title: Case management of a multidrug-resistant Shigella dysenteriae serotype 1 outbreak in a crisis context in Sierra Leone, 1999-2000.
abstract: From December 1999 to the end of February 2000, 4218 cases of dysentery were reported in Kenema district, southeastern Sierra Leone, by a Médecins Sans Frontières team operating in this region. Shigella dysenteriae serotype 1 was isolated from the early cases. The overall attack rate was 7.5% but higher among children under 5 years (11.2%) compared to the rest of the population (6.8%) (RR = 1.6; 95% CI 1.5-1.8). The case fatality ratio was 3.1%, and higher for children under 5 years (6.1% vs. 2.1%) (RR = 2.9; 95% CI 2.1-4.1). A case management strategy based on stratification of affected cases was chosen in this resource-poor setting. Patients considered at higher risk of death were treated with a 5 day ciprofloxacin regimen in isolation centres. Five hundred and eighty-three cases were treated with a case fatality ratio of 0.9%. Patients who did not have signs of severity when seen by health workers were given hygiene advice and oral rehydration salts. This strategy was effective in this complex emergency.
authors.affiliation: Epicentre, 8 rue Saint Sabin, 75011 Paris, France. philippe.guerin@epicentre.msf.org
authors.forename: P J
authors.initials: PJ
authors.lastname: Guerin
authors.forename: C
authors.initials: C
authors.lastname: Brasher
authors.forename: E
authors.initials: E
authors.lastname: Baron
authors.forename: D
authors.initials: D
authors.lastname: Mic
authors.forename: F
authors.initials: F
authors.lastname: Grimont
authors.forename: M
authors.initials: M
authors.lastname: Ryan
authors.forename: P
authors.initials: P
authors.lastname: Aavitsland
authors.forename: D
authors.initials: D
authors.lastname: Legros
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004351:Drug Resistance; D004405:Dysentery, Bacillary / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012703:Serotyping; D017678:Sex Distribution; D012762:Shigella dysenteriae / Q000145:classification / Q000302:isolation & purification*; D012807:Sierra Leone / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin