Epidemiology of highly endemic multiply antibiotic-resistant shigellosis in children in the Peruvian Amazon.
Journal Article (Journal Article)
Objective
Our goal was to estimate the impact of a Shigella vaccine in an area where shigellosis is endemic by characterizing the disease burden and antibiotic-resistance profiles of isolates and by determining the prevalence of Shigella flexneri serotypes.Patients and methods
We conducted a 43-month-long prospective, community-based diarrheal disease surveillance in 442 children <72 months of age in the Peruvian Amazon between October 1, 2002, and April 15, 2006.Results
The incidence of diarrheal disease was 4.38 episodes per child-year. The incidence rate for shigellosis was 0.34 episodes per child-year in children <72 months of age and peaked in children between 12 and 23 months at 0.43 episodes per child-year. Maternal education at or beyond the primary grade level, piped water supply, weight-for-age z score, and improved water-storage practices were the most significant determinants of disease in this community with living conditions comparable to many rural areas in the developing world.Conclusions
Children living in this region had a 20-fold higher rate of disease incidence detected by active surveillance as those recently estimated by passive detection. Most symptomatic disease was caused by S flexneri, although the diversity of serotypes will require a multivalent vaccine to have a significant impact on the burden of disease caused by shigellosis. Several other public health disease-control interventions targeted at water source and improved storage, nutritional interventions, and improved maternal education seem to have a greater impact than a univalent S flexneri 2a vaccine.Full Text
Duke Authors
Cited Authors
- Kosek, M; Yori, PP; Pan, WK; Olortegui, MP; Gilman, RH; Perez, J; Chavez, CB; Sanchez, GM; Burga, R; Hall, E
Published Date
- September 2008
Published In
Volume / Issue
- 122 / 3
Start / End Page
- e541 - e549
PubMed ID
- 18710884
Pubmed Central ID
- PMC6204332
Electronic International Standard Serial Number (EISSN)
- 1098-4275
International Standard Serial Number (ISSN)
- 0031-4005
Digital Object Identifier (DOI)
- 10.1542/peds.2008-0458
Language
- eng