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CLINIC-BASED SURVEILLANCE FOR BACTERIAL- AND ROTAVIRUS-ASSOCIATED DIARRHEA IN EGYPTIAN CHILDREN

To identify enteropathogens for vaccine development, we implemented clinic-based surveillance for severe pediatric diarrhea in Egypt’s Nile River Delta. Over 2 years, a physician clinically evaluated and obtained stool samples for microbiology from patients with diarrhea and less than 6 years of age. In the first (N = 714) and second clinic (N = 561), respectively, 36% (N = 254) and 46% (N = 260) of children were infected with rotavirus, enterotoxigenic Escherichia coli (ETEC), Campylobacter, or Shigella. When excluding mixed rotavirus-bacterial infections, for the first and second clinic, 23% and 10% had rotavirus-associated diarrhea, and 14% and 17% had ETEC-associated diarrhea, respectively. Campylobacter-associated diarrhea was 1% and 3%, and Shigella-associated diarrhea was 2% and 1%, respectively, for the two clinics. Rotavirus-associated diarrhea peaked in late summer to early winter, while bacterial agents were prevalent during summer. Rotavirus-associated cases presented with dehydration, vomiting, and were often hospitalized. Children with Shigella- or Campylobacter-associated diarrhea reported as watery diarrhea and rarely dysentery. ETEC did not have any clinically distinct characteristics. For vaccine development and/or deployment, our study suggests that rotavirus is of principle concern, followed by ETEC, Shigella, and Campylobacter.

Received April 8, 2005. Accepted for publication June 20, 2005.

Acknowledgments: The authors thank Dr. Anne Marie Svennerholm for providing the reagents used in testing for enterotoxigenic E. coli and Ms. Manal Mostafa for assisting with the data management and analysis of the study. This study was approved by institutional review boards at the Naval Medical Research Unit No. 3 in compliance with all Federal regulations governing the protection of human subjects. All subjects or their guardians gave voluntary, informed consent for participation prior to enrollment in this study.

Financial support: Global Emerging Infections System (GEIS), Work Unit No.: 847705.82000.25GB.E0018

^* Address correspondence to Thomas F. Wierzba, Ph.D., M.P.H., 6190 Kathmandu Place, Dulles, VA 20189. E-mail: wierzbat{at}who.org.np

Authors’ addresses: Thomas F. Wierzba, 6190 Kathmandu Place, Dulles, VA, 20189, Telephone: +977-1-444-4950, Fax: +977-1-553-0150, E-mail: wierzbat{at}who.org.np. Ibrahim Adib Abdel-Messih, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835, Telephone: +20-2-342-1375, Fax: +20-2-342-9625, E-mail: adibi{at}namru3.med.navy.mil. Remon Abu-Elyazeed, 150 Beach Road #22-00, Gateway west, Singapore 189720, Telephone: 65-232 8338, Fax: 65-6732 8678, E-mail: remon.abu-elyazeed{at}gsk.com. Shannon D. Putnam, U.S. Naval Medical Research Unit No. 2, FPO AP 96520, Telephone: +62-21-421-4457, Fax: +62-21-424-4507, E-mail: putnam{at}namru2.org. Karim A. Kamal, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835, Telephone: +20-2-342-1375, Fax: +20-2-342-9625, E-mail: kamalk{at}menanet.net. Patrick Rozmajzl, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, Telephone: 1-301-319-9667, Fax: 301-319-7460, E-mail: rozmajzlp{at}nmrc.navy.mil. Salwa F. Ahmed, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835, Telephone: +20-2-342-1375, Fax: +20-2-342-9625, E-mail: fouads{at}namru3.med.navy.mil. Hind I. Shaheen, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835, Telephone: +20-2-342-1375, Fax: +20-2-342-9625, E-mail: shaheenh{at}namru3.med.navy.mil. Abdel Fatah, Benha Fever Hospital, Benha, Qalubya Governorate, Egypt, Telephone: +20-2-421764, Fax: +20-2-421764. Khaled Zabedy, Abu Homos District Hospital, Beheira Governorate, Egypt, Telephone: +20-45-256 0044, Fax: +20-45-256 0130. John Sanders, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835, Telephone: +20-2-342-1375, Fax: +20-2-342-9625, E-mail: sandersj{at}namru3.navy.med.mil. Robert Frenck, U.S. Naval Medical Research Unit No. 3, PSC 452, Box 5000, FPO AE 09835, Telephone: +20-2-342-1375, Fax: +20-2-342-9625, E-mail: rfrenck{at}uclacvr.labiomed.org.

Reprint requests: Thomas F. Wierzba, Ph.D., M.P.H., 6190 Kath-mandu Place, Dulles, VA 20189, Telephone: +977-1-444-4950, Fax: +977-1-553-0150, E-mail: wierzbat{at}who.org.np.