Syndromic gastrointestinal panel diagnostic tests have changed our understanding of the epidemiology of Yersinia enterocolitica—Foodborne Diseases Active Surveillance Network, 2010–2021

Abstract Background In the United States, Yersinia enterocolitica causes a diarrheal disease historically associated with winter months and understood to predominantly occur among Black or African American infants and Asian children. Clinical laboratory adoption of culture-independent diagnostic tests (CIDTs), in place of culture methods has led to marked increases in diagnoses. Methods We describe laboratory-diagnosed infections caused by Y. enterocolitica in 10 state health departments of the Foodborne Diseases Active Surveillance Network. A counterfactual random forest model was used to identify individual, and community-level social determinants of health associated with the type of test used to detect Y. enterocolitica. Results Annual reported incidence of Y. enterocolitica infection increased from 0.3 per 100,000 in 2010 to 1.3 per 100,000 in 2021. The proportion of infections detected by CIDT increased from 3% in 2012 to 89% in 2021. Nearly all (97%) CIDT-positive infections were detected by commercially available syndromic gastrointestinal panel tests. Reported incidence increased for adults ≥18 years, regardless of race and ethnicity. Nearly half of infections occurred during May to September in 2016–2021. The probability of CIDT-detected infection increased with age and was greater for White compared with Asian persons. In addition to year, an ill person’s location of residence had a significant impact on odds of infection detection by CIDT versus culture method. Conclusions Improved detection due to increased use of CIDTs has altered our understanding of yersinosis epidemiology. Our findings suggest that yersinosis diagnosis quantitatively varies between demographic groups by diagnostic method and that differential access to CIDTs may still affect our understanding of yersinosis epidemiology.