collab>International Monetary Fund</collab>. <article-title>World Economic Outlook. Database WEO Groups and Aggregates Information. World Economic and Financial Surveys [serial on the Internet]</article-title>. <year>2009</year>: <comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://www.imf.org/external/pubs/ft/weo/2009/02/weodata/groups.htm#ae">http://www.imf.org/external/pubs/ft/weo/2009/02/weodata/groups.htm#ae</ext-link></mixed-citation></ref><ref id="ref37"><label>37.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jackson</surname><given-names>D</given-names></name><name><surname>Bowden</surname><given-names>J</given-names></name><name><surname>Baker</surname><given-names>R</given-names></name></person-group><article-title>How does the DerSimonian and Laird procedure for random effects meta-analysis compare with its more efficient but harder to compute counterparts?</article-title><source>J Stat Plann Infer</source><year>2010</year>;<volume>140</volume>:<fpage>961</fpage>-<lpage>70</lpage></mixed-citation></ref><ref id="ref38"><label>38.</label><mixed-citation publication-type="web"><person-group person-group-type="author"><name><surname>Borenstein</surname><given-names>M</given-names></name><name><surname>Hedges</surname><given-names>L</given-names></name><name><surname>Higgins</surname><given-names>J</given-names></name><name><surname>Rothstein</surname><given-names>H</given-names></name></person-group><article-title>Comprehensive Meta-analysis Version 2</article-title>. <comment>Englewood NJ Biostat</comment>; <year>2005</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://www.meta-analysis.com/downloads/Meta-Analysis-Manual.pdf">http://www.meta-analysis.com/downloads/Meta-Analysis-Manual.pdf</ext-link></mixed-citation></ref><ref id="ref39"><label>39.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tin</surname><given-names>A</given-names></name><name><surname>Mar</surname><given-names>N</given-names></name><name><surname>Kyi</surname><given-names>K</given-names></name><etal></etal></person-group><article-title>Epidemiology and aetiology of acute childhood diarrhoea in Burma: a rural community survey</article-title>. <source>Trans R Soc Trop Med Hyg</source><year>1989</year>;<volume>83</volume>:<fpage>827</fpage>-<lpage>30</lpage><pub-id pub-id-type="pmid">2559512</pub-id></mixed-citation></ref><ref id="ref40"><label>40.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huilan</surname><given-names>S</given-names></name><name><surname>Zhen</surname><given-names>LG</given-names></name><name><surname>Mathan</surname><given-names>MM</given-names></name><etal></etal></person-group><article-title>Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries</article-title>. <source>Bull World Health Organ</source><year>1991</year>;<volume>69</volume>:<fpage>549</fpage>-<lpage>55</lpage><pub-id pub-id-type="pmid">1659953</pub-id></mixed-citation></ref><ref id="ref41"><label>41.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kain</surname><given-names>KC</given-names></name><name><surname>Barteluk</surname><given-names>RL</given-names></name><name><surname>Kelly</surname><given-names>MT</given-names></name><etal></etal></person-group><article-title>Etiology of childhood diarrhea in Beijing, China</article-title>. <source>J Clin Microbiol</source><year>1991</year>;<volume>29</volume>:<fpage>90</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">1993771</pub-id></mixed-citation></ref><ref id="ref42"><label>42.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yu</surname><given-names>J-M</given-names></name><name><surname>Li</surname><given-names>D-D</given-names></name><name><surname>Xu</surname><given-names>Z-Q</given-names></name><etal></etal></person-group><article-title>Human bocavirus infection in children hospitalized with acute gastroenteritis in China</article-title>. <source>J Clin Virol</source><year>2008</year>;<volume>42</volume>:<fpage>280</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">18499516</pub-id></mixed-citation></ref><ref id="ref43"><label>43.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Soenarto</surname><given-names>Y</given-names></name><name><surname>Sebodo</surname><given-names>T</given-names></name><name><surname>Suryantoro</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>Bacteria, parasitic agents and rotaviruses associated with acute diarrhoea in hospital in-patient Indonesian children</article-title>. <source>Trans R Soc Trop Med Hyg</source><year>1983</year>;<volume>77</volume>:<fpage>724</fpage>-<lpage>30</lpage><pub-id pub-id-type="pmid">6659051</pub-id></mixed-citation></ref><ref id="ref44"><label>44.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yamashiro</surname><given-names>T</given-names></name><name><surname>Nakasone</surname><given-names>N</given-names></name><name><surname>Higa</surname><given-names>N</given-names></name><etal></etal></person-group><article-title>Etiological study of diarrheal patients in Vientiane, Lao People’s Democratic Republic</article-title>. <source>J Clin Microbiol</source><year>1998</year>;<volume>36</volume>:<fpage>2195</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">9665990</pub-id></mixed-citation></ref><ref id="ref45"><label>45.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>LJ</given-names></name><name><surname>Yang</surname><given-names>YJ</given-names></name><name><surname>Kuo</surname><given-names>PH</given-names></name><etal></etal></person-group><article-title>Diagnostic value of bacterial stool cultures and viral antigen tests based on clinical manifestations of acute gastroenteritis in pediatric patients</article-title>. <source>Eur J Clin Microbiol Infect Dis</source><year>2005</year>;<volume>24</volume>:<fpage>559</fpage>-<lpage>61</lpage><pub-id pub-id-type="pmid">16096776</pub-id></mixed-citation></ref><ref id="ref46"><label>46.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lu</surname><given-names>C-Y</given-names></name><name><surname>Tsai-Ling</surname><given-names>L</given-names></name><name><surname>Fang</surname><given-names>Y-H</given-names></name><etal></etal></person-group><article-title>Disease burden and related medical costs of rotavirus infections in Taiwan</article-title>. <source>BMC Infect Dis</source><year>2006</year>;<volume>6</volume>:<fpage>176</fpage><pub-id pub-id-type="pmid">17173677</pub-id></mixed-citation></ref><ref id="ref47"><label>47.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Isenbarger</surname><given-names>D</given-names></name><name><surname>Hien</surname><given-names>B</given-names></name><name><surname>Ha</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Prospective study of the incidence of diarrhoea and prevalence of bacterial pathogens in a cohort of Vietnamese children along the Red River</article-title>. <source>Epidemiol Infect</source><year>2001</year>;<volume>127</volume>:<fpage>229</fpage>-<lpage>36</lpage><pub-id pub-id-type="pmid">11693500</pub-id></mixed-citation></ref><ref id="ref48"><label>48.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bodhidatta</surname><given-names>L</given-names></name><name><surname>Vithayasai</surname><given-names>N</given-names></name><name><surname>Eimpokalarp</surname><given-names>B</given-names></name><etal></etal></person-group><article-title>Bacterial enteric pathogens in children with acute dysentery in Thailand: increasing importance of quinolone-resistant Campylobacter</article-title>. <source>Southeast Asian J Trop Med Public Health</source><year>2002</year>;<volume>33</volume>:<fpage>752</fpage>-<lpage>7</lpage><pub-id pub-id-type="pmid">12757222</pub-id></mixed-citation></ref><ref id="ref49"><label>49.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nguyen</surname><given-names>TV</given-names></name><name><surname>Le</surname><given-names>Van P</given-names></name><name><surname>Le</surname><given-names>Huy C</given-names></name><etal></etal></person-group><article-title>Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam</article-title>. <source>Int J Infect Dis</source><year>2006</year>;<volume>10</volume>:<fpage>298</fpage>-<lpage>308</lpage><pub-id pub-id-type="pmid">16458564</pub-id></mixed-citation></ref><ref id="ref50"><label>50.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hien</surname><given-names>BTT</given-names></name><name><surname>Trang</surname><given-names>DT</given-names></name><name><surname>Scheutz</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Diarrhoeagenic Escherichia coli and other causes of childhood diarrhoea: a case control study in children living in a wastewater-use area in Hanoi, Vietnam</article-title>. <source>J Med Microbiol</source><year>2007</year>;<volume>56</volume>:<fpage>1086</fpage>-<lpage>96</lpage><pub-id pub-id-type="pmid">17644717</pub-id></mixed-citation></ref><ref id="ref51"><label>51.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Seigel</surname><given-names>RR</given-names></name><name><surname>Santana e Sant’anna</surname><given-names>C</given-names></name><name><surname>Salgado</surname><given-names>K</given-names></name><name><surname>de-Jesus</surname><given-names>P</given-names></name></person-group><article-title>Acute diarrhea among children from high and low socioeconomic communities in Salvador, Brazil</article-title>. <source>Int J Infect Dis</source><year>1996</year>;<volume>1</volume>:<fpage>28</fpage>-<lpage>34</lpage></mixed-citation></ref><ref id="ref52"><label>52.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barreto</surname><given-names>ML</given-names></name><name><surname>Milroy</surname><given-names>CA</given-names></name><name><surname>Strina</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Community-based monitoring of diarrhea in urban Brazilian children: incidence and associated pathogens</article-title>. <source>Trans R Soc Trop Med Hyg</source><year>2006</year>;<volume>100</volume>:<fpage>234</fpage>-<lpage>42</lpage><pub-id pub-id-type="pmid">16303156</pub-id></mixed-citation></ref><ref id="ref53"><label>53.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Flores-Abuxapqui</surname><given-names>JJ</given-names></name><name><surname>Suárez-Hoil</surname><given-names>GdJ</given-names></name><name><surname>Puc-Franco</surname><given-names>MA</given-names></name><etal></etal></person-group><article-title>Etiology of acute diarrhea in hospital in-patient mexican children</article-title>. <source>Revista Biomedica</source><year>1994</year>;<volume>5</volume>:<fpage>117</fpage>-<lpage>25</lpage></mixed-citation></ref><ref id="ref54"><label>54.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ochoa</surname><given-names>TJ</given-names></name><name><surname>Ecker</surname><given-names>L</given-names></name><name><surname>Barletta</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Age-related susceptibility to infection with diarrheagenic Escherichia coli among infants from Periurban Areas in Lima, Peru</article-title>. <source>Clin Infect Dis</source><year>2009</year>;<volume>49</volume>:<fpage>1694</fpage>-<lpage>702</lpage><pub-id pub-id-type="pmid">19857163</pub-id></mixed-citation></ref><ref id="ref55"><label>55.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Paniagua</surname><given-names>G</given-names></name><name><surname>Monroy</surname><given-names>E</given-names></name><name><surname>García-González</surname><given-names>O</given-names></name><etal></etal></person-group><article-title>Two or more enteropathogens are associated with diarrhoea in Mexican children</article-title>. <source>Ann Clin Microbiol Antimicrob</source><year>2007</year>;<volume>6</volume>:<fpage>17</fpage><pub-id pub-id-type="pmid">18162140</pub-id></mixed-citation></ref><ref id="ref56"><label>56.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pazzaglia</surname><given-names>G</given-names></name><name><surname>Sack</surname><given-names>RB</given-names></name><name><surname>Salazar</surname><given-names>E</given-names></name><etal></etal></person-group><article-title>High frequency of coinfecting enteropathogens in Aeromonas-associated diarrhea of hospitalized Peruvian infants</article-title>. <source>J Clin Microbiol</source><year>1991</year>;<volume>29</volume>:<fpage>1151</fpage>-<lpage>6</lpage><pub-id pub-id-type="pmid">1864933</pub-id></mixed-citation></ref><ref id="ref57"><label>57.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Torres</surname><given-names>ME</given-names></name><name><surname>Pírez</surname><given-names>MC</given-names></name><name><surname>Schelotto</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Etiology of children’s diarrhea in Montevideo, Uruguay: associated pathogens and unusual isolates</article-title>. <source>J Clin Microbiol</source><year>2001</year>;<volume>39</volume>:<fpage>2134</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">11376047</pub-id></mixed-citation></ref><ref id="ref58"><label>58.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>El-Mohamady</surname><given-names>H</given-names></name><name><surname>Abdel-Messih</surname><given-names>IA</given-names></name><name><surname>Youssef</surname><given-names>FG</given-names></name><etal></etal></person-group><article-title>Enteric pathogens associated with diarrhea in children in Fayoum, Egypt</article-title>. <source>Diagn Microbiol Infect Dis</source><year>2006</year>;<volume>56</volume>:<fpage>1</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">16675181</pub-id></mixed-citation></ref><ref id="ref59"><label>59.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Elamreen</surname><given-names>FHA</given-names></name><name><surname>Abed</surname><given-names>AA</given-names></name><name><surname>Sharif</surname><given-names>FA</given-names></name></person-group><article-title>Detection and identification of bacterial enteropathogens by polymerase chain reaction and conventional techniques in childhood acute gastroenteritis in Gaza, Palestine</article-title>. <source>Int J Infect Dis</source><year>2007</year>;<volume>11</volume>:<fpage>501</fpage>-<lpage>7</lpage><pub-id pub-id-type="pmid">17398132</pub-id></mixed-citation></ref><ref id="ref60"><label>60.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>El-Sheikh</surname><given-names>SM</given-names></name><name><surname>El-Assouli</surname><given-names>SM</given-names></name></person-group><article-title>Prevalence of viral, bacterial and parasitic enteropathogens among young children with acute diarrhoea in Jeddah, Saudi Arabia</article-title>. <source>J Health Popul Nutr</source><year>2001</year>;<volume>19</volume>:<fpage>25</fpage>-<lpage>30</lpage><pub-id pub-id-type="pmid">11394180</pub-id></mixed-citation></ref><ref id="ref61"><label>61.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Youssef</surname><given-names>M</given-names></name><name><surname>Shurman</surname><given-names>A</given-names></name><name><surname>Bougnoux</surname><given-names>M-E</given-names></name><etal></etal></person-group><article-title>Bacterial, viral and parasitic enteric pathogens associated with acute diarrhea in hospitalized children from northern Jordan</article-title>. <source>FEMS Immunol Med Microbiol</source><year>2000</year>;<volume>28</volume>:<fpage>257</fpage>-<lpage>63</lpage><pub-id pub-id-type="pmid">10865179</pub-id></mixed-citation></ref><ref id="ref62"><label>62.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Al-Gallas</surname><given-names>N</given-names></name><name><surname>Bahri</surname><given-names>O</given-names></name><name><surname>Bouratbeen</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Etiology of acute diarrhea in children and adults in Tunis, Tunisia, with emphasis on diarrheagenic Escherichia coli: prevalence, phenotyping, and molecular epidemiology</article-title>. <source>Am J Trop Med Hyg</source><year>2007</year>;<volume>77</volume>:<fpage>571</fpage>-<lpage>82</lpage><pub-id pub-id-type="pmid">17827382</pub-id></mixed-citation></ref><ref id="ref63"><label>63.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Barnes</surname><given-names>GL</given-names></name><name><surname>Uren</surname><given-names>E</given-names></name><name><surname>Stevens</surname><given-names>KB</given-names></name><name><surname>Bishop</surname><given-names>RF</given-names></name></person-group><article-title>Etiology of acute gastroenteritis in hospitalized children in Melbourne, Australia, from April 1980 to March 1993</article-title>. <source>J Clin Microbiol</source><year>1998</year>;<volume>36</volume>:<fpage>133</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">9431936</pub-id></mixed-citation></ref><ref id="ref64"><label>64.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McIver</surname><given-names>CJ</given-names></name><name><surname>Hansman</surname><given-names>G</given-names></name><name><surname>White</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>Diagnosis of enteric pathogens in children with gastroenteritis</article-title>. <source>Pathology</source><year>2001</year>;<volume>33</volume>:<fpage>353</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">11523939</pub-id></mixed-citation></ref><ref id="ref65"><label>65.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Olesen</surname><given-names>B</given-names></name><name><surname>Neimann</surname><given-names>J</given-names></name><name><surname>Böttiger</surname><given-names>B</given-names></name><etal></etal></person-group><article-title>Etiology of diarrhea in young children in Denmark: a case-control study</article-title>. <source>J Clin Microbiol</source><year>2005</year><volume>43</volume>:<fpage>3636</fpage>-<lpage>41</lpage><pub-id pub-id-type="pmid">16081890</pub-id></mixed-citation></ref><ref id="ref66"><label>66.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rautelin</surname><given-names>HI</given-names></name><name><surname>Renkonen</surname><given-names>OV</given-names></name><name><surname>Von</surname><given-names>Bonsdorff C-H</given-names></name><etal></etal></person-group><article-title>Prospective study of the etiology of diarrhea in adult outpatients and inpatients</article-title>. <source>Scand J Gastroenterol</source><year>1989</year>;<volume>24</volume>:<fpage>329</fpage>-<lpage>33</lpage><pub-id pub-id-type="pmid">2734591</pub-id></mixed-citation></ref><ref id="ref67"><label>67.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Levidiotou</surname><given-names>S</given-names></name><name><surname>Gartzonika</surname><given-names>C</given-names></name><name><surname>Papaventsis</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Viral agents of acute gastroenteritis in hospitalized children in Greece</article-title>. <source>Clin Microbiol Infect</source><year>2009</year>;<volume>15</volume>:<fpage>596</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">19604279</pub-id></mixed-citation></ref><ref id="ref68"><label>68.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Colomba</surname><given-names>C</given-names></name><name><surname>De</surname><given-names>Grazia S</given-names></name><name><surname>Giammanco</surname><given-names>GM</given-names></name><etal></etal></person-group><article-title>Viral gastroenteritis in children hospitalised in Sicily, Italy</article-title>. <source>Eur J Clin Microbiol Infect Dis</source><year>2006</year>;<volume>25</volume>:<fpage>570</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">16917775</pub-id></mixed-citation></ref><ref id="ref69"><label>69.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Albert</surname><given-names>MJ</given-names></name><name><surname>Faruque</surname><given-names>ASG</given-names></name><name><surname>Faruque</surname><given-names>SM</given-names></name><etal></etal></person-group><article-title>Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh</article-title>. <source>J Clin Microbiol</source><year>1999</year>;<volume>37</volume>:<fpage>3458</fpage>-<lpage>64</lpage><pub-id pub-id-type="pmid">10523534</pub-id></mixed-citation></ref><ref id="ref70"><label>70.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ghosh</surname><given-names>AR</given-names></name><name><surname>Nair</surname><given-names>GB</given-names></name><name><surname>Dutta</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>Acute diarrhoeal diseases in infants aged below six months in hospital in Calcutta, India: an aetiological study</article-title>. <source>Trans R Soc Trop Med Hyg</source><year>1991</year>;<volume>85</volume>:<fpage>796</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">1801358</pub-id></mixed-citation></ref><ref id="ref71"><label>71.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Haque</surname><given-names>R</given-names></name><name><surname>Mondal</surname><given-names>D</given-names></name><name><surname>Kirkpatrick</surname><given-names>BD</given-names></name><etal></etal></person-group><article-title>Epidemiologic and clinical characteristics of acute diarrhoea with emphasis on entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh</article-title>. <source>Am J Trop Med Hyg</source><year>2003</year>;<volume>69</volume>:<fpage>398</fpage>-<lpage>405</lpage><pub-id pub-id-type="pmid">14640500</pub-id></mixed-citation></ref><ref id="ref72"><label>72.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Klein</surname><given-names>E</given-names></name><name><surname>Boster</surname><given-names>DR</given-names></name><name><surname>Stapp</surname><given-names>JR</given-names></name><etal></etal></person-group><article-title>Diarrhea etiology in a children’s hospital emergency department: a prospective cohort study</article-title>. <source>Clin Infect Dis</source><year>2006</year>;<volume>43</volume>:<fpage>807</fpage>-<lpage>13</lpage><pub-id pub-id-type="pmid">16941358</pub-id></mixed-citation></ref><ref id="ref73"><label>73.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kyung-Hee</surname><given-names>K</given-names></name><name><surname>Inn-Soo</surname><given-names>Suh</given-names></name><name><surname>Jung</surname><given-names>Mogg Kim</given-names></name><etal></etal></person-group><article-title>Etiology of childhood diarrhoea in Korea</article-title>. <source>J Clin Microbiol</source><year>1989</year>;<volume>27</volume>:<fpage>1192</fpage>-<lpage>6</lpage><pub-id pub-id-type="pmid">2666437</pub-id></mixed-citation></ref><ref id="ref74"><label>74.</label><mixed-citation publication-type="web"><person-group person-group-type="author"><name><surname>Neuwelt</surname><given-names>P</given-names></name><name><surname>Simmons</surname><given-names>G</given-names></name></person-group><article-title>A public health portrait of severe paediatric gastroenteritis in the Auckland region: report of the 2005 Auckland Paediatric Gastroenteritis Investigation</article-title>. <comment>Auckland: Auckland Regional Public Health Service</comment>; <year>2006</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="https://researchspace.auckland.ac.nz/bitstream/handle/2292/8273/PaedsGastro_Apr06.pdf?sequence=2">https://researchspace.auckland.ac.nz/bitstream/handle/2292/8273/PaedsGastro_Apr06.pdf?sequence=2</ext-link></mixed-citation></ref><ref id="ref75"><label>75.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Uysal</surname><given-names>G</given-names></name><name><surname>Do ru</surname><given-names>Ü</given-names></name><name><surname>Aysev</surname><given-names>D</given-names></name><name><surname>Karabiber</surname><given-names>N</given-names></name></person-group><article-title>Campylobacter jejuni gastroenteritis in Turkish children</article-title>. <source>Infection</source><year>1997</year>;<volume>25</volume>:<fpage>159</fpage>-<lpage>62</lpage><pub-id pub-id-type="pmid">9181383</pub-id></mixed-citation></ref><ref id="ref76"><label>76.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Djeneba</surname><given-names>O</given-names></name><name><surname>Damintoti</surname><given-names>K</given-names></name><name><surname>Denise</surname><given-names>I</given-names></name><etal></etal></person-group><article-title>Prevalence of rotavirus adenovirus and enteric parasites amongst paediatric patients attending Saint Camille Medical Centre in Ouagadougou</article-title>. <source>Pak J Biol Sci</source><year>2007</year>;<volume>10</volume>:<fpage>4266</fpage>-<lpage>70</lpage><pub-id pub-id-type="pmid">19086583</pub-id></mixed-citation></ref><ref id="ref77"><label>77.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Germani</surname><given-names>Y</given-names></name><name><surname>Minssart</surname><given-names>P</given-names></name><name><surname>Vohito</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Etiologies of acute, persistent, and dysenteric diarrheas in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus</article-title>. <source>Am J Trop Med Hyg</source><year>1998</year>;<volume>59</volume>:<fpage>1008</fpage>-<lpage>14</lpage><pub-id pub-id-type="pmid">9886215</pub-id></mixed-citation></ref><ref id="ref78"><label>78.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hoge</surname><given-names>CW</given-names></name><name><surname>Echeverria</surname><given-names>P</given-names></name><name><surname>Rajah</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Prevalence of Cyclospora species and other enteric pathogens among children less than 5 years of age in Nepal</article-title>. <source>J Clin Microbiol</source><year>1995</year>;<volume>33</volume>:<fpage>3058</fpage>-<lpage>60</lpage><pub-id pub-id-type="pmid">8576377</pub-id></mixed-citation></ref><ref id="ref79"><label>79.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Reither</surname><given-names>K</given-names></name><name><surname>Ignatius</surname><given-names>R</given-names></name><name><surname>Weitzel</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Acute childhood diarrhoea in northern Ghana: epidemiological, clinical and microbiological characteristics</article-title>. <source>BMC Infect Dis</source><year>2007</year>;<volume>7</volume>:<fpage>104</fpage><pub-id pub-id-type="pmid">17822541</pub-id></mixed-citation></ref><ref id="ref80"><label>80.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yongsi</surname><given-names>HBN</given-names></name></person-group><article-title>Pathogenic microorganisms associated with childhood diarrhoea in low-and-middle income countries: case study of Youande-Cameroon</article-title>. <source>Int J Environmen Res Public Health</source><year>2008</year>;<volume>5</volume>: <fpage>213</fpage>-<lpage>29</lpage></mixed-citation></ref><ref id="ref81"><label>81.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Anyanwu</surname><given-names>BN</given-names></name></person-group><article-title>The aetiologic agents of bacterial diarrhoea in the children of the former East Central State of Nigeria</article-title>. <source>Int J Environ Health Res</source><year>1997</year>;<volume>7</volume>:<fpage>215</fpage>-<lpage>32</lpage></mixed-citation></ref><ref id="ref82"><label>82.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ogbu</surname><given-names>O</given-names></name><name><surname>Agumadu</surname><given-names>N</given-names></name><name><surname>Uneke</surname><given-names>CJ</given-names></name><name><surname>Amadi</surname><given-names>ES</given-names></name></person-group><article-title>Aetiology of acute infantile diarrhoea in the south-Eastern Nigeria: an assessment of microbiological and antibiotic sensitivity profile</article-title>. <source>Internet J Third World Med</source><year>2008</year>;<volume>7</volume>:<fpage>2</fpage></mixed-citation></ref><ref id="ref83"><label>83.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ogunsanya</surname><given-names>TI</given-names></name><name><surname>Rotimi</surname><given-names>VO</given-names></name><name><surname>Adenuga</surname><given-names>A</given-names></name></person-group><article-title>A study of the aetiological agents of childhood diarrhoea in Lagos, Nigeria</article-title>. <source>J Med Microbiol</source><year>1994</year>;<volume>40</volume>:<fpage>10</fpage>-<lpage>4</lpage><pub-id pub-id-type="pmid">8289209</pub-id></mixed-citation></ref><ref id="ref84"><label>84.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Olowe</surname><given-names>OA</given-names></name><name><surname>Olayemi</surname><given-names>AB</given-names></name><name><surname>Eniola</surname><given-names>KIT</given-names></name><name><surname>Adeyeba</surname><given-names>OA</given-names></name></person-group><article-title>Aetiology agents of diarrhoea in children under five years of age in Osogbo, Osun State</article-title>. <source>Afr J Clin Exper Microbiol</source><year>2003</year>;<volume>4</volume>:<fpage>62</fpage>-<lpage>6</lpage></mixed-citation></ref><ref id="ref85"><label>85.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>van Eijk</surname><given-names>AM</given-names></name><name><surname>Brooks</surname><given-names>JT</given-names></name><name><surname>Adcock</surname><given-names>PM</given-names></name><etal></etal></person-group><article-title>Diarrhea in children less than two years of age with known HIV status in Kisumu, Kenya</article-title>. <source>Int J Infect Dis</source><year>2010</year>;<volume>14</volume>:<fpage>e220</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">19664950</pub-id></mixed-citation></ref><ref id="ref86"><label>86.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Brink</surname><given-names>AK</given-names></name><name><surname>Mahé</surname><given-names>C</given-names></name><name><surname>Watera</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Diarrhoea, cd4 counts and enteric infections in a community-based cohort of hiv-infected adults in Uganda</article-title>. <source>J Infect</source><year>2002</year>;<volume>45</volume>:<fpage>99</fpage>-<lpage>106</lpage><pub-id pub-id-type="pmid">12217712</pub-id></mixed-citation></ref><ref id="ref87"><label>87.</label><mixed-citation publication-type="book"><person-group person-group-type="author"><name><surname>Cajetan</surname><given-names>ICI</given-names></name><name><surname>Nnennaya</surname><given-names>IR</given-names></name><name><surname>Casmir</surname><given-names>AA</given-names></name><name><surname>Florence</surname><given-names>IN</given-names></name></person-group><source>Enteric bacteria pathogens associated with diarrhoea of children in the federal capital territory Abuja</source>, <publisher-loc>Nigeria</publisher-loc><publisher-name>New York Sci J</publisher-name><year>2010</year>;<volume>3</volume></mixed-citation></ref><ref id="ref88"><label>88.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Musiime</surname><given-names>V</given-names></name><name><surname>Kalyesubula</surname><given-names>I</given-names></name><name><surname>Kaddu-Mulindwa</surname><given-names>D</given-names></name><name><surname>Byarugaba</surname><given-names>J</given-names></name></person-group><article-title>Enteric bacterial pathogens in hiv-infected children with acute diarrhea in Mulago referral and teaching hospital, Kampala, Uganda</article-title>. <source>J Int Assoc Physicians AIDS Care</source><year>2009</year>;<volume>8</volume>:<fpage>185</fpage>-<lpage>90</lpage></mixed-citation></ref><ref id="ref89"><label>89.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vargas</surname><given-names>M</given-names></name><name><surname>Gascon</surname><given-names>J</given-names></name><name><surname>Casals</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Etiology of diarrhea in children less than five years of age in Ifakara, Tanzania</article-title>. <source>Am J Trop Med Hyg</source><year>2004</year>;<volume>70</volume>:<fpage>536</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">15155987</pub-id></mixed-citation></ref><ref id="ref90"><label>90.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>De Mol</surname><given-names>P</given-names></name><name><surname>Hemelhof</surname><given-names>W</given-names></name><name><surname>Butzler</surname><given-names>J P</given-names></name><etal></etal></person-group><article-title>Enteropathogenic agents in children with diarrhoea in rural Zaire</article-title>. <source>Lancet</source><year>1983</year>;<volume>321</volume>:<fpage>516</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">6131221</pub-id></mixed-citation></ref><ref id="ref91"><label>91.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Henry</surname><given-names>M-C</given-names></name><name><surname>Alary</surname><given-names>M</given-names></name><name><surname>Desmet</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>Community survey of diarrhooea in children under five years in Kinshasa Zaire</article-title>. <source>Ann Soc Belge Med Trop</source><year>1995</year>;<volume>75</volume>:<fpage>105</fpage>-<lpage>14</lpage></mixed-citation></ref><ref id="ref92"><label>92.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kelly</surname><given-names>P</given-names></name><name><surname>Baboo</surname><given-names>K</given-names></name><name><surname>Wolff</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>The prevalence and aetiology of persistent diarrhoea in adults in urban Zambia</article-title>. <source>Acta Tropica</source><year>1996</year>;<volume>61</volume>:<fpage>183</fpage>-<lpage>90</lpage><pub-id pub-id-type="pmid">8790769</pub-id></mixed-citation></ref><ref id="ref93"><label>93.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nakano</surname><given-names>T</given-names></name><name><surname>Kamiya</surname><given-names>H</given-names></name><name><surname>Matsubayashi</surname><given-names>N</given-names></name><etal></etal></person-group><article-title>Diagnosis of bacterial enteric infections in children in Zambia</article-title>. <source>Acta Paediatr Jpn</source><year>1998</year>;<volume>40</volume>:<fpage>259</fpage>-<lpage>63</lpage><pub-id pub-id-type="pmid">9695302</pub-id></mixed-citation></ref><ref id="ref94"><label>94.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Podkolzin</surname><given-names>AT</given-names></name><name><surname>Fenske</surname><given-names>EB</given-names></name><name><surname>Yu Abramycheva</surname><given-names>N</given-names></name><etal></etal></person-group><article-title>Hospital-based surveillance of rotavirus and other viral agents of diarrhea in children and adults in Russia, 2005-2007</article-title>. <source>J Infect Dis 2009</source>;<volume>200</volume><issue>Suppl 1</issue>:<fpage>S228</fpage>-<lpage>33</lpage></mixed-citation></ref><ref id="ref95"><label>95.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>O’Neill</surname><given-names>HJ</given-names></name><name><surname>McCaughey</surname><given-names>C</given-names></name><name><surname>Coyle</surname><given-names>PV</given-names></name><etal></etal></person-group><article-title>Clinical utility of nested multiplex RT-PCR for group F adenovirus, rotavirus and norwalklike viruses in acute viral gastroenteritis in children and adults</article-title>. <source>J Clin Virol</source><year>2002</year>;<volume>25</volume>:<fpage>335</fpage>-<lpage>43</lpage><pub-id pub-id-type="pmid">12423697</pub-id></mixed-citation></ref><ref id="ref96"><label>96.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jansen</surname><given-names>A</given-names></name><name><surname>Stark</surname><given-names>K</given-names></name><name><surname>Kunkel</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Aetiology of community-acquired, acute gastroenteritis in hospitalised adults: a prospective cohort study</article-title>. <source>BMC Infect Dis</source><year>2008</year>;<volume>8</volume>:<fpage>143</fpage><pub-id pub-id-type="pmid">18940017</pub-id></mixed-citation></ref><ref id="ref97"><label>97.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Olsen</surname><given-names>JE</given-names></name><name><surname>Aabo</surname><given-names>S</given-names></name><name><surname>Hill</surname><given-names>W</given-names></name><etal></etal></person-group><article-title>Probes and polymerase chain reaction for detection of food-borne bacterial pathogens</article-title>. <source>Int J Food Microbiol</source><year>1995</year>;<volume>28</volume>:<fpage>1</fpage>-<lpage>78</lpage><pub-id pub-id-type="pmid">8751091</pub-id></mixed-citation></ref><ref id="ref98"><label>98.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ashley</surname><given-names>DVM</given-names></name><name><surname>Walters</surname><given-names>C</given-names></name><name><surname>Dockery-Brown</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Interventions to prevent and control food-borne diseases associated with a reduction in traveler’s diarrhea in tourists to Jamaica</article-title>. <source>J Travel Med</source><year>2004</year>;<volume>11</volume>:<fpage>364</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">15569573</pub-id></mixed-citation></ref><ref id="ref99"><label>99.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fletcher</surname><given-names>SM</given-names></name><name><surname>Maharaj</surname><given-names>SR</given-names></name><name><surname>James</surname><given-names>K</given-names></name></person-group><article-title>Description of the food safety system in hotels and how it compares with HACCP standards</article-title>. <source>J Travel Med</source><year>2009</year>;<volume>16</volume>:<fpage>35</fpage>-<lpage>41</lpage><pub-id pub-id-type="pmid">19192126</pub-id></mixed-citation></ref><ref id="ref100"><label>100.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Steffen</surname><given-names>R</given-names></name><name><surname>Collard</surname><given-names>F</given-names></name><name><surname>Tornieporth</surname><given-names>N</given-names></name><etal></etal></person-group><article-title>Epidemiology, etiology, and impact of traveler’s diarrhea in Jamaica</article-title>. <source>JAMA</source><year>1999</year>;<volume>281</volume>:<fpage>811</fpage>-<lpage>7</lpage><pub-id pub-id-type="pmid">10071002</pub-id></mixed-citation></ref><ref id="ref101"><label>101.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sanchez-Padilla</surname><given-names>E</given-names></name><name><surname>Grais</surname><given-names>RF</given-names></name><name><surname>Guerin</surname><given-names>PJ</given-names></name><etal></etal></person-group><article-title>Burden of disease and circulating serotypes of rotavirus infection in sub-Saharan Africa: systematic review and meta-analysis</article-title>. <source>Lancet Infect Dis</source><year>2009</year>;<volume>9</volume>:<fpage>567</fpage>-<lpage>76</lpage><pub-id pub-id-type="pmid">19695493</pub-id></mixed-citation></ref><ref id="ref102"><label>102.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Genser</surname><given-names>B</given-names></name><name><surname>Strina</surname><given-names>A</given-names></name><name><surname>Dos Santos</surname><given-names>LA</given-names></name><etal></etal></person-group><article-title>Impact of a city-wide sanitation intervention in a large urban centre on social, environmental and behavioural determinants of childhood diarrhoea: analysis of two cohort studies</article-title>. <source>Int J Epidemiol</source><year>2008</year>;<volume>37</volume>:<fpage>831</fpage>-<lpage>40</lpage><pub-id pub-id-type="pmid">18653513</pub-id></mixed-citation></ref><ref id="ref103"><label>103.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Robins-Browne</surname><given-names>RM</given-names></name><name><surname>Levine</surname><given-names>MM</given-names></name></person-group><article-title>laboratory diagnostic challenges in case/control studies of diarrhea in developing countries</article-title>. <source>Clin Infect Dis</source><year>2012</year>;<volume>55</volume><issue>Suppl 4</issue>:<fpage>S312</fpage>-<lpage>S6</lpage><pub-id pub-id-type="pmid">23169943</pub-id></mixed-citation></ref><ref id="ref104"><label>104.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Richardson</surname><given-names>S</given-names></name><name><surname>Grimwood</surname><given-names>K</given-names></name><name><surname>Gorrell</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Extended excretion of rotavirus after severe diarrhoea in young children</article-title>. <source>Lancet</source><year>1998</year>;<volume>351</volume>:<fpage>1844</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">9652668</pub-id></mixed-citation></ref><ref id="ref105"><label>105.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>van Hal</surname><given-names>S</given-names></name><name><surname>Fotedar</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Comparison of stool antigen detection kits to PCR for diagnosis of amebiasis</article-title>. <source>J Clin Microbiol</source><year>2008</year>;<volume>46</volume>:<fpage>1678</fpage>-<lpage>81</lpage><pub-id pub-id-type="pmid">18367563</pub-id></mixed-citation></ref><ref id="ref106"><label>106.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bruijnesteijn van Coppenraet</surname><given-names>LES</given-names></name><name><surname>Wallinga</surname><given-names>JA</given-names></name><name><surname>Ruijs</surname><given-names>GJHM</given-names></name><etal></etal></person-group><article-title>Parasitological diagnosis combining an internally controlled realtime PCR assay for the detection of four protozoa in stool samples with a testing algorithm for microscopy</article-title>. <source>Clin Microbiol Infect</source><year>2009</year>;<volume>15</volume>:<fpage>869</fpage>-<lpage>74</lpage><pub-id pub-id-type="pmid">19624500</pub-id></mixed-citation></ref><ref id="ref107"><label>107.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Al-Qassab</surname><given-names>SE</given-names></name><name><surname>Barratt</surname><given-names>JLN</given-names></name><etal></etal></person-group><article-title>Evaluation of multiplex tandem real-time PCR for detection of Cryptosporidium spp., Dientamoeba fragilis, eEntamoeba histolytica, and Giardia intestinalis in clinical stool samples</article-title>. <source>J Clin Microbiol</source><year>2011</year>;<volume>49</volume>:<fpage>257</fpage>-<lpage>62</lpage><pub-id pub-id-type="pmid">21048004</pub-id></mixed-citation></ref><ref id="ref108"><label>108.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Barratt</surname><given-names>J</given-names></name><name><surname>Roberts</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>A Review of the clinical presentation of dientamoebiasis</article-title>. <source>Am J Trop Med Hyg</source><year>2010</year>;<volume>82</volume>:<fpage>614</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">20348509</pub-id></mixed-citation></ref><ref id="ref109"><label>109.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Barratt</surname><given-names>J</given-names></name><name><surname>Roberts</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Comparison of microscopy, two xenic culture techniques, conventional and real-time PCR for the detection of Dientamoeba fragilis in clinical stool samples</article-title>. <source>Eur J Clin Microbiol Infect Dis</source><year>2010</year>;<volume>29</volume>:<fpage>411</fpage>-<lpage>6</lpage><pub-id pub-id-type="pmid">20155433</pub-id></mixed-citation></ref><ref id="ref110"><label>110.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fotedar</surname><given-names>R</given-names></name><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Beebe</surname><given-names>N</given-names></name><etal></etal></person-group><article-title>Laboratory diagnostic techniques for Entamoeba species</article-title>. <source>Clin Microbiol Rev</source><year>2007</year>;<volume>20</volume>:<fpage>511</fpage>-<lpage>32</lpage><pub-id pub-id-type="pmid">17630338</pub-id></mixed-citation></ref><ref id="ref111"><label>111.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Putignani</surname><given-names>L</given-names></name><name><surname>Menichella</surname><given-names>D</given-names></name></person-group><article-title>Global distribution, public health and clinical impact of the protozoan pathogen Cryptosporidium</article-title>. <source>Interdiscip Perspect Infect Dis</source><year>2010</year>;<volume>2010</volume>:<fpage>1</fpage>-<lpage>39</lpage></mixed-citation></ref><ref id="ref112"><label>112.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thapar</surname><given-names>N</given-names></name><name><surname>Sanderson</surname><given-names>PIR</given-names></name></person-group><article-title>Diarrhoea in children: an interface between developing and developed countries</article-title>. <source>Lancet</source><year>2004</year>;<volume>363</volume>:<fpage>641</fpage>-<lpage>53</lpage><pub-id pub-id-type="pmid">14987892</pub-id></mixed-citation></ref><ref id="ref113"><label>113.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Glass</surname><given-names>R.</given-names></name><name><surname>Parashar</surname><given-names>UD</given-names></name><name><surname>Estes</surname><given-names>M</given-names></name></person-group><article-title>Norovirus gastroenteritis</article-title>. <source>N Engl J Med</source><year>2009</year>;<volume>361</volume>:<fpage>1776</fpage>-<lpage>85</lpage><pub-id pub-id-type="pmid">19864676</pub-id></mixed-citation></ref><ref id="ref114"><label>114.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fletcher</surname><given-names>SM</given-names></name><name><surname>Van Hal</surname><given-names>S</given-names></name><name><surname>Andresen</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Gastrointestinal pathogen distribution in symptomatic children in Sydney, Australia</article-title>. <source>J Epidemiol Global Health</source><year>2012</year>;<volume>3</volume>:<fpage>11</fpage>-<lpage>21</lpage></mixed-citation></ref><ref id="ref115"><label>115.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cook</surname><given-names>SM</given-names></name><name><surname>Glass</surname><given-names>RI</given-names></name><name><surname>LeBaron</surname><given-names>CW</given-names></name><name><surname>Ho</surname><given-names>M-S</given-names></name></person-group><article-title>Global seasonality of rotavirus infections</article-title>. <source>Bull World Health Organ</source><year>1990</year>;<volume>68</volume>:<fpage>171</fpage>-<lpage>7</lpage><pub-id pub-id-type="pmid">1694734</pub-id></mixed-citation></ref><ref id="ref116"><label>116.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Curns</surname><given-names>AT</given-names></name><name><surname>Steiner</surname><given-names>CA</given-names></name><name><surname>Barrett</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Reduction in acute gastroenteritis hospitalizations among US children after introduction of rotavirus vaccine: analysis of hospital discharge data from 18 US States</article-title>. <source>J Infect Dis</source><year>2010</year>;<volume>201</volume>:<fpage>1617</fpage>-<lpage>24</lpage><pub-id pub-id-type="pmid">20402596</pub-id></mixed-citation></ref><ref id="ref117"><label>117.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chiu</surname><given-names>C</given-names></name><name><surname>Dey</surname><given-names>A</given-names></name><name><surname>Wang</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Vaccine preventable diseases in Australia, 2005 to 2007</article-title>. <source>Commun Dis Intell Q Rep</source>. <year>2010</year>;<volume>34</volume><comment>Supp:</comment><fpage>S1</fpage>-<lpage>167</lpage><pub-id pub-id-type="pmid">21416762</pub-id></mixed-citation></ref><ref id="ref118"><label>118.</label><mixed-citation publication-type="journal"><collab>NCIRS</collab>, <person-group person-group-type="author"><name><surname>Brotherton</surname><given-names>J</given-names></name><name><surname>Wang</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Vaccine preventable diseases and vaccination coverage in Australia, 2003 to 2005</article-title>. <source>Commun Dis Intell Q Rep</source><year>2007</year>;<volume>31</volume><comment>Suppl</comment>:<fpage>S1</fpage>-<lpage>152</lpage><pub-id pub-id-type="pmid">17844780</pub-id></mixed-citation></ref><ref id="ref119"><label>119.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hull</surname><given-names>B P</given-names></name><name><surname>Mahajan</surname><given-names>D</given-names></name><name><surname>Dey</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Immunisation coverage annual report, 2008</article-title>. <source>Commun Dis Intell Q Rep</source><year>2010</year>;<volume>34</volume>:<fpage>241</fpage>-<lpage>58</lpage><pub-id pub-id-type="pmid">21090180</pub-id></mixed-citation></ref><ref id="ref120"><label>120.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Madhi</surname><given-names>SA</given-names></name><name><surname>Cunliffe</surname><given-names>NA</given-names></name><name><surname>Steele</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Effect of human rotavirus vaccine on severe diarrhea in African infants</article-title>. <source>N Engl J Med</source><year>2010</year>;<volume>362</volume>:<fpage>289</fpage>-<lpage>98</lpage><pub-id pub-id-type="pmid">20107214</pub-id></mixed-citation></ref><ref id="ref121"><label>121.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Santosham</surname><given-names>M</given-names></name></person-group><article-title>Rotavirus vaccine - a powerful tool to combat deaths from diarrhea</article-title>. <source>N Engl J Med</source><year>2010</year>;<volume>362</volume>:<fpage>358</fpage>-<lpage>60</lpage><pub-id pub-id-type="pmid">20107222</pub-id></mixed-citation></ref><ref id="ref122"><label>122.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Svraka</surname><given-names>S</given-names></name><name><surname>Duizer</surname><given-names>E</given-names></name><name><surname>Vennema</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Etiological role of viruses in outbreaks of acute gastroenteritis in The Netherlands from 1994 through 2005</article-title>. <source>J Clin Microbiol</source><year>2007</year>;<volume>45</volume>:<fpage>1389</fpage>-<lpage>94</lpage><pub-id pub-id-type="pmid">17360839</pub-id></mixed-citation></ref><ref id="ref123"><label>123.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fischer Walker</surname><given-names>CL</given-names></name><name><surname>Sack</surname><given-names>D</given-names></name><name><surname>Black</surname><given-names>RE</given-names></name></person-group><article-title>Etiology of diarrhea in older children, adolescents and adults: a systematic review</article-title>. <source>PLoS Negl Trop Dis</source><year>2010</year>;<volume>4</volume>:<fpage>e768</fpage><pub-id pub-id-type="pmid">20689809</pub-id></mixed-citation></ref><ref id="ref124"><label>124.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Voetsch</surname><given-names>AC</given-names></name><name><surname>Van Gilder</surname><given-names>TJ</given-names></name><name><surname>Angulo</surname><given-names>FJ</given-names></name><etal></etal></person-group><article-title>FoodNet estimate of the burden of illness caused by nontyphoidal salmonella infections in the United States</article-title>. <source>Clin Infect Dis</source><year>2004</year>;<volume>38</volume><issue>Suppl 3</issue>:<fpage>S127</fpage>-<lpage>34</lpage><pub-id pub-id-type="pmid">15095181</pub-id></mixed-citation></ref><ref id="ref125"><label>125.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rabsch</surname><given-names>W</given-names></name><name><surname>Tschäpe</surname><given-names>H</given-names></name><name><surname>Bäumler</surname><given-names>AJ</given-names></name></person-group><article-title>Non-typhoidal salmonellosis: emerging problems</article-title>. <source>Microb Infect</source><year>2001</year>;<volume>3</volume>:<fpage>237</fpage>-<lpage>47</lpage></mixed-citation></ref><ref id="ref126"><label>126.</label><mixed-citation publication-type="web"><person-group person-group-type="author"><name><surname>Bambrick</surname><given-names>H</given-names></name><name><surname>Dear</surname><given-names>K</given-names></name><name><surname>Woodruff</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>The impacts of climate change on three health outcomes: temperature-related mortality and hospitalisations, salmonellosis and other bacterial gastroenteritis, and population at risk from dengue</article-title>. <comment>June</comment><year>2008</year><comment>Available from</comment>: <ext-link ext-link-type="uri" xlink:href="http://garnautreview.org.au/CA25734E0016A131/WebObj/03-AThreehealthoutcomes/$File/03-A%20Three%20health%20out-comes.pdf">http://garnautreview.org.au/CA25734E0016A131/WebObj/03-AThreehealthoutcomes/$File/03-A%20Three%20health%20out-comes.pdf</ext-link></mixed-citation></ref><ref id="ref127"><label>127.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>O’Ryan</surname><given-names>M</given-names></name><name><surname>Prado</surname><given-names>V</given-names></name><name><surname>Pickering</surname><given-names>LK</given-names></name></person-group><article-title>A millennium update on pediatric diarrheal illness in the developing world</article-title>. <source>Sem Pediatr Infect Dis</source><year>2005</year>;<volume>16</volume>:<fpage>125</fpage>-<lpage>36</lpage></mixed-citation></ref><ref id="ref128"><label>128.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Raso</surname><given-names>G</given-names></name><name><surname>Luginbuhl</surname><given-names>A</given-names></name><name><surname>Adjoua</surname><given-names>CA</given-names></name><etal></etal></person-group><article-title>Multiple parasite infections and their relationship to self-reported morbidity in a community of rural Cote d’Ivoire</article-title>. <source>Int J Epidemiol</source><year>2004</year>;<volume>33</volume>:<fpage>1092</fpage>-<lpage>102</lpage><pub-id pub-id-type="pmid">15256525</pub-id></mixed-citation></ref><ref id="ref129"><label>129.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mor Siobhan</surname><given-names>M</given-names></name><name><surname>Tzipori</surname><given-names>S</given-names></name></person-group><article-title>Cryptosporidiosis in Children in Sub-Saharan Africa: a lingering challenge</article-title>. <source>Clin Infect Dis</source><year>2008</year>;<volume>47</volume>:<fpage>915</fpage>-<lpage>21</lpage><pub-id pub-id-type="pmid">18715159</pub-id></mixed-citation></ref><ref id="ref130"><label>130.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Barratt</surname><given-names>JLN</given-names></name><name><surname>van Hal</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Clinical significance of enteric protozoa in the immunosuppressed human population</article-title>. <source>Clin Microbiol Rev</source><year>2009</year>;<volume>22</volume>:<fpage>634</fpage>-<lpage>50</lpage><pub-id pub-id-type="pmid">19822892</pub-id></mixed-citation></ref><ref id="ref131"><label>131.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jones</surname><given-names>M</given-names></name><name><surname>Whipps</surname><given-names>C</given-names></name><name><surname>Ganac</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Association of Blastocystis subtype 3 and 1 with patients from an Oregon community presenting with chronic gastrointestinal illness</article-title>. <source>Parasitol Res</source><year>2009</year>;<volume>104</volume>:<fpage>341</fpage>-<lpage>5</lpage><pub-id pub-id-type="pmid">18923844</pub-id></mixed-citation></ref><ref id="ref132"><label>132.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Boorom</surname><given-names>K</given-names></name><name><surname>Smith</surname><given-names>H</given-names></name><name><surname>Nimri</surname><given-names>L</given-names></name><etal></etal></person-group><article-title>Oh my aching gut: irritable bowel syndrome, Blastocystis, and asymptomatic infection</article-title>. <source>Parasites Vectors</source><year>2008</year>;<volume>1</volume>:<fpage>40</fpage><pub-id pub-id-type="pmid">18937874</pub-id></mixed-citation></ref><ref id="ref133"><label>133.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dogruman-Al</surname><given-names>F</given-names></name><name><surname>Kustimur</surname><given-names>S</given-names></name><name><surname>Yoshikawa</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Blastocystis subtypes in irritable bowel syndrome and inflammatory bowel disease in Ankara, Turkey</article-title>. <source>Mem Inst Oswaldo Cruz</source><year>2009</year>;<volume>104</volume>:<fpage>724</fpage>-<lpage>7</lpage><pub-id pub-id-type="pmid">19820833</pub-id></mixed-citation></ref><ref id="ref134"><label>134.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>van Hal</surname><given-names>S</given-names></name><name><surname>Marriott</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis</article-title>. <source>Int J Parasitol</source><year>2007</year>;<volume>37</volume>:<fpage>11</fpage>-<lpage>20</lpage><pub-id pub-id-type="pmid">17070814</pub-id></mixed-citation></ref><ref id="ref135"><label>135.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jimenez-Gonzalez</surname><given-names>D</given-names></name><name><surname>Martinez-Flores</surname><given-names>W</given-names></name><name><surname>Reyes-Gordillo</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Blastocystis infection is associated with irritable bowel syndrome in a Mexican patient population</article-title>. <source>Parasitol Res</source><year>2011</year>:<fpage>1</fpage>-<lpage>7</lpage></mixed-citation></ref><ref id="ref136"><label>136.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Roberts</surname><given-names>T</given-names></name><name><surname>Stark</surname><given-names>D</given-names></name><name><surname>Harkness</surname><given-names>J</given-names></name><name><surname>Ellis</surname><given-names>J</given-names></name></person-group><article-title>Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis</article-title>. <source>Eur J Clin Microbiol Infect Dis</source><year>2012</year>;<volume>32</volume>:<fpage>1</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">23263838</pub-id></mixed-citation></ref><ref id="ref137"><label>137.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kotloff</surname><given-names>KL</given-names></name><name><surname>Blackwelder</surname><given-names>WC</given-names></name><name><surname>Nasrin</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>The global enteric multicenter study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study</article-title>. <source>Clin Infect Dis</source><year>2012</year>;<volume>55</volume><issue>Suppl 4</issue>:<fpage>S232</fpage>-<lpage>S45</lpage><pub-id pub-id-type="pmid">23169936</pub-id></mixed-citation></ref><ref id="ref138"><label>138.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Panchalingam</surname><given-names>S</given-names></name><name><surname>Antonio</surname><given-names>M</given-names></name><name><surname>Hossain</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Diagnostic microbiologic methods in the GEMS-1 case/control study</article-title>. <source>Clin Infect Dis</source><year>2012</year>;<volume>55</volume><issue>Suppl 4</issue>:<fpage>S294</fpage>-<lpage>S302</lpage><pub-id pub-id-type="pmid">23169941</pub-id></mixed-citation></ref><ref id="ref139"><label>139.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fletcher</surname><given-names>SM</given-names></name><name><surname>Van Hal</surname><given-names>S</given-names></name><name><surname>Andresen</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Gastrointestinal pathogen distribution in symptomatic children in Sydney, Australia</article-title>. <source>J Epidemiol Global Health</source><year>2012</year>;<volume>3</volume>:<fpage>11</fpage>-<lpage>21</lpage></mixed-citation></ref><ref id="ref140"><label>140.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grimwood</surname><given-names>K</given-names></name><name><surname>Huang</surname><given-names>QS</given-names></name><name><surname>Cohet</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Rotavirus hospitalisation in New Zealand children under 3 years of age</article-title>. <source>J Paediatr Child Health</source><year>2006</year>;<volume>42</volume>:<fpage>196</fpage>-<lpage>203</lpage><pub-id pub-id-type="pmid">16630321</pub-id></mixed-citation></ref><ref id="ref141"><label>141.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mounts</surname><given-names>AW</given-names></name><name><surname>Ando</surname><given-names>T</given-names></name><name><surname>Koopmans</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Cold weather seasonality of gastroenteritis associated with Norwalk-like viruses</article-title>. <source>J Infect Dis</source><year>2000</year>;<volume>181</volume><issue>Suppl 2</issue>:<lpage>S284</lpage>-<lpage>S7</lpage></mixed-citation></ref><ref id="ref142"><label>142.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lal</surname><given-names>A</given-names></name><name><surname>Hales</surname><given-names>S</given-names></name><name><surname>French</surname><given-names>N</given-names></name><name><surname>Baker</surname><given-names>MG</given-names></name></person-group><article-title>Seasonality in human zoonotic enteric diseases: a systematic review</article-title>. <source>PLoS One</source><year>2012</year>;<volume>7</volume>:<fpage>e31883</fpage><pub-id pub-id-type="pmid">22485127</pub-id></mixed-citation></ref><ref id="ref143"><label>143.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>SSW</given-names></name><name><surname>Ng</surname><given-names>KC</given-names></name><name><surname>Lam</surname><given-names>PK-W</given-names></name><etal></etal></person-group><article-title>Predictors of positive stool culture in adult patients with acute infectious diarrhea</article-title>. <source>J Emerg Med</source><year>2002</year>;<volume>23</volume>:<fpage>125</fpage>-<lpage>30</lpage><pub-id pub-id-type="pmid">12359279</pub-id></mixed-citation></ref><ref id="ref144"><label>144.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ekdahl</surname><given-names>K</given-names></name><name><surname>De</surname><given-names>Jong B</given-names></name><name><surname>Wollin</surname><given-names>R</given-names></name><name><surname>Andersson</surname><given-names>Y</given-names></name></person-group><article-title>Travel-associated non-typhoidal salmonellosis: geographical and seasonal differences and serotype distribution</article-title>. <source>Clin Microbiol Infect</source><year>2005</year>;<volume>11</volume>:<fpage>138</fpage>-<lpage>44</lpage><pub-id pub-id-type="pmid">15679488</pub-id></mixed-citation></ref><ref id="ref145"><label>145.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ekdahl</surname><given-names>L</given-names></name><name><surname>Andersson</surname><given-names>Y</given-names></name></person-group><article-title>The epidemiology of travel-associated shigellosis-regional risks, seasonality and serogroups</article-title>. <source>J Infect</source><year>2005</year>;<volume>51</volume>:<fpage>222</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">16230220</pub-id></mixed-citation></ref><ref id="ref146"><label>146.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gauci</surname><given-names>C</given-names></name><name><surname>Gilles</surname><given-names>H</given-names></name><name><surname>O’Brien</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>The magnitude and distribution of infectious intestinal disease in Malta: a population-based study</article-title>. <source>Epidemiol Infect</source><year>2007</year>;<volume>135</volume>:<fpage>1282</fpage>-<lpage>9</lpage><pub-id pub-id-type="pmid">17224088</pub-id></mixed-citation></ref><ref id="ref147"><label>147.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hall</surname><given-names>G</given-names></name><name><surname>Kirk</surname><given-names>M</given-names></name><name><surname>Ashbolt</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Frequency of infectious intestinal illness in Australia, 2002: regional, seasonal and demographic variation</article-title>. <source>Epidemiol Infect</source><year>2006</year>;<volume>134</volume>:<fpage>111</fpage>-<lpage>8</lpage><pub-id pub-id-type="pmid">16409657</pub-id></mixed-citation></ref><ref id="ref148"><label>148.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kovats</surname><given-names>RS</given-names></name><name><surname>Edwards</surname><given-names>SJ</given-names></name><name><surname>Charron</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Climate variability and campylobacter infection: an international study</article-title>. <source>Int J Biometeorol</source><year>2005</year>;<volume>49</volume>:<fpage>207</fpage>-<lpage>14</lpage><pub-id pub-id-type="pmid">15565278</pub-id></mixed-citation></ref><ref id="ref149"><label>149.</label><mixed-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pardhan-Ali</surname><given-names>A</given-names></name><name><surname>Wilson</surname><given-names>J</given-names></name><name><surname>Edge</surname><given-names>VL</given-names></name><etal></etal></person-group><article-title>A descriptive analysis of notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008</article-title>. <source>BMJ Open</source><year>2012</year>;<volume>2</volume>:<fpage>e000732</fpage></mixed-citation></ref></ref-list></back><floats-group><table-wrap id="table001" orientation="portrait" position="float"><label>Table 1.</label><caption><p>Summary of 60 studies included in the systematic review of gastrointestinal pathogens worldwide.</p></caption><table frame="box" rules="all"><thead><tr><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th colspan="2" align="center" rowspan="1">Study details</th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th rowspan="1" colspan="1"></th><th colspan="2" align="center" rowspan="1">Laboratory analysis (tests done)</th></tr><tr><th align="left" rowspan="1" colspan="1">Region<break></break> (studies)</th><th align="center" rowspan="1" colspan="1">Country</th><th align="center" rowspan="1" colspan="1">First author/<break></break>year (ref)</th><th align="center" rowspan="1" colspan="1">Study<break></break> period</th><th align="center" rowspan="1" colspan="1">Study<break></break> design</th><th align="center" rowspan="1" colspan="1">Source<break></break> of specimen</th><th align="center" rowspan="1" colspan="1">Sampling<break></break> method</th><th align="center" rowspan="1" colspan="1">Age<break></break> groups<break></break> (yrs)</th><th align="center" rowspan="1" colspan="1">Sample<break></break> size</th><th align="center" rowspan="1" colspan="1">Bacterial<break></break> culture</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">EAP (13)</td><td align="left" valign="top" rowspan="1" colspan="1">Burma</td><td align="left" valign="top" rowspan="1" colspan="1">Tin 1989 (39)</td><td align="left" valign="top" rowspan="1" colspan="1">1982-1983</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">501 cases,<break></break> 374 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">China</td><td align="left" valign="top" rowspan="1" colspan="1">Huilan Sima 1991 (40)</td><td align="left" valign="top" rowspan="1" colspan="1">1982-1985</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">594 cases,<break></break> 562 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology, parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">China</td><td align="left" valign="top" rowspan="1" colspan="1">Kain Kevin 1991 (41)</td><td align="left" valign="top" rowspan="1" colspan="1">1989-1989</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">221 cases,<break></break> 108 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology, parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Indonesia</td><td align="left" valign="top" rowspan="1" colspan="1">Soenarto 1983 (43)</td><td align="left" valign="top" rowspan="1" colspan="1">1978-1979</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-12</td><td align="left" valign="top" rowspan="1" colspan="1">338 cases,<break></break> 69 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology, parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Myanmar</td><td align="left" valign="top" rowspan="1" colspan="1">Huilan 1991 (40)</td><td align="left" valign="top" rowspan="1" colspan="1">1982-1985</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">813 cases,<break></break> 813 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology; parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Vietnam</td><td align="left" valign="top" rowspan="1" colspan="1">Hien. 2007 (50)</td><td align="left" valign="top" rowspan="1" colspan="1">2002-2004</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-6</td><td align="left" valign="top" rowspan="1" colspan="1">111 cases,<break></break> 111 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology; parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Vietnam</td><td align="left" valign="top" rowspan="1" colspan="1">Isenbarger 2001 (47)</td><td align="left" valign="top" rowspan="1" colspan="1">1998-1999</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">2160 cases,<break></break> 203 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Vietnam</td><td align="left" valign="top" rowspan="1" colspan="1">Nguyen 2006 (49)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2002</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/<break></break>community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">587 cases,<break></break> 249 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">China</td><td align="left" valign="top" rowspan="1" colspan="1">Yu 2008 (42)</td><td align="left" valign="top" rowspan="1" colspan="1">2006-2007</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">1216 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Laos PDR</td><td align="left" valign="top" rowspan="1" colspan="1">Yamashiro 1998 (44)</td><td align="left" valign="top" rowspan="1" colspan="1">1996-1997</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-15</td><td align="left" valign="top" rowspan="1" colspan="1">880 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Taiwan</td><td align="left" valign="top" rowspan="1" colspan="1">Liu 2005 (45)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2001</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">657 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Taiwan</td><td align="left" valign="top" rowspan="1" colspan="1">Lu 2006 (46)</td><td align="left" valign="top" rowspan="1" colspan="1">2001-2002</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Systematic random 0-5</td><td align="left" valign="top" rowspan="1" colspan="1">768 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Thailand</td><td align="left" valign="top" rowspan="1" colspan="1">Bodhidatta 2002 (48)</td><td align="left" valign="top" rowspan="1" colspan="1">1998-2000</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-12</td><td align="left" valign="top" rowspan="1" colspan="1">623 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">LAC (80)</td><td align="left" valign="top" rowspan="1" colspan="1">Brazil</td><td align="left" valign="top" rowspan="1" colspan="1">Seigel 1996 (51)</td><td align="left" valign="top" rowspan="1" colspan="1">1994-1994</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">112 cases,<break></break> 106 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Mexico</td><td align="left" valign="top" rowspan="1" colspan="1">Huilan 1991 (40)</td><td align="left" valign="top" rowspan="1" colspan="1">1982-1985</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">559 cases,<break></break> 559 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Mexico</td><td align="left" valign="top" rowspan="1" colspan="1">Paniagua 2007 (55)</td><td align="left" valign="top" rowspan="1" colspan="1">2004-2006</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">>2 -< 12</td><td align="left" valign="top" rowspan="1" colspan="1">300 cases,<break></break> 80 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Peru</td><td align="left" valign="top" rowspan="1" colspan="1">Pazzaglia 1991 (56)</td><td align="left" valign="top" rowspan="1" colspan="1">1988-1989</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-2</td><td align="left" valign="top" rowspan="1" colspan="1">391 cases,<break></break> 138 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Peru</td><td align="left" valign="top" rowspan="1" colspan="1">Ochoa 2009 (54)</td><td align="left" valign="top" rowspan="1" colspan="1">2006-2007</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-1</td><td align="left" valign="top" rowspan="1" colspan="1">936 cases,<break></break> 424 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Brazil</td><td align="left" valign="top" rowspan="1" colspan="1">Barreto 2006 (52)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2002</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Random</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">1233 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Mexico</td><td align="left" valign="top" rowspan="1" colspan="1">Flores-Abuxapqui 1994 (53)</td><td align="left" valign="top" rowspan="1" colspan="1">1991-1991</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-2</td><td align="left" valign="top" rowspan="1" colspan="1">148 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Uruguay</td><td align="left" valign="top" rowspan="1" colspan="1">Torres 2001 (57)</td><td align="left" valign="top" rowspan="1" colspan="1">1990-1994</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-4</td><td align="left" valign="top" rowspan="1" colspan="1">224 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">MENA (8)</td><td align="left" valign="top" rowspan="1" colspan="1">Tunisia</td><td align="left" valign="top" rowspan="1" colspan="1">Al-Gallas 2007(62)</td><td align="left" valign="top" rowspan="1" colspan="1">2001-2004</td><td align="left" valign="top" rowspan="1" colspan="1">Case control<break></break> (divided into<break></break> 2 age gps)</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-15<break></break> 18-80</td><td align="left" valign="top" rowspan="1" colspan="1">115 cases,<break></break> 73 controls;<break></break> 54 cases,<break></break> 29 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Egypt</td><td align="left" valign="top" rowspan="1" colspan="1">El-Mohamady 2006 (58)</td><td align="left" valign="top" rowspan="1" colspan="1">2003-2003</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">356 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Gaza</td><td align="left" valign="top" rowspan="1" colspan="1">Elamreen 2007 (59)</td><td align="left" valign="top" rowspan="1" colspan="1">2005-2005</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">150 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Jordan</td><td align="left" valign="top" rowspan="1" colspan="1">Youssef 2000 (61)</td><td align="left" valign="top" rowspan="1" colspan="1">1993-1994</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">265 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Saudi Arabia</td><td align="left" valign="top" rowspan="1" colspan="1">El-Sheikh 2001 (60)</td><td align="left" valign="top" rowspan="1" colspan="1">1995-1996</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">576 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">nOECD (2)</td><td align="left" valign="top" rowspan="1" colspan="1">Rep. of Korea<break></break> (South)</td><td align="left" valign="top" rowspan="1" colspan="1">Kyung-Hee 1989 (73)</td><td align="left" valign="top" rowspan="1" colspan="1">1984-1985</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-15</td><td align="left" valign="top" rowspan="1" colspan="1">231 cases,<break></break> 104 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> (no in controls)</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Turkey</td><td align="left" valign="top" rowspan="1" colspan="1">Uysal 1997 (75)</td><td align="left" valign="top" rowspan="1" colspan="1">1993-1994</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-14</td><td align="left" valign="top" rowspan="1" colspan="1">400</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> Parasitology</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">OECD (11)</td><td align="left" valign="top" rowspan="1" colspan="1">Denmark</td><td align="left" valign="top" rowspan="1" colspan="1">Olesen 2005 (65)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2001</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">424 cases,<break></break> 866 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Australia</td><td align="left" valign="top" rowspan="1" colspan="1">Barnes 1998 (63)</td><td align="left" valign="top" rowspan="1" colspan="1">1980-1993</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-14</td><td align="left" valign="top" rowspan="1" colspan="1">3785 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Australia</td><td align="left" valign="top" rowspan="1" colspan="1">McIver 2001 (64)</td><td align="left" valign="top" rowspan="1" colspan="1">1997-1998</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Random</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">412 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">England</td><td align="left" valign="top" rowspan="1" colspan="1">O’Neill 2002 (95)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2001</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">10-90<break></break> 0-5</td><td align="left" valign="top" rowspan="1" colspan="1">735 cases<break></break> 1051 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Virology; parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Russia</td><td align="left" valign="top" rowspan="1" colspan="1">Podkolzin 2009 (94)</td><td align="left" valign="top" rowspan="1" colspan="1">2005-2007</td><td align="left" valign="top" rowspan="1" colspan="1">Prospective</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">14-60<break></break> 0-5</td><td align="left" valign="top" rowspan="1" colspan="1">1354 cases<break></break> 2848 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Finland</td><td align="left" valign="top" rowspan="1" colspan="1">Rautelin 1989 (66)</td><td align="left" valign="top" rowspan="1" colspan="1">1985-1986</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">15-60</td><td align="left" valign="top" rowspan="1" colspan="1">253 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Germany</td><td align="left" valign="top" rowspan="1" colspan="1">Jansen 2008 (96)</td><td align="left" valign="top" rowspan="1" colspan="1">2005-2007</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">18-60</td><td align="left" valign="top" rowspan="1" colspan="1">132 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Greece</td><td align="left" valign="top" rowspan="1" colspan="1">Levidiotou 2009 (67)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2006</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">4604 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Virology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Italy</td><td align="left" valign="top" rowspan="1" colspan="1">Colomba 2006 (68)</td><td align="left" valign="top" rowspan="1" colspan="1">1999-2000</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-12</td><td align="left" valign="top" rowspan="1" colspan="1">215 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">New Zealand</td><td align="left" valign="top" rowspan="1" colspan="1">Montgomery 2006 (74)</td><td align="left" valign="top" rowspan="1" colspan="1">2005-2005</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-15</td><td align="left" valign="top" rowspan="1" colspan="1">128</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">USA</td><td align="left" valign="top" rowspan="1" colspan="1">Klein 2006 (72)</td><td align="left" valign="top" rowspan="1" colspan="1">1998-2001</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">372 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SAP (7)</td><td align="left" valign="top" rowspan="1" colspan="1">Bangladesh Albert 1999 (69)</td><td align="left" valign="top" rowspan="1" colspan="1">1993-1994</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Systematic<break></break> random</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">814 cases,<break></break> 814 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">India</td><td align="left" valign="top" rowspan="1" colspan="1">Huilan 1991 (40)</td><td align="left" valign="top" rowspan="1" colspan="1">1982-1985</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">916 cases,<break></break> 587 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">India</td><td align="left" valign="top" rowspan="1" colspan="1">Ghosh 1991 (70)</td><td align="left" valign="top" rowspan="1" colspan="1">1986-1988</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-1</td><td align="left" valign="top" rowspan="1" colspan="1">218 cases,<break></break> 102 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Nepal</td><td align="left" valign="top" rowspan="1" colspan="1">Hoge 1995 (78)</td><td align="left" valign="top" rowspan="1" colspan="1">1994-1994</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">124 cases,<break></break> 103 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Pakistan</td><td align="left" valign="top" rowspan="1" colspan="1">Huilan 1991 (40)</td><td align="left" valign="top" rowspan="1" colspan="1">1982-1985</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">758 cases,<break></break> 758 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Bangladesh</td><td align="left" valign="top" rowspan="1" colspan="1">Haque 2003 (71)</td><td align="left" valign="top" rowspan="1" colspan="1">1999-2002</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">289 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">India</td><td align="left" valign="top" rowspan="1" colspan="1">Dutta 1991 (8)</td><td align="left" valign="top" rowspan="1" colspan="1">1990</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">383 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SSA (18)</td><td align="left" valign="top" rowspan="1" colspan="1">Central<break></break> African Rep</td><td align="left" valign="top" rowspan="1" colspan="1">Georges 1984 (7)</td><td align="left" valign="top" rowspan="1" colspan="1">1981-1982</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-15</td><td align="left" valign="top" rowspan="1" colspan="1">1197 cases,<break></break> 748 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Central<break></break> African Rep</td><td align="left" valign="top" rowspan="1" colspan="1">Germani 1998 (77)</td><td align="left" valign="top" rowspan="1" colspan="1">1995-1996</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">18-80</td><td align="left" valign="top" rowspan="1" colspan="1">290 cases,<break></break> 140 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Ghana</td><td align="left" valign="top" rowspan="1" colspan="1">Reither 2007 (79)</td><td align="left" valign="top" rowspan="1" colspan="1">2005-2006</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-12</td><td align="left" valign="top" rowspan="1" colspan="1">243 cases,<break></break> 124 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Nigeria</td><td align="left" valign="top" rowspan="1" colspan="1">Ogunsanya 1994 (83)</td><td align="left" valign="top" rowspan="1" colspan="1">1989-1990</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">215 cases,<break></break> 100 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Zaire<break></break> De Mol 1983 (90)</td><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">1979-1979</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">355 cases,<break></break> 320 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Zaire</td><td align="left" valign="top" rowspan="1" colspan="1">Henry 1995 (91)</td><td align="left" valign="top" rowspan="1" colspan="1">1990-1990</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Cluster random</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">173 cases,<break></break> 155 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Burkina Faso</td><td align="left" valign="top" rowspan="1" colspan="1">Djeneba 2007 (76)</td><td align="left" valign="top" rowspan="1" colspan="1">2006</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">GP</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">66 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Virology; parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Cameroon</td><td align="left" valign="top" rowspan="1" colspan="1">Yongsi 2008 (80)</td><td align="left" valign="top" rowspan="1" colspan="1">2000-2005</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Community</td><td align="left" valign="top" rowspan="1" colspan="1">Stratified rando</td><td align="left" valign="top" rowspan="1" colspan="1">m 0-5</td><td align="left" valign="top" rowspan="1" colspan="1">437 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Nigeria</td><td align="left" valign="top" rowspan="1" colspan="1">Olowe 2003 (84)</td><td align="left" valign="top" rowspan="1" colspan="1">2001-2002</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">135 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Nigeria</td><td align="left" valign="top" rowspan="1" colspan="1">Cajetan 2010 (87)</td><td align="left" valign="top" rowspan="1" colspan="1">2008-2008</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Random</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">404 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Tanzania</td><td align="left" valign="top" rowspan="1" colspan="1">Vargas 2004 (89)</td><td align="left" valign="top" rowspan="1" colspan="1">1996-1997</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">451 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Uganda</td><td align="left" valign="top" rowspan="1" colspan="1">Musiime 2009 (88)</td><td align="left" valign="top" rowspan="1" colspan="1">2008-2008</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">190 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Zambia</td><td align="left" valign="top" rowspan="1" colspan="1">Kelly 1996 (92)</td><td align="left" valign="top" rowspan="1" colspan="1">1994</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital/<break></break>community</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">18-80</td><td align="left" valign="top" rowspan="1" colspan="1">77 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Nigeria</td><td align="left" valign="top" rowspan="1" colspan="1">Ogbu O 2008 (82)</td><td align="left" valign="top" rowspan="1" colspan="1">2005-2006</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-3</td><td align="left" valign="top" rowspan="1" colspan="1">150 cases,<break></break> 50 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Uganda</td><td align="left" valign="top" rowspan="1" colspan="1">Brink 2002 (86)</td><td align="left" valign="top" rowspan="1" colspan="1">1995-1997</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-15</td><td align="left" valign="top" rowspan="1" colspan="1">357 cases,<break></break> 127 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology,<break></break> parasitology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Zambia</td><td align="left" valign="top" rowspan="1" colspan="1">Nakano 1998 (93)</td><td align="left" valign="top" rowspan="1" colspan="1">1992-1993</td><td align="left" valign="top" rowspan="1" colspan="1">Cross-sectional</td><td align="left" valign="top" rowspan="1" colspan="1">PHC</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">639 cases,</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Nigeria</td><td align="left" valign="top" rowspan="1" colspan="1">Anynwu 1997 (81)</td><td align="left" valign="top" rowspan="1" colspan="1">1997-1997</td><td align="left" valign="top" rowspan="1" colspan="1">Case control</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-5</td><td align="left" valign="top" rowspan="1" colspan="1">1015 cases,<break></break> 401 controls</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology</td></tr><tr><td rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1">Kenya</td><td align="left" valign="top" rowspan="1" colspan="1">van Eijk 2009 (85)</td><td align="left" valign="top" rowspan="1" colspan="1">1997-2001</td><td align="left" valign="top" rowspan="1" colspan="1">Prosp. cohort</td><td align="left" valign="top" rowspan="1" colspan="1">Hospital</td><td align="left" valign="top" rowspan="1" colspan="1">Consecutive</td><td align="left" valign="top" rowspan="1" colspan="1">0-2</td><td align="left" valign="top" rowspan="1" colspan="1">630 cases</td><td align="left" valign="top" rowspan="1" colspan="1">Bacteriology, virology;<break></break> parasitology</td></tr></tbody></table><table-wrap-foot><fn><p>Specimens were obtained from persons seen at hospitals, Primary Health Care Centre (PHC), General Practitioner (GP), or from the community. Sampling methods include taking consecutive (or convenience or census) specimen, systematic random, random, stratified random sampling and some studies collected samples from routine surveillance programmes. Cas cont. = case control study; cross-sect. = cross sectional; Cohort = prospective follow-up studies. MENA = Middle East and North Africa; EAP= East Asia & the Pacific; SAP= South Asia; LAC= Latin America and the Caribbean; SSA= Sub-Saharan Africa; OECD= Developed Countries including non-OECD. Source: World Bank Country Classification July 2009. Available at http://go.world-bank.org/D7SN0B8YU0. Accessed December 29, 2009.</p></fn></table-wrap-foot></table-wrap><table-wrap id="table002" orientation="portrait" position="float"><label>Table 2.</label><caption><p>Age specific and source related regional estimate of overall pathogen detection.</p></caption><table frame="box" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1">Overall<break></break> detection rate<break></break> Regions</th><th colspan="2" align="center" rowspan="1">Children</th><th colspan="2" align="center" rowspan="1">Adults</th><th colspan="2" align="center" rowspan="1">All cases</th><th align="center" rowspan="1" colspan="1">Hospital</th><th align="center" rowspan="1" colspan="1">Community</th></tr><tr><th rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Number of<break></break> studies</th><th align="center" rowspan="1" colspan="1">Detection<break></break> rate (95% CI)</th><th align="center" rowspan="1" colspan="1">Number of<break></break> studies</th><th align="center" rowspan="1" colspan="1">Detection<break></break> rate % (95% CI)</th><th align="center" rowspan="1" colspan="1">Number of<break></break> studies</th><th align="center" rowspan="1" colspan="1">Detection<break></break> rate % (95% CI)</th><th align="center" rowspan="1" colspan="1">Detection rate %<break></break> (95% CI)</th><th align="center" rowspan="1" colspan="1">Detection rate %<break></break> (95% CI)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">SAP</td><td align="center" valign="top" rowspan="1" colspan="1">7</td><td align="center" valign="top" rowspan="1" colspan="1">64.4 (57.6-70.7)</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1">N/R</td><td align="center" valign="top" rowspan="1" colspan="1">13</td><td align="center" valign="top" rowspan="1" colspan="1">54.1 (43.9-63.9)</td><td align="center" valign="top" rowspan="1" colspan="1">66.7 (58.3-74.1)</td><td align="center" valign="top" rowspan="1" colspan="1">58.7 (55.6-61.7)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">LAC</td><td align="center" valign="top" rowspan="1" colspan="1">8</td><td align="center" valign="top" rowspan="1" colspan="1">61.0 (51.2-70.1)</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1">N/R</td><td align="center" valign="top" rowspan="1" colspan="1">8</td><td align="center" valign="top" rowspan="1" colspan="1">61.0 (51.2-70.1)</td><td align="center" valign="top" rowspan="1" colspan="1">65.0 (56.3-72.8)</td><td align="center" valign="top" rowspan="1" colspan="1">52.6 (35.6-69.1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">SSA</td><td align="center" valign="top" rowspan="1" colspan="1">16</td><td align="center" valign="top" rowspan="1" colspan="1">59.4 (48.5-69.3)</td><td align="center" valign="top" rowspan="1" colspan="1">2</td><td align="center" valign="top" rowspan="1" colspan="1">69.7 (39.6-89.0)</td><td align="center" valign="top" rowspan="1" colspan="1">6</td><td align="center" valign="top" rowspan="1" colspan="1">54.5 (40.2-68.1)</td><td align="center" valign="top" rowspan="1" colspan="1">52.8 (39.9-65.4)</td><td align="center" valign="top" rowspan="1" colspan="1">62.6 (43.3-78.6)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">EAP</td><td align="center" valign="top" rowspan="1" colspan="1">13</td><td align="center" valign="top" rowspan="1" colspan="1">54.1 (43.9-63.9)</td><td align="center" valign="top" rowspan="1" colspan="1">0</td><td align="center" valign="top" rowspan="1" colspan="1">N/R</td><td align="center" valign="top" rowspan="1" colspan="1">7</td><td align="center" valign="top" rowspan="1" colspan="1">64.4 (57.6-70.7)</td><td align="center" valign="top" rowspan="1" colspan="1">59.4 (49.7-68.5)</td><td align="center" valign="top" rowspan="1" colspan="1">52.5 (27.7-76.1)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">MENA</td><td align="center" valign="top" rowspan="1" colspan="1">5</td><td align="center" valign="top" rowspan="1" colspan="1">43.6 (31.7-56.2)</td><td align="center" valign="top" rowspan="1" colspan="1">1</td><td align="center" valign="top" rowspan="1" colspan="1">90.4 (81.2-95.4)</td><td align="center" valign="top" rowspan="1" colspan="1">18</td><td align="center" valign="top" rowspan="1" colspan="1">60.5 (50.6-69.7)</td><td align="center" valign="top" rowspan="1" colspan="1">36.9 (22.0-54.9)</td><td align="center" valign="top" rowspan="1" colspan="1">N/R</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">OECD</td><td align="center" valign="top" rowspan="1" colspan="1">11</td><td align="center" valign="top" rowspan="1" colspan="1">50.1 (42.5-57.7)</td><td align="center" valign="top" rowspan="1" colspan="1">4</td><td align="center" valign="top" rowspan="1" colspan="1">32.5 (14.7-57.3)</td><td align="center" valign="top" rowspan="1" colspan="1">15</td><td align="center" valign="top" rowspan="1" colspan="1">45.2 (37.2-53.5)</td><td align="center" valign="top" rowspan="1" colspan="1">50.4 (42.5-58.3)</td><td align="center" valign="top" rowspan="1" colspan="1">N/R</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Total</td><td align="center" valign="top" rowspan="1" colspan="1">60</td><td align="center" valign="top" rowspan="1" colspan="1">56.7 (53.0-60.4)</td><td align="center" valign="top" rowspan="1" colspan="1">7</td><td align="center" valign="top" rowspan="1" colspan="1">74.8 (63.1-83.8)</td><td align="center" valign="top" rowspan="1" colspan="1">67</td><td align="center" valign="top" rowspan="1" colspan="1">57.2 (53.4-60.9)</td><td align="center" valign="top" rowspan="1" colspan="1">58.1 (54.0-62.0)</td><td align="center" valign="top" rowspan="1" colspan="1">58.5 (55.6-61.4)</td></tr></tbody></table><table-wrap-foot><fn><p>Random-Effect estimate [Q (df) P-value] for difference between hospital and community based studies = 0.25 (1) 0.619; Adults = (20.7 (2) 0.001 and children = 13.2 (5) 0.022; regions = 13.9 (5) 0.016. The weighted mean detection rate is calculated by dividing number of positive stool tests for individual pathogens by the total number of specimen tested. DerSimonian-Laird random-effect (RE) method was calculated on the basis of the Cochran’s Q-test with alpha set at the 5% level. Regions: EAP=East Asia & the Pacific; MENA = Middle East and North Africa; SAP= South Asia; LAC= Latin America and the Caribbean; SSA= Sub-Saharan Africa; OECD= Developed Countries including non-OECD developed countries. N/R= not reported.</p></fn></table-wrap-foot></table-wrap><table-wrap id="table003" orientation="portrait" position="float"><label>Table 3.</label><caption><p>Weighted average prevalence of enteric pathogens from children 0-12 years in developing regions and OECD countries.</p></caption><table frame="box" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1"><break></break>N. of studies (60)<break></break> Pathogens</th><th align="center" rowspan="1" colspan="1">EAP<break></break> 13<break></break> Detection rate %<break></break> (95% CI)</th><th align="center" rowspan="1" colspan="1">LAC<break></break> 8<break></break> Detection rate %<break></break> (95% CI)</th><th align="center" rowspan="1" colspan="1">MENA<break></break> 5<break></break> Detection rate %<break></break> (95% CI)</th><th align="center" rowspan="1" colspan="1">OECD<break></break> 11<break></break> Detection rate %<break></break> (95% CI)</th><th align="center" rowspan="1" colspan="1">SAP<break></break> 7<break></break> Detection rate %<break></break> (95% CI)</th><th align="center" rowspan="1" colspan="1">SSA<break></break> 16<break></break> Detection rate %<break></break> (95% CI)</th></tr></thead><tbody><tr><td colspan="7" align="center" rowspan="1"><bold>Bacteria</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Aeromonas</italic></td><td align="center" rowspan="1" colspan="1">0.1 (0.0-0.6)</td><td align="center" rowspan="1" colspan="1">0.3 (0.00-6.9)</td><td align="center" rowspan="1" colspan="1">0.7 (0.3-1.9)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.2)</td><td align="center" rowspan="1" colspan="1">2.9 (1.4-6.1)</td><td align="center" rowspan="1" colspan="1">0.3 (0.2-0.6)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Campylobacter jejuni</italic></td><td align="center" rowspan="1" colspan="1">2.1 (1.0-4.2)</td><td align="center" rowspan="1" colspan="1">5.5 (2.8-10.4)</td><td align="center" rowspan="1" colspan="1">2.4 (1.1-5.5)</td><td align="center" rowspan="1" colspan="1">3.4 (2.3-4.9)</td><td align="center" rowspan="1" colspan="1">6.6 (3.9-10.9)</td><td align="center" rowspan="1" colspan="1">2.7 (1.5-4.8)</td></tr><tr><td align="left" rowspan="1" colspan="1">EPEC</td><td align="center" rowspan="1" colspan="1">2.9 (1.7-4.8)</td><td align="center" rowspan="1" colspan="1">5.6 (2.3-12.6)</td><td align="center" rowspan="1" colspan="1">1.4 (0.3-6.6)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.9)</td><td align="center" rowspan="1" colspan="1">8.5 (5.4-13.1)</td><td align="center" rowspan="1" colspan="1">3.2 (2.0-5.2)</td></tr><tr><td align="left" rowspan="1" colspan="1">ETEC</td><td align="center" rowspan="1" colspan="1">4.1 (2.2-7.5)</td><td align="center" rowspan="1" colspan="1">5.9 (3.1-11.2)</td><td align="center" rowspan="1" colspan="1">5.4 (1.7-15.6)</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-1.6)</td><td align="center" rowspan="1" colspan="1">12.7 (8.6-18.3)</td><td align="center" rowspan="1" colspan="1">1.0 (0.5-2.1)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Other diarrh E. coli pathotypes</italic></td><td align="center" rowspan="1" colspan="1">1.7 (0.8-3.4)</td><td align="center" rowspan="1" colspan="1">1.9 (0.5-6.8)</td><td align="center" rowspan="1" colspan="1">10.6 (4.2-24.3)</td><td align="center" rowspan="1" colspan="1">0.4 (0.1-1.2)</td><td align="center" rowspan="1" colspan="1">1.8 (0.5-5.6)</td><td align="center" rowspan="1" colspan="1">4.3 (2.1-8.6)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Salmonella</italic> spp.</td><td align="center" rowspan="1" colspan="1">2.8 (1.5-5.4)</td><td align="center" rowspan="1" colspan="1">1.7 (0.3-9.2)</td><td align="center" rowspan="1" colspan="1">3.2 (1.6-6.5)</td><td align="center" rowspan="1" colspan="1">4.1 (2.8-5.9)</td><td align="center" rowspan="1" colspan="1">2.5 (1.6-3.8)</td><td align="center" rowspan="1" colspan="1">3.6 (2.5-5.0)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Shigella</italic> spp.</td><td align="center" rowspan="1" colspan="1">4.4 (2.8-7.0)</td><td align="center" rowspan="1" colspan="1">2.9 (1.4-6.1)</td><td align="center" rowspan="1" colspan="1">3.5 (2.4-5.3)</td><td align="center" rowspan="1" colspan="1">0.5 (0.1-2.1)</td><td align="center" rowspan="1" colspan="1">5.6 (3.0-10.1)</td><td align="center" rowspan="1" colspan="1">4.3 (2.6-7.0)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Vibrio cholerae</italic></td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.4)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.5)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.3)</td><td align="center" rowspan="1" colspan="1">2.1 (1.0-4.8)</td><td align="center" rowspan="1" colspan="1">0.4 (0.1-0.9)</td></tr><tr><td colspan="7" align="center" rowspan="1">Viruses</td></tr><tr><td align="left" rowspan="1" colspan="1">Astrovirus</td><td align="center" rowspan="1" colspan="1">0.1 (0.0-0.6)</td><td align="center" rowspan="1" colspan="1">0.4 (0.2-0.8)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">1.3 (0.7-2.7)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.3)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td></tr><tr><td align="left" rowspan="1" colspan="1">Adenovirus type 40/41</td><td align="center" rowspan="1" colspan="1">0.4 (0.2-0.9)</td><td align="center" rowspan="1" colspan="1">0.5 (0.2-1.6)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">4.5 (3.3-6.1)</td><td align="center" rowspan="1" colspan="1">1.5 (0.6-3.4)</td><td align="center" rowspan="1" colspan="1">0.5 (0.2-1.5)</td></tr><tr><td align="left" rowspan="1" colspan="1">Norovirus</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">0.3 (0.1-1.6)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">3.3 (1.9-5.7)</td><td align="center" rowspan="1" colspan="1">0.7 (0.3-1.8)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.9)</td></tr><tr><td align="left" rowspan="1" colspan="1">Rotavirus</td><td align="center" rowspan="1" colspan="1">12.1 (7.4-19.3)</td><td align="center" rowspan="1" colspan="1">12.0 (7.4-19.0)</td><td align="center" rowspan="1" colspan="1">14.4 (7.8-25.0)</td><td align="center" rowspan="1" colspan="1">24.8 (18.0-33.1)</td><td align="center" rowspan="1" colspan="1">7.9 (4.7-12.8)</td><td align="center" rowspan="1" colspan="1">4.8 (2.6-8.7)</td></tr><tr><td colspan="7" align="center" rowspan="1">Parasites</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Ascaris</italic></td><td align="center" rowspan="1" colspan="1">0.2 (0.0-0.7)</td><td align="center" rowspan="1" colspan="1">0.3 (0.1-1.0)</td><td align="center" rowspan="1" colspan="1">0.5 (0.2-1.1)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.2)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.3)</td><td align="center" rowspan="1" colspan="1">0.3 (0.1-1.1)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Blastocystis</italic> spp.</td><td align="center" rowspan="1" colspan="1">0.1 (0.0-0.2)</td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.4)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.5)</td><td align="center" rowspan="1" colspan="1">0.1 (0.04-0.3)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.3)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Cryptosporidium</italic> sp</td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.2)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-2.0)</td><td align="center" rowspan="1" colspan="1">1.0 (0.2-4.9)</td><td align="center" rowspan="1" colspan="1">0.3 (0.1-0.5)</td><td align="center" rowspan="1" colspan="1">1.7 (0.8-3.1)</td><td align="center" rowspan="1" colspan="1">0.3 (0.1-0.9)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Dientamoeba fragilis</italic></td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.2)</td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.4)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.7)</td><td align="center" rowspan="1" colspan="1">0.1 (0.03-0.2)</td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.3)</td><td align="center" rowspan="1" colspan="1">0.2 (0.1-0.3)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Entamoeba</italic> spp.</td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.9)</td><td align="center" rowspan="1" colspan="1">0.6 (0.1-6.5)</td><td align="center" rowspan="1" colspan="1">1.5 (0.6-4.2)</td><td align="center" rowspan="1" colspan="1">0.1 (0.03-0.4)</td><td align="center" rowspan="1" colspan="1">0.6 (0.1-2.5)</td><td align="center" rowspan="1" colspan="1">1.5 (0.9-2.5)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Giardia intestinalis</italic></td><td align="center" rowspan="1" colspan="1">0.1 (0.1-0.3)</td><td align="center" rowspan="1" colspan="1">1.9 (0.6-6.5)</td><td align="center" rowspan="1" colspan="1">1.2 (0.5-3.2)</td><td align="center" rowspan="1" colspan="1">0.3 (0.1-0.8)</td><td align="center" rowspan="1" colspan="1">3.0 (1.5-5.9)</td><td align="center" rowspan="1" colspan="1">2.7 (1.8-4.3)</td></tr></tbody></table><table-wrap-foot><fn><p>EAP=East Asia & the Pacific; MENA = Middle East and North Africa; SAP= South Asia; LAC= Latin America and the Caribbean; SSA= Sub-Saharan Africa; OECD= Developed Countries including non-OECD developed countries. EPEC- Enteropathogenic E. coli; ETEC- Enterotoxigenic <italic>E. coli.</italic></p></fn></table-wrap-foot></table-wrap><table-wrap id="table004" orientation="portrait" position="float"><label>Table 4.</label><caption><p>Weighted average prevalence of enteric pathogens from adults >12 years in developing regions and OECD countries</p></caption><table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Regions<break></break> No. of Studies (7)<break></break> Pathogens</th><th align="center" valign="top" rowspan="1" colspan="1">MENA<break></break> 1<break></break> Detection rate % (95%CI)</th><th align="center" valign="top" rowspan="1" colspan="1">OECD<break></break> 4<break></break> Detection rate % (95%CI)</th><th align="center" valign="top" rowspan="1" colspan="1">SSA<break></break> 2<break></break> Detection rate % (95%CI)</th></tr></thead><tbody><tr><td colspan="4" align="center" rowspan="1"><bold>Bacteria</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Aeromonas</italic> sp.</td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.2 (0.01-0.6)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Campylobacter jejuni</italic></td><td align="center" rowspan="1" colspan="1">1.4 (0.2-9.1)</td><td align="center" rowspan="1" colspan="1">3.3 (0.9-12.0)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">EPEC</td><td align="center" rowspan="1" colspan="1">N/R</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-0.5)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">ETEC</td><td align="center" rowspan="1" colspan="1">N/R</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-0.5)</td><td align="center" rowspan="1" colspan="1">1.0 (0.3-2.7)</td></tr><tr><td align="left" rowspan="1" colspan="1">Other diarrh <italic>E. coli</italic> pathotypes</td><td align="center" rowspan="1" colspan="1">37 (26.7-48.6)</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-0.5)</td><td align="center" rowspan="1" colspan="1">3.6 (0.3-36.2)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Salmonella</italic> spp.</td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">1.9 (0.4-7.7)</td><td align="center" rowspan="1" colspan="1">4.0 (0.2-43.5)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Shigella</italic> spp.</td><td align="center" rowspan="1" colspan="1">4.1 (1.3-12.0)</td><td align="center" rowspan="1" colspan="1">0.2 (0.01-1.0)</td><td align="center" rowspan="1" colspan="1">2.2 (1.1-4.5)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Vibrio cholerae</italic></td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-0.5)</td><td align="center" rowspan="1" colspan="1">N/R</td></tr><tr><td colspan="4" align="center" rowspan="1"><bold>Viruses</bold></td></tr><tr><td align="left" rowspan="1" colspan="1">Astrovirus</td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.4 (0.01-2.9)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Adenovirus type 40/41</td><td align="center" rowspan="1" colspan="1">6.8 (2.9-15.4)</td><td align="center" rowspan="1" colspan="1">1.0 (0.4-2.4)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Norovirus</td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">10.5 (7.5-14.7)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1">Rotavirus</td><td align="center" rowspan="1" colspan="1">1.4 (0.2-9.1)</td><td align="center" rowspan="1" colspan="1">3.6 (1.4-9.2)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td colspan="4" align="center" rowspan="1"><bold>Parasites</bold></td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Ascaris</italic></td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-0.5)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Blastocystis</italic> spp.</td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.2 (0.01-1.5)</td><td align="center" rowspan="1" colspan="1">4.0 (0.5-24.7)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Cryptosporidium</italic> sp</td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-3.1)</td><td align="center" rowspan="1" colspan="1">9.4 (1.0-50.2)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Dientamoeba fragilis</italic></td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.1 (0.01-0.5)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Entamoeba</italic> spp.</td><td align="center" rowspan="1" colspan="1">1.4 (0.2-9.1)</td><td align="center" rowspan="1" colspan="1">0.2 (0.01-0.6)</td><td align="center" rowspan="1" colspan="1">2.5 (1.2-5.1)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Giardia intestinalis</italic></td><td align="center" rowspan="1" colspan="1">0.7 (0.01-9.9)</td><td align="center" rowspan="1" colspan="1">0.3 (0.01-2.3)</td><td align="center" rowspan="1" colspan="1">1.4 (0.6-3.2)</td></tr></tbody></table><table-wrap-foot><fn><p>EAP=East Asia & the Pacific; MENA = Middle East and North Africa; SAP= South Asia; LAC= Latin America and the Caribbean; SSA= Sub-Saharan Africa; OECD= Developed Countries including non-OECD developed countries. EPEC- Enteropathogenic E. coli; ETEC- Enterotoxigenic <italic>E. coli.</italic></p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002E96 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 002E96 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:4140330
|texte= Prevalence of Gastrointestinal Pathogens In Developed and Developing Countries: Systematic Review and Meta-Analysis
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:25170480" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
| This area was generated with Dilib version V0.6.32. |  |