Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance
Open accessAbstract
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.
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There are unresolved methodological issues within population-based studies, including recall period selection and recall bias.
“However, there are still unresolved methodological issues within population-based studies, including recall period selection and recall bias [17, 19, 20].”
From Burden of acute gastrointestinal illness in the Metropolitan region, Chile, 2008 (2011) · cites this paper as [17]
The Community rates section identifies recall bias as a probable reason retrospective estimates were higher than prospective estimates. The Community cohort section specifies a one-month recall period, but the paper does not discuss recall-period selection as an unresolved methodological issue. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe overall range of annual incidence rates of 0.98-2.3 episodes per person-year in this study is higher than those reported in Ireland, the UK and The Netherlands.
“The overall range of annual incidence rates of 0 . 98-2 . 3 episodes per person-year in our study are higher than those reported in Ireland, the UK and The Netherlands [14, 17, 24].”
From Burden of acute gastrointestinal illness in the Metropolitan region, Chile, 2008 (2011) · cites this paper as [17]
Retrospective methods may be more subject to recall bias and thus under ideal conditions, prospective methodology is preferred.
“Retrospective methods may be more subject to recall bias and thus under ideal conditions, prospective methodology is preferred [17].”
From Burden of acute gastrointestinal illness in the Metropolitan region, Chile, 2008 (2011) · cites this paper as [17]
The current study's result is contrary to the suggestion that 'telescoping' past illnesses into the observation period causes overestimates of disease in the population when using retrospective methods.
“However, this is contrary to the suggestion that 'telescoping' past illnesses into the observation period causes overestimates of disease in the population when using retrospective methods, as suggested by Wheeler et al . [17].”
From Burden of acute gastrointestinal illness in the Metropolitan region, Chile, 2008 (2011) · cites this paper as [17]
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“Similar under-reporting has been found by several other studies in developed countries (9,12,14,15,17-19,28).”
BackgroundMethodResultInfluential
- Authors
- Wheeler, J. G., Sethi, D., Cowden, J. M., Wall, P. G., Rodrigues, L. C., Tompkins, D. S., Hudson, M. J., & Roderick, P. J.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Ruchill Hospital (GB)
- Food Safety Authority of Ireland (IE)
- University of Southampton (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1999-04-17
- Volume
- 318
- Issue
- 7190
- Pages
- 1046-1050
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC27838
- OpenAlex
- W2054078306
- Semantic Scholar
- 2d91877629a13f31cb4fe91fa2f815e58cc7eb36
- Cited by
- 794
- References
- 22
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 7 · 2022: 4 · 2021: 9 · 2020: 7 · 2019: 14 · 2018: 11 · 2017: 17 · 2016: 27 · 2015: 25 · 2014: 29 · 2013: 24 · 2012: 36
- FWCI
- 28.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Department of Science and Technology, Ministry of Science and Technology, India
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
- Health Sciences › Medicine › Surgery › Gastrointestinal disorders and treatments
- Keywords
- intestinal infection, incidence, community-based surveillance, Salmonella, Campylobacter, rotavirus, small round structured viruses, pathogenic bacteria, England
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, England, Family Practice, Feces, Humans, Infant, Infant, Newborn, Infections, Intestinal Diseases, Middle Aged, Patient Acceptance of Health Care, Population Surveillance, Retrospective Studies, Cohort Studies, Incidence
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