title: Shigella isolates from the global enteric multicenter study inform vaccine development.
abstract: BACKGROUND
  Shigella, a major diarrheal disease pathogen worldwide, is the target of vaccine development. The Global Enteric Multicenter Study (GEMS) investigated burden and etiology of moderate-to-severe diarrheal disease in children aged <60 months and matched controls without diarrhea during 3 years at 4 sites in Africa and 3 in Asia. Shigella was 1 of the 4 most common pathogens across sites and age strata. GEMS Shigella serotypes are reviewed to guide vaccine development.
  
  
  METHODS
  Subjects' stool specimens/rectal swabs were transported to site laboratories in transport media and plated onto xylose lysine desoxycholate and MacConkey agar. Suspect Shigella colonies were identified by biochemical tests and agglutination with antisera. Shigella isolates were shipped to the GEMS Reference Laboratory (Baltimore, MD) for confirmation and serotyping of S. flexneri; one-third of isolates were sent to the Centers for Disease Control and Prevention for quality control.
  
  
  RESULTS
  Shigella dysenteriae and S. boydii accounted for 5.0% and 5.4%, respectively, of 1130 Shigella case isolates; S. flexneri comprised 65.9% and S. sonnei 23.7%. Five serotypes/subserotypes comprised 89.4% of S. flexneri, including S. flexneri 2a, S. flexneri 6, S. flexneri 3a, S. flexneri 2b, and S. flexneri 1b.
  
  
  CONCLUSIONS
  A broad-spectrum Shigella vaccine must protect against S. sonnei and 15 S. flexneri serotypes/subserotypes. A quadrivalent vaccine with O antigens from S. sonnei, S. flexneri 2a, S. flexneri 3a, and S. flexneri 6 can provide broad direct coverage against these most common serotypes and indirect coverage against all but 1 (rare) remaining subserotype through shared S. flexneri group antigens.
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Sofie
authors: S
authors: Livio
authors: Escherichia and Shigella Reference Unit, Enteric Diseases Laboratory Branch Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Nancy A
authors: NA
authors: Strockbine
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Sandra
authors: S
authors: Panchalingam
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Sharon M
authors: SM
authors: Tennant
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Eileen M
authors: EM
authors: Barry
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Mark E
authors: ME
authors: Marohn
authors: Medical Research Council Unit (United Kingdom), Fajara, The Gambia.
authors: Martin
authors: M
authors: Antonio
authors: International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
authors: Anowar
authors: A
authors: Hossain
authors: Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique and the Centre de Recerca en Salut Internacional de Barcelona, Hospital Clinic/Universitat de Barcelona, Spain.
authors: Inacio
authors: I
authors: Mandomando
authors: Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
authors: John B
authors: JB
authors: Ochieng
authors: Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
authors: Joseph O
authors: JO
authors: Oundo
authors: Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors: Shahida
authors: S
authors: Qureshi
authors: National Institute of Cholera and Enteric Diseases, Kolkata, India.
authors: Thandavarayan
authors: T
authors: Ramamurthy
authors: Centre pour le Développement des Vaccins du Mali, Bamako, Mali.
authors: Boubou
authors: B
authors: Tamboura
authors: Medical Research Council Unit (United Kingdom), Fajara, The Gambia.
authors: Richard A
authors: RA
authors: Adegbola
authors: Medical Research Council Unit (United Kingdom), Fajara, The Gambia.
authors: Mohammed Jahangir
authors: MJ
authors: Hossain
authors: Medical Research Council Unit (United Kingdom), Fajara, The Gambia.
authors: Debasish
authors: D
authors: Saha
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Sunil
authors: S
authors: Sen
authors: International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
authors: Abu Syed Golam
authors: AS
authors: Faruque
authors: Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique and the Centre de Recerca en Salut Internacional de Barcelona, Hospital Clinic/Universitat de Barcelona, Spain.
authors: Pedro L
authors: PL
authors: Alonso
authors: Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors: Robert F
authors: RF
authors: Breiman
authors: Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan.
authors: Anita K M
authors: AK
authors: Zaidi
authors: National Institute of Cholera and Enteric Diseases, Kolkata, India Program for Appropriate Technology in Health (PATH), New Delhi, India.
authors: Dipika
authors: D
authors: Sur
authors: Centre pour le Développement des Vaccins du Mali, Bamako, Mali.
authors: Samba O
authors: SO
authors: Sow
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore US Food and Drug Administration, Rockville.
authors: Lynette Y
authors: LY
authors: Berkeley
authors: Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Ciara E
authors: CE
authors: O'Reilly
authors: Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Eric D
authors: ED
authors: Mintz
authors: Department of Veterans Affairs, Cooperative Studies Program Coordinating Center, Perry Point, Maryland.
authors: Kousick
authors: K
authors: Biswas
authors: Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors: Dani
authors: D
authors: Cohen
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Tamer H
authors: TH
authors: Farag
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Dilruba
authors: D
authors: Nasrin
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Yukun
authors: Y
authors: Wu
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: William C
authors: WC
authors: Blackwelder
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Karen L
authors: KL
authors: Kotloff
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: James P
authors: JP
authors: Nataro
authors: Center for Vaccine Development, University of Maryland School of Medicine, Baltimore.
authors: Myron M
authors: MM
authors: Levine
mesh_terms: D000349:Africa / Q000453:epidemiology; D000372:Agglutination Tests; D001208:Asia / Q000453:epidemiology; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D002675:Child, Preschool; D055808:Drug Discovery / Q000379:methods*; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012703:Serotyping; D012760:Shigella / Q000145:classification* / Q000302:isolation & purification*; D022281:Shigella Vaccines / Q000276:immunology* / Q000302:isolation & purification*
chemical_list: D022281:Shigella Vaccines
keywords: Shigella; serotyping; shigellosis; vaccines