Pathogenetic Characteristics of Infectious Diarrhea among the Elderly Aged ≥60 in Pudong New Area, Shanghai, 2010–2024

Weiyu Zhou; Jiafeng Chen; Anran Zhang; Chuchu Ye; Geyang Sun; Xiao Wang; Li Zhang

Abstract

This study aimed to characterize the epidemiological characteristics and pathogen distribution of diarrhea among adults aged ≥60 in Pudong New Area, Shanghai. A retrospective analysis was conducted on 4310 diarrhea cases aged ≥60 collected from the ongoing surveillance from January 2010 to December 2024. Specimens were tested for 8 bacterial and 5 viral pathogens using culture and molecular methods. Detection rates were compared across age groups and over time, and age-specific trends were evaluated using joinpoint regression. The overall pathogen-positive rate was 42.20% (1819/4310). Viral infections accounted for the largest proportion (20.26%), mainly norovirus (13.53%) and rotavirus (4.78%). Bacterial infections accounted for 15.99%, predominantly Diarrheagenic E. coli (DEC) (5.94%), non-typhoidal Salmonella (NTS) (3.57%), and Campylobacter spp. (2.60%). Pathogen positivity peaked in 2017, declined after 2020 during the COVID-19 pandemic, and slightly increased thereafter. Viral infections occurred primarily in winter–spring (October–March), whereas bacterial infections peaked in summer–autumn (June–September). Among cases with single infections, the highest viral and bacterial positivity rates were observed in the 60–69 age group (both p < 0.05), while DEC was highest in those aged ≥80 (6.57%). Joinpoint regression revealed non-linear age patterns. Viral infections declined with age but rebounded around the early 90s, whereas bacterial infections remained relatively stable before increasing at similar ages. Norovirus, rotavirus, and DEC were the leading pathogens of infectious diarrhea among the elderly in Pudong New Area, Shanghai. Age-specific, temporal, and seasonal patterns underscore the need for targeted prevention strategies, particularly for the extreme elderly.

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