Could a Shigella vaccine impact long-term health outcomes?: Summary report of an expert meeting to inform a Shigella vaccine public health value proposition, March 24 and 29, 2021

Bagamian, Karoun H.; Puett, Chloe; Anderson, J. D.; Muhib, Farzana; Pecenka, Clint; Behrman, Jere R.; Breiman, Robert F.; Edoka, Ijeoma; Horton, Susan; Kang, Gagandeep; Kotloff, Karen L.; Lanata, Claudio F.; Platts-Mills, James A; Qadri, Firdausi; McQuade, Elizabeth T Rogawski; Sudfeld, Christopher R.; Vonaesch, Pascale; Wierzba, Thomas F.; Scheele, Suzanne

doi:10.1016/j.jvacx.2022.100218

Cited by 6 publications

(10 citation statements)

References 51 publications

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“…Shigellosis is known as the second-leading cause of fatal diarrhea worldwide [ 14 ]. Shigellosis in Saudi Arabia was relatively low over the study period from 2018 to 2021 (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of Reportable Bacterial Infectious Diseases in Saudi Arabia

Alhumaid,

Alajmi,

Alosaimi

et al. 2024

Infect Dis Ther

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Introduction Bacterial infections have a significant impact on human health; they can cause severe morbidity and mortality, particularly in susceptible populations. Epidemiological surveillance is a critical tool for monitoring the population's health and facilitate the prevention and control of infectious disease outbreaks. Knowing the burden of bacterial communicable diseases is an initial core step toward public health goals. Methods Saudi epidemiology surveillance data were utilized to depict the changing epidemiology of bacterial infectious diseases in Saudi Arabia from 2018 to 2021. The cumulative numbers of cases, demographics, and incidence rates were analyzed and visualized. Parametric tests were used to compare the difference in the mean values between categorical variables. Regression analysis was employed to estimate trends in disease rates over time. Statistical significance was set at p value ≤ 0.05. Results The results revealed that brucellosis, tuberculosis, and salmonellosis were the most frequently reported bacterial infectious diseases in Saudi Arabia. Males were more significantly affected by brucellosis and tuberculosis infections than females. Salmonellosis infections were more significant among Saudi citizens, while pulmonary tuberculosis was more significant in non-Saudis. Interestingly, there was a decline in the incidence rates of numerous bacterial infectious diseases during the Coronavirus Disease 2019 (COVID-19) pandemic and COVID-19 restrictions. Some bacterial infectious diseases were rarely reported in Saudi Arabia, including syphilis and diphtheria. Conclusions The future perspective of this research is to enhance disease surveillance reporting by including different variables, such as the source of infection, travel history, hospitalization, and mortality rates. The aim is to improve the sensitivity and specificity of surveillance data and focus on the mortality associated with bacterial pathogens to identify the most significant threats and set a public health priority.

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“…Shigellosis is known as the second-leading cause of fatal diarrhea worldwide [ 14 ]. Shigellosis in Saudi Arabia was relatively low over the study period from 2018 to 2021 (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Epidemiology of Reportable Bacterial Infectious Diseases in Saudi Arabia

Alhumaid,

Alajmi,

Alosaimi

et al. 2024

Infect Dis Ther

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“… 22 Taken together, these data favour delivery of the first dose of a two-dose series by 6 months of age. 17 …”

Section: Assessing the Valuementioning

confidence: 99%

“…A plausible estimate of the effect of a single Shigella- attributable diarrhoea episode would be a 0.03 length-for-age z-score decrement for children younger than 2 years, with a cumulative upper bound for all Shigella episodes of a 0.15 length-for-age z-score decrement. 17 In contrast, the association of asymptomatic shigellosis with stunting is less well established. Given the current lack of evidence that Shigella vaccines could fully prevent infections (i.e.…”

Section: Assessing the Valuementioning

confidence: 99%

“…induce sterilizing immunity), we considered it too early to include asymptomatic shigellosis in vaccine modelling efforts. 17 …”

Section: Assessing the Valuementioning

confidence: 99%

“…Hypotheses regarding the underlying mechanisms by which Shigella and other entero-invasive pathogens may lead to stunting involve intestinal tract disruption, including the inflammation and intestinal tract atrophy that are hallmarks of environmental enteric dysfunction. 17 Uncertainties remain whether a vaccine that is effective against shigellosis but not infection itself would affect these underlying mechanisms. Nonetheless, parenterally administered conjugate vaccines targeting other pathogens such as pneumococcus have demonstrated a substantial impact on bacterial mucosal colonization.…”

Section: Assessing the Valuementioning

confidence: 99%

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Reassessing potential economic value and health impact of effective Shigella vaccines

Hausdorff,

Anderson,

Bourgeois

et al. 2024

Bull World Health Organ

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The gram-negative bacterium Shigella is a leading cause of diarrheal morbidity and mortality in children in low- and middle-income countries. Several promising vaccine candidates are in late stages of clinical development against this increasingly antibiotic-resistant pathogen. However, considering the increasingly crowded and costly paediatric immunization schedule, and likely advent of other important new vaccines, it is unclear whether introduction of a Shigella vaccine would represent a high priority for international agencies or health ministries in low- and middle-income countries. To determine whether there is a compelling public health value proposition for a Shigella vaccine, we used the World Health Organization’s Full Value of Vaccine Assessment analytic framework and formulated five broad scientific, policy, economic and commercial-related propositions regarding the development of a Shigella vaccine. We also explored the current regulatory, clinical, policy and commercial challenges to a Shigella -containing combination vaccine development and adoption. Through a series of literature reviews, expert consultations, social science field studies and model-based analyses, we addressed each of these propositions. As described in a series of separate publications that are synthesized here, we concluded that the economic and public health value of a Shigella vaccine may be greater than previously recognized, particularly if it is found to also be effective against less severe forms of diarrheal disease and childhood stunting. The decision by pharmaceutical companies to develop a standalone vaccine or a multipathogen combination will be a key factor in determining its relative prioritization by various stakeholders in low- and middle-income countries.

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