Epidemiology and Infection

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Epidemiology and Infection (2010), 138:117-124 Cambridge University Press
Copyright © Cambridge University Press 2009

Original Papers

Methods and modelling

Respiratory symptoms and the case definition of gastroenteritis: an international analysis of the potential impact on burden estimates

G. HALLa1 c1, L. McDONALDa2, S. E. MAJOWICZa2a3, E. SCALLANa4, M. KIRKa1a5, P. SOCKETTa2a3 and F. J. ANGULOa4

a1 National Centre for Epidemiology and Population Health and Medical School, Australian National University, Canberra, Australia
a2 Centre for Foodborne, Environmental, and Zoonotic Infectious Disease, Public Health Agency of Canada, Guelph and Ottawa, Ontario, Canada
a3 University of Guelph, Department of Population Medicine, Guelph, Ontario, Canada
a4 Enteric Diseases Epidemiology Branch, Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
a5 OzFoodNet, Food Safety & Surveillance Section, Department of Health and Aging, Canberra, Australia
Article author query
hall g [PubMed]  [Google Scholar]
mcdonald l [PubMed]  [Google Scholar]
majowicz se [PubMed]  [Google Scholar]
scallan e [PubMed]  [Google Scholar]
kirk m [PubMed]  [Google Scholar]
sockett p [PubMed]  [Google Scholar]
angulo fj [PubMed]  [Google Scholar]


Estimates of the burden of foodborne disease rely on attributing a proportion of syndromic gastroenteritis to foodborne transmission. Persons with syndromic diarrhoea/vomiting can also present with concurrent respiratory symptoms that could be due to respiratory infections, gastrointestinal infections, or both. This distinction is important when estimating the foodborne disease burden but has rarely been considered. Using data from population surveys from Australia, Canada and the USA we describe the effect of excluding persons with respiratory and associated symptoms from the case definition of gastroenteritis. Excluding persons first with respiratory symptoms, or second with respiratory symptoms plus fever and headache, resulted in a decrease in the weighted estimates of acute gastroenteritis of about 10–50% depending on the exclusion criteria. This has the potential to have a very significant impact on estimates of the burden of foodborne infections using syndromic case definitions of acute gastroenteritis.

(Accepted May 06 2009)

(Online publication June 04 2009)

Key Words:Acute gastroenteritis; diarrhoea; incidence; population study; vomiting; respiratory symptoms


c1 Author for correspondence: Dr G. Hall, Australian National University – NCEPH, Bld 62, ANU, Canberra Australian Capital Territory 0200, Australia. (Email: gillian.hall@anu.edu.au)