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Studies of Diarrheal Disease in Central America^*

V. ENVIRONMENTAL FACTORS IN THE ORIGIN AND TRANSMISSION OF ACUTE DIARRHEAL DISEASE IN FOUR GUATEMALAN VILLAGES^,

Hans A. Bruch, Werner Ascoli, Nevin S. Scrimshaw^|| AND John E. Gordon^¶

The acute diarrheas and dysenteries of infancy and early childhood predominate among intestinal disorders of Guatemalan highland villages. The correlation with weaning practices and the attendant malnutrition is sufficient to characterize weanling diarrhea as an epidemiologic entity, as distinct among the diarrheas and the dysenteries as epidemic diarrhea of the newborn.

Transmission is primarily by direct contact, highly favored by the habits and customs of the people, and also indirectly by food contaminated by the environment or through the agency of other family members. The index case in family outbreaks is predominantly the infant or young child, and yet with strong indication that this does not mark the original introduction of infection into the family. Conceivably, manifest disease depends upon two factors. First, an immunity having its origin in a more or less universal disease occurring at an early age protects older children and adults. Secondly, the prevailing malnutrition conditions the immature host to invasion by infectious agents ordinarily of low pathogenicity and perhaps not numbered among the normal adult intestinal flora, as well as to infection by recognized enteropathogens.

^* This work was supported by the Pan American Health Organization, the World Health Organization, and Grant AM-4827 from the National Institutes of Health (U. S.).

Many members of the professional and technical staff of INCAP participated in the general field studies of which this investigation was a part. Special acknowledgment is made to Romeo de León, Miguel A. Guzmán, Virginia Pierce and Marta de León.

Division of Statistics, INCAP.

Epidemiology Service, INCAP.

^|| Department of Nutrition, Food Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts and Consultant Director to INCAP.

^¶ Department of Epidemiology, Emeritus, Harvard University and Consultant in Epidemiology to INCAP.

INCAP Publication I-250.