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Community study of infectious intestinal disease in England

BMJ 1999; 319 doi: (Published 24 July 1999) Cite this as: BMJ 1999;319:258

Study underestimated morbidity due to specific pathogens

  1. Paul R Hunter, Consultant medical microbiologist (
  1. Public Health Laboratory, Countess of Chester Health Park, Chester CH2 1UL
  2. Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. Leeds Public Health Laboratory, Leeds LS15 7TR
  4. Centre for Applied Microbiology and Research, Porton Down, Salisbury, Wiltshire SP4 0JG
  5. Southampton University, Southampton SO6 6YD
  6. Scottish Centre for Infection and Environmental Health, Ruchill Hospital, Glasgow G20 9NB
  7. Food Safety Authority of Ireland, Dublin 1, Republic of Ireland

    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 …

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