title: A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology.
abstract: BACKGROUND
  The burden of shigellosis is greatest in resource-poor countries. Although this diarrheal disease has been thought to cause considerable morbidity and mortality in excess of 1,000,000 deaths globally per year, little recent data are available to guide intervention strategies in Asia. We conducted a prospective, population-based study in six Asian countries to gain a better understanding of the current disease burden, clinical manifestations, and microbiology of shigellosis in Asia.
  
  
  RESULTS
  Over 600,000 persons of all ages residing in Bangladesh, China, Pakistan, Indonesia, Vietnam, and Thailand were included in the surveillance. Shigella was isolated from 2,927 (5%) of 56,958 diarrhoea episodes detected between 2000 and 2004. The overall incidence of treated shigellosis was 2.1 episodes per 1,000 residents per year in all ages and 13.2/1,000/y in children under 60 months old. Shigellosis incidence increased after age 40 years. S. flexneri was the most frequently isolated Shigella species (1,976/2,927 [68%]) in all sites except in Thailand, where S. sonnei was most frequently detected (124/146 [85%]). S. flexneri serotypes were highly heterogeneous in their distribution from site to site, and even from year to year. PCR detected ipaH, the gene encoding invasion plasmid antigen H in 33% of a sample of culture-negative stool specimens. The majority of S. flexneri isolates in each site were resistant to amoxicillin and cotrimoxazole. Ciprofloxacin-resistant S. flexneri isolates were identified in China (18/305 [6%]), Pakistan (8/242 [3%]), and Vietnam (5/282 [2%]).
  
  
  CONCLUSIONS
  Shigella appears to be more ubiquitous in Asian impoverished populations than previously thought, and antibiotic-resistant strains of different species and serotypes have emerged. Focusing on prevention of shigellosis could exert an immediate benefit first by substantially reducing the overall diarrhoea burden in the region and second by preventing the spread of panresistant Shigella strains. The heterogeneous distribution of Shigella species and serotypes suggest that multivalent or cross-protective Shigella vaccines will be needed to prevent shigellosis in Asia.
authors.affiliation: International Vaccine Institute, Seoul, Korea. lseidlein@ivi.int
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: Deok Ryun
authors.initials: DR
authors.lastname: Kim
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.forename: Hyejon
authors.initials: H
authors.lastname: Lee
authors.forename: Xuanyi
authors.initials: X
authors.lastname: Wang
authors.forename: Vu Dinh
authors.initials: VD
authors.lastname: Thiem
authors.forename: Do Gia
authors.initials: DG
authors.lastname: Canh
authors.forename: Wanpen
authors.initials: W
authors.lastname: Chaicumpa
authors.forename: Magdarina D
authors.initials: MD
authors.lastname: Agtini
authors.forename: Anowar
authors.initials: A
authors.lastname: Hossain
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Carl
authors.initials: C
authors.lastname: Mason
authors.forename: Ornthipa
authors.initials: O
authors.lastname: Sethabutr
authors.forename: Kaisar
authors.initials: K
authors.lastname: Talukder
authors.forename: G B
authors.initials: GB
authors.lastname: Nair
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Deen
authors.forename: Karen
authors.initials: K
authors.lastname: Kotloff
authors.forename: John
authors.initials: J
authors.lastname: Clemens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003967:Diarrhea / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology*; D004405:Dysentery, Bacillary / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012760:Shigella / Q000302:isolation & purification; D012762:Shigella dysenteriae / Q000302:isolation & purification