Epidemiology of Highly Endemic Multiply Antibiotic-Resistant Shigellosis in Children in the Peruvian Amazon

Abstract

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.

Risk Factors for Diarrhea in Children Under Five Years of Age Residing in Peri-urban Communities in Cochabamba, Bolivia

“…22 A few studies have assessed risk factors for diarrhea by enteric pathogens. In Kosek and others, 9 age, maternal education, floor type, and rainy season were found to be significant risk factors for shigellosis in children 5 years of age. For Campylobacter, maternal education and household water connection were found to be significant risk factors for this age group.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]41 These risk factors were on water, sanitation, hygiene, and knowledge of the causes of childhood diarrheal disease and prevention. All of these variables were obtained from the baseline KPC survey administered to the primary caregiver in each household.…”

“…In Cochabamba, Bolivia, the site of this study, the most recent government survey from 2008 reported a diarrhea prevalence of 36.2% for children 5 years of age for the department. 2 Previous studies have identified risk factors for diarrhea such as younger age, 3,4 male gender, 4,5 early weaning, 5-8 seasonal patterns, 5,7,9 low maternal education, 5,9,10 lack of piped water supply, 9,[11][12][13][14][15] poor water-storage practices, 9,14-18 younger maternal age, 11,12 lack of hand washing with soap by caregiver, 18,19 poor sanitation, 9,16,18,20,21 visible feces in the yard, 4 indiscriminate disposal of child feces, 17 unsatisfactory garbage disposal, 11 shorter boiling time, 13 using water from cistern trucks, 13 and not treating water in the home. 13 In a recent multisite study it was found that rotavirus was the most common cause of moderate to severe diarrhea in children 0-23 months of age, and shigellosis for the age group 24-59 months of age.…”

Sustained Uptake of a Hospital-Based Handwashing with Soap and Water Treatment Intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): A Randomized Controlled Trial

“…1 Previous studies have identified lack of caregiver handwashing with soap and drinking water treatment, poor water storage practices, and lack of caregiver knowledge of diarrhea prevention as important risk factors for diarrheal disease in pediatric populations. [2][3][4][5][6][7][8] Water, sanitation, and hygiene (WASH) interventions promoting household chlorination of drinking water and handwashing with soap have the potential to reduce diarrheal disease incidence in children less than 5 years of age by an estimated rate of 20-40%. [9][10][11] However, in many low-income countries, community-based WASH interventions are often difficult to implement in urban settings because of limited community health work infrastructure.…”

Caracterización molecular de aislamientos de Shigella sonnei recuperados en el Programa de Vigilancia por el Laboratorio de la Enfermedad Diarreica Aguda en Colombia

“…incluye la ampicilina, el trimetoprim-sulfametoxazol y el ácido nalidíxico, pero debido al aumento a nivel mundial de la resistencia de Shigella spp. a la mayoría de estos antibióticos (6), se recomienda la ciprofloxacina como el medicamento de elección para pacientes con shigelosis de cualquier grupo de edad (7,8).…”