Gastroenteritis Burden in the Adult Community: Prospects for Vaccines

  • Filippo AnsaldiEmail author
Part of the Practical Issues in Geriatrics book series (PIG)


The Global Burden of Diseases collaborators reported in 2016 that among the 30 leading causes of death over the last decade, diarrhoeal disease (GE) is the ninth cause of death overall worldwide. The specific causes of GE in adults and the elderly are poorly identified, but severe GE leading to hospitalization and death is more frequently observed in the elderly. Age is thus clearly a very important risk factor. The aetiology of transmission modes as reported by the US surveillance systems shows that around 60% are person-to-person environmental transmissions and only about 30% are food- and water-borne. The most common settings are long-term care facilities, schools, child care facilities and hospitals. The total economic burden of GE is greatest in young children, but the highest cost per illness is observed among older age groups, largely due to productivity losses resulting from acute illness. In the hospital setting, Clostridium difficile is a common cause of antibiotic-associated diarrhoea, and infection may lead to sepsis or even death. The majority of infections with C. difficile occur among persons aged over 65 years and in those in healthcare facilities, such as hospitals and long-term care facilities. Vaccination programmes against GE-causing pathogens need to take into account the fact that some groups have higher risk of infection and clinical complications (elderly, nursing home residents, travellers), while others have higher risk of transmitting infection to other groups (healthcare workers, food handlers) and some can have both (young children, immunocompromised patients). Vaccine development is at different stages for these various infectious agents. The potential population-level effects and the cost-effectiveness of vaccination also warrant further investigation.


Vaccination Gastroenteritis Diarrhoea Environmental transmission Norovirus Rotavirus Clostridium difficile 


  1. 1.
    Mortality GBD, Causes of Death C. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–544.CrossRefGoogle Scholar
  2. 2.
    Lopman BA, Hall AJ, Curns AT, Parashar UD. Increasing rates of gastroenteritis hospital discharges in US adults and the contribution of norovirus, 1996–2007. Clin Infect Dis. 2011;52(4):466–74.CrossRefGoogle Scholar
  3. 3.
    Kirk MD, Hall GV, Becker N. Gastroenteritis in older people living in the community: results of two Australian surveys. Epidemiol Infect. 2012;140(11):2028–36.CrossRefGoogle Scholar
  4. 4.
    Kirk MD, Pires SM, Black RE, Caipo M, Crump JA, Devleesschauwer B, et al. World Health Organization estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases, 2010: a data synthesis. PLoS Med. 2015;12(12):e1001921.CrossRefGoogle Scholar
  5. 5.
    Gangarosa RE, Glass RI, Lew JF, Boring JR. Hospitalizations involving gastroenteritis in the United States, 1985: the special burden of the disease among the elderly. Am J Epidemiol. 1992;135(3):281–90.CrossRefGoogle Scholar
  6. 6.
    Chen Y, Liu BC, Glass K, Kirk MD. High incidence of hospitalisation due to infectious gastroenteritis in older people associated with poor self-rated health. BMJ Open. 2015;5(12):e010161.CrossRefGoogle Scholar
  7. 7.
    Wikswo ME, Kambhampati A, Shioda K, Walsh KA, Bowen A, Hall AJ, et al. Outbreaks of acute gastroenteritis transmitted by person-to-person contact, environmental contamination, and unknown modes of transmission—United States, 2009–2013. MMWR Surveill Summ. 2015;64(12):1–16.CrossRefGoogle Scholar
  8. 8.
    Bartsch SM, Lopman BA, Ozawa S, Hall AJ, Lee BY. Global economic burden of norovirus gastroenteritis. PLoS One. 2016;11(4):e0151219.CrossRefGoogle Scholar
  9. 9.
    Barret AS, Jourdan-da Silva N, Ambert-Balay K, Delmas G, Bone A, Thiolet JM, et al. Surveillance for outbreaks of gastroenteritis in elderly long-term care facilities in France, November 2010 to May 2012. Euro Surveill. 2014;19(29):20859.CrossRefGoogle Scholar
  10. 10.
    Lausch KR, Westh L, Kristensen LH, Lindberg J, Tarp B, Larsen CS. Rotavirus is frequent among adults hospitalised for acute gastroenteritis. Dan Med J. 2017;64(1):A5312.PubMedGoogle Scholar
  11. 11.
    Anderson EJ, Shippee DB, Weinrobe MH, Davila MD, Katz BZ, Reddy S, et al. Indirect protection of adults from rotavirus by pediatric rotavirus vaccination. Clin Infect Dis. 2013;56(6):755–60.CrossRefGoogle Scholar
  12. 12.
    Lopman BA, Curns AT, Yen C, Parashar UD. Infant rotavirus vaccination may provide indirect protection to older children and adults in the United States. J Infect Dis. 2011;204(7):980–6.CrossRefGoogle Scholar
  13. 13.
    National Center for Health Statistics. Rates of Clostridium difficile infection among hospitalized patients aged ≥65 years,* by Age Group—National Hospital Discharge Survey, United States, 1996–2009. MMWR Morb Mortal Wkly Rep. 2011;60(34):1171.Google Scholar
  14. 14.
    Riggs MM, Sethi AK, Zabarsky TF, Eckstein EC, Jump RL, Donskey CJ. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis. 2007;45(8):992–8.CrossRefGoogle Scholar
  15. 15.
    Arvand M, Moser V, Schwehn C, Bettge-Weller G, Hensgens MP, Kuijper EJ. High prevalence of Clostridium difficile colonization among nursing home residents in Hesse, Germany. PLoS One. 2012;7(1):e30183.CrossRefGoogle Scholar
  16. 16.
    Campbell RR, Beere D, Wilcock GK, Brown EM. Clostridium difficile in acute and long-stay elderly patients. Age Ageing. 1988;17(5):333–6.CrossRefGoogle Scholar
  17. 17.
    Rudensky B, Rosner S, Sonnenblick M, van Dijk Y, Shapira E, Isaacsohn M. The prevalence and nosocomial acquisition of Clostridium difficile in elderly hospitalized patients. Postgrad Med J. 1993;69(807):45–7.CrossRefGoogle Scholar
  18. 18.
    Walker KJ, Gilliland SS, Vance-Bryan K, Moody JA, Larsson AJ, Rotschafer JC, et al. Clostridium difficile colonization in residents of long-term care facilities: prevalence and risk factors. J Am Geriatr Soc. 1993;41(9):940–6.CrossRefGoogle Scholar
  19. 19.
    Rivera EV, Woods S. Prevalence of asymptomatic Clostridium difficile colonization in a nursing home population: a cross-sectional study. J Gend Specif Med. 2003;6(2):27–30.PubMedGoogle Scholar
  20. 20.
    Ryan J, Murphy C, Twomey C, Paul Ross R, Rea MC, MacSharry J, et al. Asymptomatic carriage of Clostridium difficile in an Irish continuing care institution for the elderly: prevalence and characteristics. Ir J Med Sci. 2010;179(2):245–50.CrossRefGoogle Scholar
  21. 21.
    Fulton JD, Fallon RJ. Is Clostridium difficile endemic in chronic-care facilities? Lancet. 1987;2(8555):393–4.CrossRefGoogle Scholar
  22. 22.
    Simor AE, Yake SL, Tsimidis K. Infection due to Clostridium difficile among elderly residents of a long-term-care facility. Clin Infect Dis. 1993;17(4):672–8.CrossRefGoogle Scholar
  23. 23.
    Davies KA, Longshaw CM, Davis GL, Bouza E, Barbut F, Barna Z, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14(12):1208–19.CrossRefGoogle Scholar
  24. 24.
    Alicino C, Giacobbe DR, Durando P, Bellina D, DI Bella AM, Paganino C, et al. Increasing incidence of Clostridium difficile infections: results from a 5-year retrospective study in a large teaching hospital in the Italian region with the oldest population. Epidemiol Infect. 2016;144(12):2517–26.CrossRefGoogle Scholar
  25. 25.
    Debbink K, Lindesmith LC, Baric RS. The state of norovirus vaccines. Clin Infect Dis. 2014;58(12):1746–52.CrossRefGoogle Scholar
  26. 26.
    Tan M, Jiang X. Vaccine against norovirus. Hum Vaccin Immunother. 2014;10(6):1449–56.CrossRefGoogle Scholar
  27. 27.
    Yen C, Tate JE, Hyde TB, Cortese MM, Lopman BA, Jiang B, et al. Rotavirus vaccines: current status and future considerations. Hum Vaccin Immunother. 2014;10(6):1436–48.CrossRefGoogle Scholar
  28. 28.
    Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2012;11:CD008521.PubMedGoogle Scholar
  29. 29.
    Leuzzi R, Adamo R, Scarselli M. Vaccines against Clostridium difficile. Hum Vaccin Immunother. 2014;10(6):1466–77.CrossRefGoogle Scholar
  30. 30.
    de Bruyn G, Saleh J, Workman D, Pollak R, Elinoff V, Fraser NJ, et al. Defining the optimal formulation and schedule of a candidate toxoid vaccine against Clostridium difficile infection: a randomized phase 2 clinical trial. Vaccine. 2016;34(19):2170–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Health SciencesDiSSal and CIR-IT, University of GenoaGenoaItaly

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