Infectious Disease · Medical Literature
[Corrections] Correction to Lancet Infect Dis 2026; published online June 2. https://doi.org/10.1016/S1473-3099(26)00194-5
Abstract
GBD 2023 Diarrhoeal Disease and Enteric Infectious Diseases Collaborators. Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet Infect Dis 2026; published online June 2. https://doi.org/10.1016/S1473-3099(26)00194-5—In this Article, the spelling of author Fitsum Bekele Tolossa's name was incorrect, and the GBD 2023 Diarrhoeal Disease and Enteric Infectious Diseases Collaborators list has been updated.
Clinical relevance
What are the current global incidence, mortality, and disability-adjusted life-year (DALY) burdens of enteric infectious diseases and diarrhoeal diseases — and their contributing aetiologies — across 204 countries and territories from 1990 to 2023, and how does this progress compare to the GAPPD mortality target for children under 5 years? __SNAPSHOT__ {"studyDesign":"Systematic analysis (observational epidemiological modelling study) — Global Burden of Disease Study 2023","setting":"Global; 204 countries and territories, coordinated by the Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, USA","sampleSize":"Population-level modelled estimates across 204 countries and territories, 1990–2023; individual-level sample size not applicable","population":"All ages, both sexes, across 204 countries and territories; sub-analyses focused on children younger than 5 years. Diseases included: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases, with 15 diarrhoeal aetiologies examined.","intervention":"Not applicable — observational burden-of-disease analysis","comparator":"Not applicable — temporal trends (1990 vs. 2023) and comparison against the GAPPD target of fewer than 20 deaths per 100,000 children under 5 years by 2025","primaryOutcome":"Incidence, mortality, and DALYs of enteric infectious diseases stratified by age, sex, year, and geography; population-attributable fractions (PAFs) of diarrhoeal deaths by aetiology; proportion of countries meeting the GAPPD under-5 mortality target","followUp":"33 years (1990–2023)","fundingSource":"Includes support from the Bill & Melinda Gates Foundation (multiple grants noted in conflict-of-interest disclosures); additional funding sources not fully reported in abstract"}
Key findings
Enteric infectious diseases claimed more than 1 million lives annually as of the study period. Mortality and age-standardised mortality rates (ASMRs) declined substantially between 1990 and 2023, consistent with expansion of public health interventions and socioeconomic development; however, the absolute burden remained high. South Asia accounted for approximately 599,000 (95% UI: 441,000–882,000) deaths due to enteric infectious diseases in 2023, and sub-Saharan Africa accounted for approximately 501,000 (95% UI: 373,000–648,000), with diarrhoeal disease predominating in both regions. Rotavirus was the leading aetiology for all-age diarrhoeal disease deaths (PAF 16.3% [95% UI: 12.0–21.5]), followed by norovirus (PAF 10.2% [95% UI: 2.4–17.0]) and Shigella spp (PAF 9.3% [95% UI: 5.4–15.2]). Among children under 5 years, rotavirus accounted for a PAF of 40.2% (95% UI: 32.5–48.5) of diarrhoeal deaths, Shigella spp for 24.0% (95% UI: 15.1–36.7), and adenovirus for 23.4% (95% UI: 13.7–34.3). Of 204 countries and territories, 141 met the GAPPD under-5 mortality target in 2023; rotavirus was consistently the highest or second-highest contributor to child deaths in countries that had not yet met this target. Absolute effect sizes (e.g., NNT/NNH), p-values for trend comparisons, and DALYs by specific aetiology are not reported in the abstract.
Practice implications
This GBD 2023 systematic analysis establishes that the global burden of enteric infectious diseases has declined significantly since 1990, representing a major public health achievement. However, it also establishes that the burden remains unacceptably high — concentrated in South Asia and sub-Saharan Africa — and that more than a quarter of all countries had not achieved the GAPPD under-5 mortality target by 2023. The findings most directly apply to public health policy, resource allocation, and vaccination programme prioritisation rather than individual patient management. Rotavirus emerges as the single most impactful aetiology across all ages and particularly in under-5 mortality, reinforcing the clinical and policy importance of rotavirus vaccination scale-up. Shigella and adenovirus are major under-5 burdens for which licensed vaccines are not yet widely available. High-income country clinicians managing individual patients may find the global burden data less directly actionable, but findings are highly relevant for clinicians engaged in global health, travel medicine, refugee health, and paediatric infectious disease. CRITICAL LIMITATION: This summary is based exclusively on the abstract and publicly available summary data; the full dataset, supplemental analyses, country-level breakdowns, DALY estimates by aetiology, and trend statistics were not accessible for review. Furthermore, the document submitted for this summary was a correction notice (erratum) correcting only one collaborator's name — it contains no independent scientific content. All clinical data herein derive from the primary article. __LIMITATIONS__ Modelling-dependent estimates: all outputs are derived from statistical models (DisMod-MR 2.1, Cause of Death Ensemble Modelling) applied to heterogeneous data sources including vital registration, verbal autopsy, and minimally invasive tissue sampling — data quality varies substantially across countries.,Reliance on surrogate and indirect data: countries with weakest health systems and highest burden often have the least reliable surveillance data, potentially introducing systematic underestimation or estimation uncertainty in highest-burden regions.,Wide uncertainty intervals in key estimates (e.g., South Asia deaths: 441,000–882,000) reflect substantial uncertainty and should caution against over-precise policy conclusions.,Cross-sectional aetiology PAFs do not establish causality and may be subject to misclassification, co-attribution, and diagnostic heterogeneity across settings.,GAPPD target assessment uses a single-year snapshot (2023) and does not account for trajectory of progress or countries approaching but not yet achieving the target.,Funding from the Bill & Melinda Gates Foundation, which has programmatic interests in vaccine development and global health priorities (e.g., rotavirus, typhoid), represents a potential source of emphasis or framing bias, though this is common across GBD analyses.,This teaching summary is based on the abstract only; full methodology, sensitivity analyses, and country-level data were not reviewable.,The submitted document was a correction notice (erratum), not the primary research article; no scientific content is contained in the correction itself. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ The GBD 2023 enteric disease analysis confirms substantial global progress in diarrhoeal disease mortality since 1990, but documents a persistently catastrophic burden — over 1 million annual deaths — concentrated in South Asia and sub-Saharan Africa. Rotavirus is the leading preventable aetiology across all ages and is the dominant driver of under-5 diarrhoeal mortality in countries that have not met the GAPPD target, strongly supporting continued and expanded rotavirus vaccination programmes. These findings are hypothesis-generating and policy-informing at the population level; they do not alter individual clinical management but underscore the critical importance of vaccination, WASH infrastructure, and oral rehydration in high-burden settings.