Abstract
BackgroundShigellosis continues to be a public health challenge for developing countries, including Bangladesh. The aim of the study is to demonstrate recent changes in Shigella sero-groups and their geographical diversity.MethodsData were extracted from data archive of four diarrheal disease surveillance systems. A 2% sub sample from urban Dhaka Hospital (2008–2011; n = 10,650), and 10% from urban Mirpur Treatment Centre (2009–2011; n = 3,585), were enrolled systematically; whereas, all patients coming from the Health and Demographic Surveillance System area in rural Matlab (2008–2011; n = 6,399) and rural Mirzapur (2010–2011; n = 2,812) were included irrespective of age, sex, and disease severity. A fresh stool specimen was collected for identification of Shigella spp. Of them, 315 (3%) were positive for Shigella in Dhaka, 490 (8%) from Matlab, 109 (3%) from Mirpur and 369 (13%) from Mirzapur and considered as analyzable sample size.ResultsAmong all Shigella isolates regardless of age, significant decreases in percentage of S. flexneri over time was observed in Mirpur (55→29%; p value of χ2-for trend = 0.019) and Mirzapur (59→47%; p = 0.025). A non-significant decrease was also seen in Dhaka (58→48%), while in Matlab there was a non-significant increase (73→81%). Similar patterns were observed among under-5 children at all sites. Emergence of S. sonnei was found in Dhaka (8→25%; p<0.001) and Mirpur (10→33%; p = 0.015), whereas it decreased in Mirzapur (32→23%; p = 0.056). The emergence of S. boydii was seen in all ages in Mirzapur [(3→28%; p<0.001); (3→27%; p<0.001)]. On the other hand, we saw non-significant percent reductions in S. boydii in Dhaka [overall (25→16%); under-5 (16→9%)]. Decreasing rates of Shigella dysenteriae were observed in Matlab, Mirpur and Mirzapur; whereas, in Dhaka it remained unchanged.Conclusion and SignificanceEmergence of S. sonnei and S. boydii as important infectious diarrhea etiologies and variations in geographical diversity underscore the need for monitoring, with possible implications for vaccine development.
Highlights
Shigellosis, a food-borne illness caused by the genus Shigella, is usually transmitted through person-to-person contact [1]
Considering poor socio-economic status, lesser proportion of individuals with shigellosis belonged to Mirpur compared to others sites
Proportion of individuals having access to sanitary toilets and used antimicrobials before hospital visit was low in rural Matlab
Summary
Shigellosis, a food-borne illness caused by the genus Shigella, is usually transmitted through person-to-person contact [1]. It is one of the most common causes of childhood dysentery and an important infectious cause of morbidity and mortality in children under 5 years of age. A population-based prospective multi-country study in Asia aiming to get a better understanding of the current disease burden, clinical manifestations, and microbiology of shigellosis revealed that Shigella appears to be more universal in Asian impoverished populations than previously estimated and antibiotic-resistant strains of different species and serotypes have emerged [4]. The aim of the study is to demonstrate recent changes in Shigella sero-groups and their geographical diversity
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