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• W80202393 abstract "Editor—Wheeler et al’s paper estimates the burden of symptomatic infectious intestinal disease in the United Kingdom.1 One aspect of their findings was the high proportion (55%) of community episodes in which no pathogen was identified. I would suggest that this study severely underestimates the prevalence of certain intestinal pathogens. For example, the authors calculate the incidence of cryptosporidium infection in their community study to be only 0.81 (95% confidence interval 0.26 to 2.5) per 1000 person years.Another approach to determining the incidence of an infectious disease is to determine the prevalence of antibodies in the community and then calculate the annual attack rate required to give that degree of antibody positivity. If an individual is assumed to remain antibody positive for life after an infection then this attack rate is given by a simple formula: cases/100 person years=% seropositive/average life expectancy.Few studies of cryptosporidium antibodies have been carried out in the United Kingdom, but McLauchlin et al reported prevalences of 21% and 49% in two areas.2 In Oklahoma in the United States rates in adolescents were up to 58%.3 Given that life expectancy in the United Kingdom is about 76 years, this would give an estimated attack rate of up to 6.58/1000 person years (for 50% positivity), some eight times higher than that suggested by Wheeler et al. This figure itself is probably an underestimate given the observation that infection in human volunteers offers little protection against reinfection one year later.4 If individuals suffer repeated infection or if antibodies become undetectable after only a few years the real infection rate may be many times greater still.The arguments that I have presented apply equally to other pathogens. We must be cautious about using data collected from this type of study in assessing the health and cost benefits of public health interventions aimed at single pathogens. A study of the seroepidemiology of various enteric pathogens is needed." @default.
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• W80202393 date "1999-07-24" @default.
• W80202393 modified "2023-10-16" @default.
• W80202393 title "Community study of infectious intestinal disease in England" @default.
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• W80202393 doi "https://doi.org/10.1136/bmj.319.7204.258a" @default.
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