Global burden of enteric infections related foodborne diseases,1990-2021:findings from the Global Burden of Disease Study 2021

Background Understanding the global burden of enteric infections is crucial for prioritizing control strategies for foodborne and waterborne diseases.This study aimed to assess the global burden of enteric infections in 2021 and identify risk factors from One Health aspects.Methods Leveraging the Global Burden of Disease(GBD)2021 database,the incidence,disability-adjusted life years(DALYs),and deaths of enteric infections and the subtypes were estimated,including diarrheal diseases,typhoid and paratyphoid fever,invasive non-typhoidal Salmonella(iNTS)infections,and other intestinal infectious diseases.The estimates were quantified by absolute number,age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR)and age-standardized DALY rate with 95%uncertainty intervals(UIs).Thirteen pathogens and three risk factors associated with diarrheal diseases were analyzed.Results In 2021,the global age-standardized DALY rate of enteric infections was 1020.15 per 100,000 popultion(95%UI:822.70-1259.39 per 100,000 population)with an estimated annual percentage change(EAPC)of-4.11%(95%confidence interval:-4.31%to-3.90%)in 1990-2021.A larger burden was observed in regions with lower socio-demographic index(SDI)levels.Diarrheal disease was the most serious subtype with Western Sub-Saharan Africa exhibiting the highest age-standardized DALY rate(2769.81 per 100,000 population,95%UI:1976.80-3674.41 per 100,000 population).Children under 5 and adults over 65 years suffered more from diarrheal diseases with the former experiencing the highest global age-standardized DALY rate(9382.46 per 100,000 population,95%UI:6771.76-13,075.12 per 100,000 population).Rotavirus remained the leading cause of diarrheal diseases despite a cross-year decline in the observed age-standardized DALY rate.Unsafe water,sanitation,and handwashing contributed most to the disease burden.Conclusion The reduced burden of enteric infections suggested the effectiveness of previous control strategies;however,more efforts should be made in vulnerable regions and populations through a One Health approach.