Evidence map›Paper›PMID 30266330›Full record

ArticleThe Lancet. Infectious diseases2018

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990-2016.

Ibrahim A Khalil, Christopher Troeger, Brigette F Blacker, Puja C Rao, Alexandria Brown, Deborah E Atherly, Thomas G Brewer, Cyril M Engmann, Eric R Houpt, Gagandeep Kang and 18 more

Erratum issued Registry-linked trialOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT06523231 (Safety and Immunogenicity of a Second Generation Shigella Bioconjugate Vaccine), which is not on this map. Cited by 416 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
416citing papers in PubMed, 4 pooled it
37.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06523231 phase2completednot on this mapstarted 2025, after this paper: background citation

Safety and Immunogenicity of a Second Generation Shigella Bioconjugate Vaccine: a Phase II Randomized, Controlled, and Blinded Study in 9-month-old Infants

TypeinterventionalSponsorLimmaTech Biologics AGRan2025 to 2026Enrolled110ConditionsShigellosisArmsShigella4V2, MenACWY
3 · Its place in the literature

Who cites it

416 citing papers in PubMed, 4 syntheses or guidelines pooled it, 697 citations in OpenAlex.

  1. Pooled it
  2. Burden ofBMJ global health · 2026
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Trial
  7. Trial
  8. Article
  9. Flagellar regulation in enterotoxigenicInfection and immunity · 2026
    Article
  10. New microbes and new infections · 2026
    Review
  11. Article
  12. Sequential invasion of epithelial and immune cells in Shigellosis.bioRxiv : the preprint server for biology · 2026
    Article
  13. Multifunctional antibody responses from a primateScience translational medicine · 2026
    Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article

356 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors at 13 institutions in 4 countries.

Ibrahim A KhalilInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Christopher TroegerInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Brigette F BlackerInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Puja C RaoInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Alexandria BrownInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Deborah E AtherlyCenter for Vaccine Innovation and Access, PATH, Seattle, WA, USA.
Thomas G BrewerDepartment of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
Cyril M EngmannMaternal, Newborn, Child Health & Nutrition, PATH, Seattle, WA, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
Eric R HouptDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Gagandeep KangTranslational Health Science and Technology Institute, Faridabad, India.
Karen L KotloffDepartment of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Myron M LevineDepartment of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Stephen P LubyDivision of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
Calman A MacLennanEnteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA.
William K PanInstitute for Health Metrics and Evaluation, Seattle WA, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
Patricia B PavlinacDepartment of Global Health, University of Washington School of Public Health, Seattle, WA, USA.
James A Platts-MillsDivision of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Firdausi QadriInfectious Diseases Division, International Center for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Mark S RiddleUniformed Services University, Bethesda, MD, USA.
Edward T RyanDivision of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology & Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
David A ShoultzDrug Development, PATH, Seattle, WA, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Albers School of Business & Economics, Seattle University, Seattle, WA, USA.
A Duncan SteeleEnteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA.
Judd L WalsonDepartment of Global Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA.
John W SandersWake Forest University School of Medicine, Winston-Salem, NC, USA.
Ali H MokdadInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Christopher J L MurrayInstitute for Health Metrics and Evaluation, Seattle WA, USA.
Simon I HayInstitute for Health Metrics and Evaluation, Seattle WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Robert C ReinerInstitute for Health Metrics and Evaluation, Seattle WA, USA. Electronic address: bcreiner@uw.edu.
Institute for Health Metrics and Evaluation · USUniversity of Washington · USBill & Melinda Gates Foundation · USProgram for Appropriate Technology in Health · USUniversity of Maryland, Baltimore · USUniversity of Virginia · USInternational Centre for Diarrhoeal Disease Research · BDMassachusetts General Hospital · USSeattle University · USStanford University · USTranslational Health Science and Technology Institute · INUniformed Services University of the Health Sciences · USWake Forest University · US

Funding

Medical Research Council MR/P008852/1Medical Research Council MR/R005974/1
6 · The paper itself

Abstract

backgroundShigella and enterotoxigenic Escherichia coli (ETEC) are bacterial pathogens that are frequently associated with diarrhoeal disease, and are a significant cause of mortality and morbidity worldwide. The Global Burden of Diseases, Injuries, and Risk Factors study 2016 (GBD 2016) is a systematic, scientific effort to quantify the morbidity and mortality due to over 300 causes of death and disability. We aimed to analyse the global burden of shigella and ETEC diarrhoea according to age, sex, geography, and year from 1990 to 2016.

methodsWe modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We used a compartmental meta-regression tool to model the incidence of shigella and ETEC, which enforces an association between incidence, prevalence, and remission on the basis of scientific literature, population representative surveys, and health-care data. We calculated 95% uncertainty intervals (UIs) for the point estimates.

findingsShigella was the second leading cause of diarrhoeal mortality in 2016 among all ages, accounting for 212 438 deaths (95% UI 136 979-326 913) and about 13·2% (9·2-17·4) of all diarrhoea deaths. Shigella was responsible for 63 713 deaths (41 191-93 611) among children younger than 5 years and was frequently associated with diarrhoea across all adult age groups, increasing in elderly people, with broad geographical distribution. ETEC was the eighth leading cause of diarrhoea mortality in 2016 among all age groups, accounting for 51 186 deaths (26 757-83 064) and about 3·2% (1·8-4·7) of diarrhoea deaths. ETEC was responsible for about 4·2% (2·2-6·8) of diarrhoea deaths in children younger than 5 years.

interpretationThe health burden of bacterial diarrhoeal pathogens is difficult to estimate. Despite existing prevention and treatment options, they remain a major cause of morbidity and mortality globally. Additional emphasis by public health officials is needed on a reduction in disease due to shigella and ETEC to reduce disease burden.

fundingBill & Melinda Gates Foundation.

Indexed as

Global HealthAdolescentAdultAgedAged, 80 and overBiostatisticsChildChild, PreschoolCost of IllnessDiarrheaDysentery, BacillaryEnterotoxigenic Escherichia coliEpidemiologic MethodsEscherichia coli InfectionsFemaleHumans

Identifiers

PMID30266330
PMCPMC6202441
OpenAlexW2893080428

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.