This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (72)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Paul E. Kilgore, MPH, MD; Robert C. Holman, MS; Matthew J. Clarke, MA; Roger I. Glass, MD, PhD

JAMA. 1995;274(14):1143-1148.

Abstract
Objectives.
—To describe temporal patterns in mortality related to diarrheal disease in US children and to assess progress toward its prevention and control.

Design.
—Retrospective analyses of death certificate data on diarrhea of all causes compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Ga.

Patients.
—Children aged 1 month through 4 years who died with diarrhea.

Setting.
—United States, 1968 through 1991.

Results.
—A total of 14137 deaths associated with diarrhea among children were reported in the United States between 1968 and 1991. Of these, 78% occurred in infants (ie, aged 1 to 11 months); the median age at the time of death has declined from 5 to 1.5 months. Diarrheal disease mortality dropped by approximately 75% during the first 18 years of the study, but no decline has occurred since 1985. Infant mortality due to diarrhea (per 100 000 live births) averaged 12.8 and was found to be high for blacks (33.1) and for residents of the southern United States (18.5). The infant mortality due to diarrhea from 1986 through 1991 is 5.9. Peaks in winter deaths previously associated with rotavirus were prominent in the early years among infants aged 4 through 11 months. Such peaks have virtually disappeared since 1985. Diarrhea was the principal cause of death, as the leading associated diagnoses (electrolyte disorders [30%], cardiac arrest [16%], shock [8%], and nausea/vomiting [4%]) were commonly recognized complications of diarrhea. Since 1979, prematurity has emerged as a common associated diagnosis.

Conclusions.
—Diarrheal deaths nationwide have declined 75% from 1968 to 1985 but stabilized since then at about 300 deaths per year. Because many of these deaths may still be preventable by early rehydration, future prevention efforts should be directed at educating health care providers about the continuing problem and recognition of the high-risk infant and at teaching mothers of such infants to begin rehydration early and to seek medical attention when their infant develops diarrhea.

(JAMA. 1995;274:1143-1148)

Author Affiliations
From the Epidemic Intelligence Service (Dr Kilgore), the Viral Gastroenteritis Section (Drs Kilgore and Glass), and Biometrics Activity (Messrs Holman and Clarke), Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.

Footnotes
Reprint requests to the Viral Gastroenteritis Section, Mailstop G-04, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA 30333 (Dr Kilgore).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Active, Population-Based Surveillance for Severe Rotavirus Gastroenteritis in Children in the United States
Payne et al.
Pediatrics 2008;122:1235-1243.
ABSTRACT | FULL TEXT  

Rotavirus Vaccines: an Overview
Dennehy
Clin. Microbiol. Rev. 2008;21:198-208.
ABSTRACT | FULL TEXT  

Effectiveness of a Practice-Based, Multimodal Quality Improvement Intervention for Gastroenteritis Within a Medicaid Managed Care Network
Zolotor et al.
Pediatrics 2007;120:e644-e650.
ABSTRACT | FULL TEXT  

Cost-effectiveness and Potential Impact of Rotavirus Vaccination in the United States
Widdowson et al.
Pediatrics 2007;119:684-697.
ABSTRACT | FULL TEXT  

Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000.
Malek et al.
Pediatrics 2006;117:1887-1892.
ABSTRACT | FULL TEXT  

Rotavirus Deaths: Rare or Unrecognized?
Staat et al.
CLIN PEDIATR 2005;44:535-537.
 

Use of Active Surveillance to Validate International Classification of Diseases Code Estimates of Rotavirus Hospitalizations in Children
Hsu et al.
Pediatrics 2005;115:78-82.
ABSTRACT | FULL TEXT  

Antiemetic Use for Acute Gastroenteritis in Children
Li et al.
Arch Pediatr Adolesc Med 2003;157:475-479.
ABSTRACT | FULL TEXT  

The World Health Organization Oral Rehydration Solution in US Pediatric Practice: A Randomized Trial to Evaluate Parent Satisfaction
Ladinsky et al.
Arch Pediatr Adolesc Med 2000;154:700-705.
ABSTRACT | FULL TEXT  

Hospitalization for Community-Acquired, Rotavirus-Associated Diarrhea: A Prospective, Longitudinal, Population-Based Study During the Seasonal Outbreak
Ford-Jones et al.
Arch Pediatr Adolesc Med 2000;154:578-585.
ABSTRACT | FULL TEXT  

Mortality from Pneumonia in Children in the United States, 1939 through 1996
Dowell et al.
NEJM 2000;342:1399-1407.
ABSTRACT | FULL TEXT  

Zinc Deficiency, Malnutrition and the Gastrointestinal Tract
Wapnir
J. Nutr. 2000;130:1388S-1392.
ABSTRACT | FULL TEXT  

Rotavirus: a new vaccine for the UK?
RAMSAY
Arch. Dis. Child. 1999;81:101-102.
FULL TEXT  

Acute Gastroentertis
Gastanaduy and Begue
CLIN PEDIATR 1999;38:1-12.
ABSTRACT  

Perinatal Risk Factors for Infant Hospitalization With Viral Gastroenteritis
Newman et al.
Pediatrics 1999;103:e3-3.
ABSTRACT | FULL TEXT  

Trends in Diarrhea-associated Hospitalizations Among American Indian and Alaska Native Children, 1980-1995
Holman et al.
Pediatrics 1999;103:e11-11.
ABSTRACT | FULL TEXT  

Prevention of Rotavirus Disease: Guidelines for Use of Rotavirus Vaccine
Committee on Infectious Diseases
Pediatrics 1998;102:1483-1491.
ABSTRACT | FULL TEXT  

Detection and Characterization of Novel Rotavirus Strains in the United States
Ramachandran et al.
J. Clin. Microbiol. 1998;36:3223-3229.
ABSTRACT | FULL TEXT  

Cost-effectiveness Analysis of a Rotavirus Immunization Program for the United States
Tucker et al.
JAMA 1998;279:1371-1376.
ABSTRACT | FULL TEXT  

Diarrheal Mortality in US Infants: Influence of Birth Weight on Risk Factors for Death
Parashar et al.
Arch Pediatr Adolesc Med 1998;152:47-51.
ABSTRACT | FULL TEXT  

Safety and Effectiveness of Homemade and Reconstituted Packet Cereal-based Oral Rehydration Solutions: A Randomized Clinical Trial
Meyers et al.
Pediatrics 1997;100:e3-e3.
ABSTRACT | FULL TEXT  

A Vaccine against Rotavirus -- When is Too Much Too Much?
Keusch and Cash
NEJM 1997;337:1228-1229.
FULL TEXT  

Treatment of Acute Gastroenteritis: Too Much and Too Little Care
Merrick et al.
CLIN PEDIATR 1996;35:429-435.
ABSTRACT