1. What is this article about?

Diarrhoeal diseases are a significant health concern in children under five years of age, with rotavirus, Shigella spp., and Cryptosporidium spp. accounting for the majority of the disease burden. However, current estimates of morbidity and mortality in older children, adults, and the elderly are largely extrapolated from paediatric data due to a lack of studies focused on these age groups. In order to close the data gap, this article explores the aetiology of diarrhoea among older individuals in South Africa.

2. Why does this matter?

In the absence of clear aetiological data and burden estimates, designing effective interventions for diarrhoeal diseases remains challenging. Generating robust data to inform and support intervention selection is essential to ensure that public health programmes are appropriately targeted toward populations most at risk for diarrhoeal disease. In addition, ensuring that these programmes generate the expected outcomes and are cost-effective and sustainable should also be considered.

3. What drew your interest in this area of research?

There are more interventions available to prevent and treat diarrhoeal diseases than any other condition that we are trying to combat today. These include hand washing with soap, access to safe water and adequate sanitation, enteric vaccines, the use of oral rehydration solution and zinc for treatment and improved case management and referral. Knowing what is causing the problem and to whom allows for the implementation of targeted interventions for those who need it most.

4. What was your role in the article?

I co-ordinate the diarrhoeal disease surveillance and have been with the programme since the start in 2009. However, research into diarrhoea in older children and adults has only garnered interest in the last few years. I have worked on all aspects of the programme, from its initial setup to laboratory analysis, training, data entry, and analysis. The diarrhoea surveillance programme has been a major part of my research for 15 years, and it has been rewarding to see the information generated.

5. Why should people read this article?

This paper provides a comprehensive summary of data from the past six years, aimed at professionals working in emergency departments, adult wards, or with vulnerable populations, including individuals living with HIV, men who have sex with men, malnourished individuals, and the elderly. It offers valuable insights into annual trends in enteric pathogen circulation at selected surveillance sites. Additionally, the paper equips healthcare providers with epidemic intelligence and enhances their ability to differentiate diagnoses when managing cases of diarrhoeal disease in adults.

6. What impact do you hope this article will have on public health policy and access to healthcare?

I hope that the paper will emphasise vulnerable adult populations at heightened risk for diarrhoeal diseases in South Africa, identifying the primary drivers of the disease burden. The data presented could be instrumental in the development of targeted diagnostic and treatment guidelines. Additionally, the findings may inform decisions regarding public health interventions and the potential introduction of new enteric vaccines, should they become available.

Prof. Nicola Page is the Acting Head for the Centre for Enteric Diseases at the National Institute for Communicable Diseases.

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