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OCCURRENCE OF SHIGELLOSIS IN THE YOUNG AND ELDERLY IN RURAL CHINA: RESULTS OF A 12-MONTH POPULATION-BASED SURVEILLANCE STUDY

In 2002, population- and treatment center–based surveillance was used to study the disease burden of shigellosis in rural Hebei Province in the People’s Republic of China. A total of 10,105 children with diarrhea or dysentery were enrolled. Infants were treated most frequently for diarrhea (1,388/1,000/year) followed by children 5 years old (618/1,000/year). Shigellosis was treated most often in children 3–4 years old (32/1,000/year) and people > 60 years of age (7/1,000/year). Fifty-six percent (184 of 331) Shigella isolates were detected in patients who had non-bloody diarrhea. Shigella flexneri was identified in 93% of 306 isolates. The most common S. flexneri serotypes were 1a (34%), X (33%), and 2a (28%). More than 90% of the Shigella isolates were resistant to cotrimoxazole and nalidixic acid, but remained susceptible to ciprofloxacin, norfloxacin, and gentamicin. Widespread resistance to antibiotics adds urgency to the development and use of vaccines to control shigellosis.

Received September 7, 2004. Accepted for publication February 28, 2005.

Acknowledgments: We thank the people of Zhengding County who participated in the study and the dedicated staff of the Zhengding Center for Disease Control and Prevention who made this study possible, the Jiangsu Center of Disease Control and Prevention for help with microbiology testing in Shanghai, Dr. Carl Mason and colleagues at the United States Armed Forces Research Institute of Medical Sciences (Bangkok, Thailand) for providing technical advice, and Dr. Jinkyoung Park (International Vaccine Institute) for the help with data management.

Financial support: This work was supported by the Diseases of the Most Impoverished Program, funded by the Bill and Melinda Gates Foundation, and coordinated by the International Vaccine Institute.

^* Address correspondence to Dr. Xuan-Yi Wang, International Vaccine Institute, Seoul, South Korea and Department of Molecular Virology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China. E-mail: xywang{at}ivi.int

Authors’ addresses: Xuan-Yi Wang and Zhi-Yi Xu, International Vaccine Institute, Seoul, South, Korea and Department of Molecular Virology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China, E-mails: xywang{at}ivi.int and xuzhiyi{at}ivi.int. Lin Du, Lanzhou Vaccine Institute, Lanzhou, People’s Republic of China. Lorenz von Seidlein, Oak-Pil Han, Hye-Jon Lee, Mohammad Ali, and John Clemens, International Vaccine Institute, Seoul, South Korea, E-mails: lseidlein{at}ivi.int, opham{at}ivi.int, hjlee{at}ivi.int, mali{at}ivi.int, and jclemens{at}ivi.int. Ying-Lin Zhang, Zhi-Yong Hao, Jing-Chen Ma, Chang-Quan Han, Zhan-Chun Xing, and Ji-Chao Chen, Center for Disease Control and Prevention of Zhengding County, Shijiazhuang, Hebei Province, People’s Republic of China.