Shigella in Africa: new insights from the Vaccine Impact on Diarrhea in Africa (VIDA) Study

Irene N Kasumba, Henry Badji, Helen Powell, M Jahangir Hossain, Richard Omore, Samba O Sow, Jennifer R Verani, James A Platts-Mills, Marc-Alain Widdowson, Syed M A Zaman, Jennifer Jones, Sunil Sen, Jasnehta Permala-Booth, Shamima Nasrin, Anna Roose, Dilruba Nasrin, John Benjamin Ochieng, Jane Juma, Sanogo Doh, Joquina Chiquita M JonesMartin Antonio, Alex O Awuor, Ciara E Sugerman, Nora Watson, Christopher Focht, Jie Liu, Eric Houpt, Karen L Kotloff, Sharon M Tennant

Research output: Contribution to journalA1: Web of Science-articlepeer-review

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Abstract

BACKGROUND: We evaluated the burden of Shigella spp from children aged 0-59 months with medically attended moderate-to-severe diarrhea and matched controls at sites in Mali, The Gambia, and Kenya participating in the Vaccine Impact on Diarrhea in Africa (VIDA) study from 2015 to 2018.

METHODS: Shigella spp were identified using coprocultures and serotyping in addition to quantitative polymerase chain reaction (qPCR). Episode-specific attributable fractions (AFe) for Shigella were calculated using Shigella DNA quantity; cases with AFe ≥0.5 were considered to have shigellosis.

RESULTS: The prevalence of Shigella was determined to be 359 of 4840 (7.4%) cases and 83 of 6213 (1.3%) controls by culture, and 1641 of 4836 (33.9%) cases and 1084 of 4846 (22.4%) controls by qPCR (cycle threshold <35); shigellosis was higher in The Gambia (30.8%) than in Mali (9.3%) and Kenya (18.7%). Bloody diarrhea attributed to Shigella was more common in 24- to 59-month-old children (50.1%) than 0- to 11-month-old infants (39.5%). The Shigella flexneri serogroup predominated among cases (67.6% of isolates), followed by Shigella sonnei (18.2%), Shigella boydii (11.8%), and Shigella dysenteriae (2.3%). The most frequent S. flexneri serotypes were 2a (40.6%), 1b (18.8%), 6 (17.5%), 3a (9.0%), and 4a (5.1%). Drug-specific resistance among 353 (98.3%) Shigella cases with AMR data was as follows: trimethoprim-sulfamethoxazole (94.9%), ampicillin (48.4%), nalidixic acid (1.7%), ceftriaxone (0.3%), azithromycin (0.3%), and ciprofloxacin (0.0%).

CONCLUSIONS: A high prevalence of shigellosis continues in sub-Saharan Africa. Strains are highly resistant to commonly used antibiotics while remaining susceptible to ciprofloxacin, ceftriaxone, and azithromycin.

Original languageEnglish
JournalClinical Infectious Diseases
Volume76
Issue numberSuppl.1
Pages (from-to)S66-S76
Number of pages11
ISSN1058-4838
DOIs
Publication statusPublished - 2023

Keywords

  • Child
  • Infant
  • Humans
  • Child, Preschool
  • Infant, Newborn
  • Dysentery, Bacillary/epidemiology
  • Azithromycin
  • Ceftriaxone
  • Shigella
  • Anti-Bacterial Agents/therapeutic use
  • Ciprofloxacin
  • Diarrhea/epidemiology
  • Mali/epidemiology
  • Microbial Sensitivity Tests

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