Regional and national burden and aetiological patterns of diarrhoeal disease in Asia with implications for travel medicine

BACKGROUND: Despite the considerable burden of diarrheal disease in Asia, etiology-specific patterns remain insufficiently characterized. This study aimed to provide a comprehensive assessment of the diarrheal disease burden across Asia from 1990 to 2023, focusing on the implications for travelers' diarrhea. METHODS: We estimated the burden of diarrheal 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 100,000 population, with 95% uncertainty intervals (UIs). Additionally, we assessed the burden attributable to risk factors and calculated pathogen-specific estimates for 13 major etiologies. RESULTS: From 1990 to 2023, ASDRs of diarrheal disease declined across Asia, with the largest decline in South Asia from 9124.29 (95% UI, 7594.46-11,673.82) per 100,000 population to 1216.90 (965.73-1633.55). The decline was accompanied by reductions in cumulative etiologic burden, particularly for rotavirus. Although norovirus was the leading etiology in High-income Asia Pacific, rotavirus remained dominant across all other Asian regions in 2023. Burdens were concentrated among those aged