Global and Regional Trends of Pediatric Enteric Infections, 1990–2021: Rising Modeled Burden of Invasive Non-Typhoidal Salmonella in High-Income Regions

(iNTS) were obtained from the Global Burden of Disease (GBD) 2021 study. Age-standardized incidence rates (ASIRs), average annual percentage changes (AAPCs), and correlations between the socio-demographic index (SDI) and ASIRs were analyzed to characterize temporal, regional, and socioeconomic patterns. From 1990 to 2021, DD and TP declined globally, whereas iNTS showed an overall increasing trend. Globally, iNTS cases increased from 245,607 (95% uncertainty intervals [UI]: 174,385-328,774) in 1990-356,475 (95% UI: 248,066-484,385) in 2021, representing a 45.14% increase. The global AAPC of iNTS was 0.951% (95% CI: 0.763-1.140). Among SDI regions, the high-SDI region had the highest AAPC (0.733%, 95% CI: 0.390-1.078). Among GBD regions, Western Europe had the highest AAPC (2.719%), followed by high-income Asia Pacific (1.941%) and high-income North America (1.353%). At the country level, the UK had the highest AAPC (4.857%, 95% CI: 4.348-5.368). In contrast, regions with high absolute iNTS burden, such as Western sub-Saharan Africa (AAPC: -0.0399%) and Nigeria (AAPC: -0.4849%), showed declining trends. Compared with previous all-age analyses, this study provides a pediatric-specific assessment of enteric infections in children aged 0-14 years and explicitly contrasts iNTS trends with DD and TP. Although DD and TP declined substantially, iNTS showed modeled increases globally and in several high-income regions. These findings should be interpreted with caution because GBD estimates depend on data availability, diagnostic capacity, and modeling assumptions. The modeled increases in high-income regions warrant enhanced surveillance, serovar and antimicrobial resistance monitoring, and further investigation.