O-87 Burden of acute gastroenteritis and foodborne pathogens in Trinidad and Tobago: evidence for policy and surveillance strengthening
Author(s):
C Lakhan , N Badrie , A Ramsubhag , L Indar
Year of Presentation:
2026
Objective: This study aimed to quantify the epidemiologic,
etiologic, and economic burden of acute gastroenteritis
(AGE) using integrated community, laboratory, and surveillance data.
Methods: A mixed-methods approach was employed. Retrospective population-based surveys (n=2,145), laboratory manager surveys across six major laboratories, and prospective enhanced pathogen testing were conducted. Culturebased testing targeted six pathogens during surveys, while PCR assays screened for 22 pathogens between 2018–2019. Secondary analyses of national syndromic surveillance data spanning 2006–2023 were performed. Statistical analyses included incidence and prevalence estimation, underreporting multipliers, χ² tests, ANOVA, multivariate modeling, and joinpoint regression.
Results: Approximately one in ten individuals experienced AGE annually, with monthly prevalence at 5.13% and annual incidence of 0.675 episodes per person-year. The underreporting multiplier was ≈6.17, indicating that over 83% of cases were unreported. Children under 15 years were disproportionately affected, with two-thirds reporting restricted activity (~3 days) and one-quarter requiring caregiving (~2.6 days). Only 16% sought medical care, though most received medication. Enhanced testing identified Salmonella, Shigella, norovirus, rotavirus, Campylobacter, and diarrhoeagenic Escherichia coli as leading pathogens, with rural hotspots. Temporal analysis revealed spikes during flooding, droughts, and Carnival, a decline during COVID19 (2018–2021), and rebound thereafter. Direct outpatient costs per case rose from $996 TTD (2009) to $1,614 TTD (2021), with national totals increasing from $128M TTD to $204M TTD.
Conclusion: AGE represents a substantial but underrecognized burden in Trinidad and Tobago. Strengthening hygiene promotion, expanding rotavirus vaccination, enhancing pathogen monitoring, and integrating food safety education into schools are critical interventions. Regional collaboration through CARPHA frameworks can modernize surveillance, prioritize high-risk events, and advance SDGaligned health outcomes.