Prevalence of Enteropathogens in Outpatients with Acute Diarrhea from Urban and Rural Areas, Southeast China, 2010–2014

Abstract

Acute diarrhea is an important public health issue. Here, we focused on the differences of enteropathogens in acute diarrhea between urban and rural areas in southeast China. Laboratory- and sentinel-based surveillance of acute diarrhea (≥ 3 loose or liquid stools/24 hours) was conducted at 16 hospitals. Fecal specimens were tested for bacterial (<i>Aeromonas</i> sp., <i>Campylobacter</i> sp., diarrheagenic <i>Escherichia coli</i>, <i>Plesiomonas shigelloides</i>, non-typhoidal <i>Salmonella</i>, <i>Shigella</i> sp., <i>Vibrio</i> sp., and <i>Yersinia</i> sp.) and viral (adenovirus, astrovirus, <i>Norovirus</i>, <i>Rotavirus</i>, and <i>Sapovirus</i>) pathogens. Descriptive statistics were used. Between January 1, 2010, and December 31, 2014, 4,548 outpatients with acute diarrhea were enrolled (urban, <i>n</i> = 3,220; rural, <i>n</i> = 1,328). Pathogens were identified in 2,074 (45.6%) patients. Norovirus (25.7%), <i>Vibrio parahaemolyticus</i> (10.2%), enteroaggregative <i>Escherichia coli</i> (EAEC) (8.8%), group A <i>Rotavirus</i> (7.0%), and enterotoxigenic <i>Escherichia coli</i> (ETEC) (5.6%) were the most common pathogens. Enteropathogens were less common in urban than in rural areas (42.0% versus 54.4%, <i>P</i> < 0.001). In urban areas, EAEC and ETEC were more common in high-income than in middle-income regions. Interventions targeting the most common enteropathogens can substantially reduce the burden of acute diarrhea in southeast China.