Infectious Agents Causing Acute Watery Diarrhoea in Infants and Young Children in Bangladesh and their Public Health Implications

Summary We studied the age specific distribution of enteropathogens in young children presenting at a large diarrhoeal diseases hospital in urban Bangladesh. A 5 per cent systematic sample was used to examine 1207 rectal swab specimens of children aged 1–35 months with acute watery diarrhoea. Variation in isolation rates of enteropathogens was observed in different age groups. Overall, rotavirus (26 per cent) and Campylobacter (26 per cent) were the most common pathogens followed by enterotoxigenic Escherichia coli (15 per cent), Vibrio cholerae 01 (7 per cent), other Vibrios (9 per cent), Shigella (4 per cent), and Salmonella (≪1 per cent). In early infancy (1–5 months) more rectal swab specimens did not yield any enteropathogen compared to older children of 24–35 months old (44 v. 30 per cent). Rotavirus was most frequently detected (35 per cent) in children between 6 and 11 months old. Attendance of cholera cases at the hospital was alarmingly high in the third year of life (29 per cent). The study provided useful information that, in general, children under 2 years are predominantly infected with agents [rotavirus, Campylobacter, and enterotoxigenic Escherichia coli (ETEC)] for which antibiotic therapy is not usually indicated. These patients can be managed effectively with oral rehydration therapy and proper feeding. Knowledge of pathogens associated with more severe forms of diarrhoea may help in optimizing strategies for vaccination when suitable vaccines are available against enteric infections.