BMJ 1999;318:1046-1050 ( 17 April )

General Practice

Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance

Jeremy G Wheeler, lecturer, infectious disease epidemiology, a Dinesh Sethi, lecturer, international public health, a John M Cowden, consultant epidemiologist, b Patrick G Wall, chief executive, c Laura C Rodrigues, senior lecturer, infectious disease epidemiology, a David S Tompkins, consultant medical microbiologist, d Michael J Hudson, principal microbiologist, e Paul J Roderick, senior lecturer in public health medicine, f on behalf of the Infectious Intestinal Disease Study Executive.

a London School of Hygiene and Tropical Medicine, London WC1E 7HT, b Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow G20 9NB, c Food Safety Authority of Ireland, Lower Abbey Street, Dublin 1, Republic of Ireland, d Leeds Public Health Laboratory, Leeds LS15 7TR, e Centre for Applied Microbiology and Research, Porton Down, Salisbury, Wiltshire SP4 0JG, f Southampton University, Southampton SO6 6YD

Correspondence to: Mr Wheeler j.wheeler{at}lshtm.ac.uk

Objective: To establish the incidence and aetiology of infectious intestinal disease in the community and presenting to general practitioners. Comparison with incidence and aetiology of cases reaching national laboratory based surveillance.
Design: Population based community cohort incidence study, general practice based incidence studies, and case linkage to national laboratory surveillance.
Setting: 70 general practices throughout England.
Participants: 459 975 patients served by the practices. Community surveillance of 9776 randomly selected patients.
Main outcome measures: Incidence of infectious intestinal disease in community and reported to general practice.
Results: 781 cases were identified in the community cohort, giving an incidence of 19.4/100 person years (95% confidence interval 18.1 to 20.8). 8770 cases presented to general practice (3.3/100 person years (2.94 to 3.75)). One case was reported to national surveillance for every 1.4 laboratory identifications, 6.2 stools sent for laboratory investigation, 23 cases presenting to general practice, and 136 community cases. The ratio of cases in the community to cases reaching national surveillance was lower for bacterial pathogens (salmonella 3.2:1, campylobacter 7.6:1) than for viruses (rotavirus 35:1, small round structured viruses 1562:1). There were many cases for which no organism was identified.
Conclusions: Infectious intestinal disease occurs in 1 in 5 people each year, of whom 1 in 6 presents to a general practitioner. The proportion of cases not recorded by national laboratory surveillance is large and varies widely by microorganism. Ways of supplementing the national laboratory surveillance system for infectious intestinal diseases should be considered.


Key messages

  • Infectious intestinal disease is common, with 9.4 million estimated cases each year in England

  • In 1.5 million cases (1 in 6) patients present to their general practitioner

  • Only a fraction of these cases are reported to national laboratory surveillance

  • A greater proportion of cases due to common bacterial pathogens are reported than cases due to common viral pathogens

  • Ways of supplementing the national laboratory surveillance system for infectious intestinal diseases should be considered




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Study of infectious intestinal disease in England underestimates morbidity due to specific pathogens
Paul R Hunter
bmj.com, 12 May 1999 [Full text]
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