Diversity of pathogens responsible for acute diarrheal disease in China.

TO THE EDITOR—Acute diarrheal disease causes approximately 2.8 billion episodes and 1.3 million child deaths annually worldwide [1, 2], hampering the achievement of Millennium Development Goal 4 [3]. Now, multidrug-resistant and enhanced-virulence diarrheal pathogens are emerging to cause serious public health problems [4–7]. In China, >10 000 diarrheal deaths occur annually and China remains one of the countries with the highest mortality rates among children due to diarrhea [3, 8]. However, the distribution and contribution of specific pathogens for acute diarrheal disease in China are not well known [3], significantly impacting its effective prevention and control measures. Here, through analyzing 22 817 diarrheal specimens between 2009 and 2012 collected from 32 nationwide sentinel hospitals, we found the diversity of types, populations affected, and temporary and spatial distribution of diarrheal pathogens. At least 1 pathogen was detected in 5783 of the 22 817 samples (25%); in total, 6155 pathogens were isolated. Rotavirus was the most commonly detected pathogen (28%), followed by Shigella species (17%), caliciviruses (15%), diarrheagenic Escherichia coli (11%), Salmonella species (9.4%), and others (Figure 1). The specimens that most frequently yielded pathogens (88%) were collected at outpatient clinics or emergency departments. Analysis of the age distribution of diarrheal pathogens revealed that bacterial pathogens were more common among