title: Clinic-based surveillance for bacterial- and rotavirus-associated diarrhea in Egyptian children.
abstract: To identify enteropathogens for vaccine development, we implemented clinic-based surveillance for severe pediatric diarrhea in Egypt's Nile River Delta. Over 2 years, a physician clinically evaluated and obtained stool samples for microbiology from patients with diarrhea and less than 6 years of age. In the first (N = 714) and second clinic (N = 561), respectively, 36% (N = 254) and 46% (N = 260) of children were infected with rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter, or Shigella. When excluding mixed rotavirus-bacterial infections, for the first and second clinic, 23% and 10% had rotavirus-associated diarrhea, and 14% and 17% had ETEC-associated diarrhea, respectively. Campylobacter-associated diarrhea was 1% and 3%, and Shigella-associated diarrhea was 2% and 1%, respectively, for the two clinics. Rotavirus-associated diarrhea peaked in late summer to early winter, while bacterial agents were prevalent during summer. Rotavirus-associated cases presented with dehydration, vomiting, and were often hospitalized. Children with Shigella- or Campylobacter-associated diarrhea reported as watery diarrhea and rarely dysentery. ETEC did not have any clinically distinct characteristics. For vaccine development and/or deployment, our study suggests that rotavirus is of principle concern, followed by ETEC, Shigella, and Campylobacter.
authors.affiliation: U.S. Naval Medical Research Unit No. 3, Cairo, Arab Republic of Egypt. wierzbat@who.org.np
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
authors.forename: Ibrahim Adib
authors.initials: IA
authors.lastname: Abdel-Messih
authors.forename: Remon
authors.initials: R
authors.lastname: Abu-Elyazeed
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Putnam
authors.forename: Karim A
authors.initials: KA
authors.lastname: Kamal
authors.forename: Patrick
authors.initials: P
authors.lastname: Rozmajzl
authors.forename: Salwa F
authors.initials: SF
authors.lastname: Ahmed
authors.forename: Abdel
authors.initials: A
authors.lastname: Fatah
authors.forename: Khaled
authors.initials: K
authors.lastname: Zabedy
authors.forename: Hind I
authors.initials: HI
authors.lastname: Shaheen
authors.forename: John
authors.initials: J
authors.lastname: Sanders
authors.forename: Robert
authors.initials: R
authors.lastname: Frenck
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011159:Population Surveillance; D012400:Rotavirus Infections / Q000453:epidemiology*; D012621:Seasons