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EPIDEMIOLOGY OF SHIGELLA-ASSOCIATED DIARRHEA IN RURAL EGYPTIAN CHILDREN

During the period from February 1995 to February 1998, the epidemiology of Shigella diarrhea was studied among children less than three years of age residing in Egypt’s Nile Delta. Children were visited twice a week and a stool sample was collected from any of them with diarrhea. The incidence of Shigella-associated diarrhea was 0.2 episodes/child-year, with S. flexneri being the most common serogroup isolated (55% of Shigella episodes). Younger age and the warm months increased the risk of developing Shigella-associated diarrhea, while breastfeeding was protective. Children with Shigella were ill for a mean of four days and passed a mean of six stools per day. Common symptoms included fever (35%), vomiting (19%), and dehydration (16%). Dysentery, however, was unusual, occurring in only 11% of the cases. In conclusion, Shigella-associated diarrhea remains relatively common in Egyptian children and supports the need for additional control measures including vaccine development.

Received December 23, 2003. Accepted for publication March 22, 2004.

Acknowledgments: We thank the children who participated in the study and their families; the staff of the Abu-Homos Field Research and Training Center for their contributions to field and laboratory work; and Drs. Badria Z. Morsy (Director General) and Mahmoud Abu El Nasr (First Undersecretary, Ministry of Health and Population of Egypt) for their support. We also thank Khaled Hassan and Dr. Atef El-Gendy (U.S. Naval Medical Research Unit No. 3) for their technical support.

Financial support: This work is supported by the U.S. Army Medical Research and Development Command (Fort Detrick, Frederick, MD), the Naval Medical Research Center (Bethesda, MD) work units M00101.HIX.3421 and M00101.PIX.3270, the Global Program on Vaccines and Immunization of the World Health Organization (Geneva, Switzerland), and the National Institute of Child Health and Human Development, National Institutes of Health (Bethesda, MD).

Disclaimer: The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of the Navy, the U.S. Department of Defense, the U.S. Government, the World Health Organization, or the Egyptian Ministry of Health.

Authors’ addresses: Remon R. Abu-Elyazeed, Thomas F. Wierzba, Robert W. Frenck, Karim A. Kamal, and Ibrahim A. Abd-El Messih, U.S. Naval Medical Research Unit No. 3, Cairo, Egypt, Telephone: 20-2-342-1381, Fax: 20-2-342-1382, E-mail: frenckr{at}namru3.org. Shannon D. Putnam, U.S. Naval Medical Research Unit No. 2, Jakarta, Indonesia. Malla R. Rao and Abdollah B. Naficy, National Institute of Child Health and Human Development, Building 31, Roonm 2A32, MSC 2425, National Institutes of Health, 31 Center Drive, Bethesda, MD 20892-2425. Stephen J. Saravino, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910. Leonard F. Peruski Jr., Indiana University School of Medicine, 3400 Broadway, Gary, IN 46408. Sahar A. El-Alkamy, Abu Homos Field Research and Training Center, Egyptian Ministry of Health and Population, Beheira, Egypt. John D. Clemens, International Vaccine Institute, Seoul, Korea.