ArticlePLoS neglected tropical diseases2016
The Burden of Cryptosporidium Diarrheal Disease among Children < 24 Months of Age in Moderate/High Mortality Regions of Sub-Saharan Africa and South Asia, Utilizing Data from the Global Enteric Multicenter Study (GEMS).
Article in PLoS neglected tropical diseases, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 166 papers, 5 of them syntheses that pooled it.
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Who cites it
166 citing papers in PubMed, 5 syntheses or guidelines pooled it, 258 citations in OpenAlex.
- Cryptosporidium spp. infections in Tunisia: Epidemiology and public health implications.Veterinary medicine and science · 2026Pooled it
- WaterborneJournal of water and health · 2024Pooled it
- The global prevalence ofParasitology · 2022Pooled it
- Anthroponotic transmission of Cryptosporidium parvum predominates in countries with poorer sanitation: a systematic review and meta-analysis.Parasites & vectors · 2019Pooled it
- Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2018Pooled it
- Clofazimine for Treatment of Cryptosporidiosis in Human Immunodeficiency Virus Infected Adults: An Experimental Medicine, Randomized, Double-blind, Placebo-controlled Phase 2a Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Cryptosporidiosis burden among children younger than 5 years with diarrhea attending Banadir hospital in Mogadishu, Somalia.IJID regions · 2026Article
- Genome-targeted enrichment and sequencing of human-infecting Cryptosporidium spp.Nature communications · 2026Article
- From conventional to biosensor-based detection ofFood and waterborne parasitology · 2026Review
- Cryptosporidium secreted proteins form a complex layered interface with the host cell.PLoS pathogens · 2026Article
- Systematic review and meta-analysis on the prevalence of cryptosporidiosis among children in India.Gut pathogens · 2026Review
- Cell Culture Infectivity to Assess Chlorine Disinfection of Cryptosporidium Oocysts in Water.Methods in molecular biology (Clifton, N.J.) · 2026Article
- Mouse Models for Use in Cryptosporidium Infection Studies, Quantification of Parasite Burden Using Flow Cytometry, qPCR and Histopathology, and Confocal Imaging of Oocysts.Methods in molecular biology (Clifton, N.J.) · 2026Article
- In Vitro Culture of Cryptosporidium spp. Using Stem Cell-Derived Intestinal Epithelial Monolayers.Methods in molecular biology (Clifton, N.J.) · 2026Article
- Early life infection withGut microbes · 2025Article
- Investigating within-host population diversity of Cryptosporidium parvum using BlooMine.BMC genomics · 2025Article
- Independent evolution of holocentric chromosomes in an early branching apicomplexan parasite.bioRxiv : the preprint server for biology · 2025Article
- Article
- Targeted CRISPR screens reveal genes essential for Cryptosporidium survival in the host intestine.Nature communications · 2025Article
- Cryptosporidium infection and associated factors among diarrheic children under five years of age in Eastern Ethiopia.PLoS neglected tropical diseases · 2025Article
106 more citing papers are in PubMed but not listed here.
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Authors and funding
49 authors at 17 institutions in 13 countries.
Funding
Abstract
backgroundThe importance of Cryptosporidium as a pediatric enteropathogen in developing countries is recognized.
methodsData from the Global Enteric Multicenter Study (GEMS), a 3-year, 7-site, case-control study of moderate-to-severe diarrhea (MSD) and GEMS-1A (1-year study of MSD and less-severe diarrhea [LSD]) were analyzed. Stools from 12,110 MSD and 3,174 LSD cases among children aged <60 months and from 21,527 randomly-selected controls matched by age, sex and community were immunoassay-tested for Cryptosporidium. Species of a subset of Cryptosporidium-positive specimens were identified by PCR; GP60 sequencing identified anthroponotic C. parvum. Combined annual Cryptosporidium-attributable diarrhea incidences among children aged <24 months for African and Asian GEMS sites were extrapolated to sub-Saharan Africa and South Asian regions to estimate region-wide MSD and LSD burdens. Attributable and excess mortality due to Cryptosporidium diarrhea were estimated.
findingsCryptosporidium was significantly associated with MSD and LSD below age 24 months. Among Cryptosporidium-positive MSD cases, C. hominis was detected in 77.8% (95% CI, 73.0%-81.9%) and C. parvum in 9.9% (95% CI, 7.1%-13.6%); 92% of C. parvum tested were anthroponotic genotypes. Annual Cryptosporidium-attributable MSD incidence was 3.48 (95% CI, 2.27-4.67) and 3.18 (95% CI, 1.85-4.52) per 100 child-years in African and Asian infants, respectively, and 1.41 (95% CI, 0.73-2.08) and 1.36 (95% CI, 0.66-2.05) per 100 child-years in toddlers. Corresponding Cryptosporidium-attributable LSD incidences per 100 child-years were 2.52 (95% CI, 0.33-5.01) and 4.88 (95% CI, 0.82-8.92) in infants and 4.04 (95% CI, 0.56-7.51) and 4.71 (95% CI, 0.24-9.18) in toddlers. We estimate 2.9 and 4.7 million Cryptosporidium-attributable cases annually in children aged <24 months in the sub-Saharan Africa and India/Pakistan/Bangladesh/Nepal/Afghanistan regions, respectively, and ~202,000 Cryptosporidium-attributable deaths (regions combined). ~59,000 excess deaths occurred among Cryptosporidium-attributable diarrhea cases over expected if cases had been Cryptosporidium-negative.
conclusionsThe enormous African/Asian Cryptosporidium disease burden warrants investments to develop vaccines, diagnostics and therapies.
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