Shigella dysenteriae serotype 1 in west Africa: intervention strategy for an outbreak in Sierra Leone.
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.
Guerin
Philippe J
PJ
Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. philippe.guerin@epicentre.msf.org
Brasher
Christopher
C
Baron
Emmanuel
E
Mic
Daniel
D
Grimont
Francine
F
Ryan
Mike
M
Aavitsland
Preben
P
Legros
Dominique
D
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
D000890:Anti-Infective Agents; D002939:Ciprofloxacin