title: Shigella dysenteriae serotype 1 in west Africa: intervention strategy for an outbreak in Sierra Leone.
abstract: In November 1999, a Médecins Sans Frontières team based in the southeastern part of Sierra Leone reported an increased number of cases of bloody diarrhoea. Shigella dysenteriae serotype 1 (Sd1) was isolated in the early cases. A total of 4218 cases of dysentery were reported in Kenema district from December, 1999, to March, 2000. The overall attack rate was 7.5%. The attack rate was higher among children younger than 5 years than in the rest of the population (11.2% vs 6.8%; relative risk=1.6; 95% CI 1.5-1.8). The case fatality was 3.1%, also higher for children younger than 5 years (6.1% vs 2.1%; relative risk=2.9; 95% CI 2.1-4.1]). Among 583 patients regarded at increased risk of death who were treated with ciprofloxacin in isolation centres, case fatality was 0.9%. A 5-day ciprofloxacin regimen, targeted to the most severe cases of bloody diarrhoea, was highly effective. This is the first time a large outbreak caused by Sd1 has been reported in west Africa.
authors.affiliation: Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. philippe.guerin@epicentre.msf.org
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Guerin
authors.forename: Christopher
authors.initials: C
authors.lastname: Brasher
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Baron
authors.forename: Daniel
authors.initials: D
authors.lastname: Mic
authors.forename: Francine
authors.initials: F
authors.lastname: Grimont
authors.forename: Mike
authors.initials: M
authors.lastname: Ryan
authors.forename: Preben
authors.initials: P
authors.lastname: Aavitsland
authors.forename: Dominique
authors.initials: D
authors.lastname: Legros
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004405:Dysentery, Bacillary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D012703:Serotyping; D012762:Shigella dysenteriae / Q000145:classification; D012807:Sierra Leone / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin