{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T03:10:28Z","timestamp":1794107428495,"version":"4.8.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Kyung Hee University in 2025","award":["KHU-20251285"],"award-info":[{"award-number":["KHU-20251285"]}],"id":[{"id":"https:\/\/ror.org\/01zqcg218","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite the considerable burden of diarrhoeal disease in Asia, aetiology-specific patterns remain insufficiently characterized. This study aimed to provide a comprehensive assessment of the diarrhoeal disease burden across Asia from 1990 to 2023, focusing on the implications for travellers\u2019 diarrhoea (TD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We estimated the burden of diarrhoeal disease in Asia, including Central, East, South, Southeast Asia and High-income Asia Pacific, across 34 countries from 1990 to 2023 using the Global Burden of Diseases Study 2023. Disease burden was calculated using age-standardized disability-adjusted life year rates (ASDRs) per 100\u2009000 population, with 95% uncertainty intervals (UIs). Additionally, we assessed the burden attributable to risk factors and calculated pathogen-specific estimates for 13 major aetiologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2023, ASDRs of diarrhoeal disease declined across Asia, with the largest decline in South Asia from 9124.29 (95% UI, 7594.46\u201311\u00a0673.82) per 100\u2009000 population to 1216.90 (965.73\u20131633.55). The decline was accompanied by reductions in cumulative aetiologic burden, particularly for rotavirus. Although norovirus was the leading aetiology in high-income Asia Pacific, rotavirus remained dominant across all other Asian regions in 2023. Burdens were concentrated among those aged &amp;lt;\u20095\u00a0years and\u2009\u2265\u200995\u00a0years. Among children aged &amp;lt;\u20095\u00a0years, rotavirus and adenovirus were the leading aetiologies, with adenovirus showing a particularly high age-specific DALY rate in South Asia (891.96 [484.65\u20131392.81] per 100\u2009000 population). Among adults aged \u226595\u00a0years, Clostridium difficile and norovirus had the highest burdens. Sex-specific burdens were generally higher in males, except in South Asia. In 2023, unsafe water sources were the leading risk factor, especially in South Asia, 831.77 (423.32\u20131206.25) per 100\u2009000 population. For viral, parasitic and gram-negative aetiologies, burdens consistently declined with increasing SDI, whereas C. difficile showed a U-shaped pattern with SDI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The heterogeneity in aetiology-specific burden, age- and sex-related vulnerability and associations with SDI across Asia underscores the need for destination-specific risk assessment and context-sensitive prevention strategies for TD in Asia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jtm\/taag071","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:41:35Z","timestamp":1784893295000},"source":"Crossref","is-referenced-by-count":2,"title":["Regional and national burden and aetiological patterns of diarrhoeal disease in Asia with implications for travel medicine"],"prefix":"10.1093","volume":"33","author":[{"given":"Dain Y","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Medicine, Korea University College of Medicine , Seoul ,","place":["South Korea"]},{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine , Seoul ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunjee","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine , Seoul ,","place":["South Korea"]},{"name":"Department of Precision Medicine, Kyung Hee University College of Medicine , Seoul ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeyu","family":"Park","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine , Seoul ,","place":["South Korea"]},{"name":"Department of 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Medicine , Seoul ,","place":["South Korea"]},{"name":"Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine , Seoul ,","place":["South Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"key":"2026110202474911100_ref1","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/S1473-3099(24)00691-1","article-title":"Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the global burden of disease study 2021","volume":"25","author":"Kyu","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2026110202474911100_ref2","doi-asserted-by":"publisher","first-page":"e2551089","DOI":"10.1001\/jamanetworkopen.2025.51089","article-title":"Geosentinel analysis of travelers' diarrhea antimicrobial resistance 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