TY - JOUR
T1 - Estimating the burden of shigellosis in Thailand
T2 - 36-Month population-based surveillance study
AU - Chompook, Pornthip
AU - Samosornsuk, Seksun
AU - Von Seidlein, Lorenz
AU - Jitsanguansuk, Supot
AU - Sirima, Nunta
AU - Sudjai, Sanit
AU - Mangjit, Prasitchai
AU - Kim, Deok Ryun
AU - Wheeler, Jeremy G.
AU - Todd, Jim
AU - Lee, Hyejon
AU - Ali, Mohammad
AU - Clemens, John
AU - Tapchaisri, Pramuan
AU - Chaicumpa, Wanpen
PY - 2005/10/1
Y1 - 2005/10/1
N2 - Objective: To estimate incidence of shigellosis in the Kaengkhoi district, Saraburi Province, Thailand. Methods: Population-based surveillance of shigellosis based in treatment centres. The detected rates of treated shigellosis were corrected for the number of cases missed due to the low sensitivity of microbiological culture methods and participants' use of health-care providers not participating in the study. Findings: The overall uncorrected incidence of shigellosis was 0.6/1000 population per year (95% confidence interval (CI) = 0.5-0.8). The unadjusted incidence of treated shigellosis was highest among children less than 5 years old (4/1000 children per year; 95% CI = 3-6) and significantly lower among people aged ≥ 5 years (0.3/1000 population per year; 95% CI = 0.2-0.5; P < 0.001). Adjusting for cases likely to be missed as a result of culture and surveillance methods increased estimates approximately five times. The majority of Shigella isolates (122/146; 84%) were S. sonnei; the rest were S. flexneri. Of the 22 S. flexneri isolates, the three most frequently encountered serotypes were 2a (36%), 1b (23%) and 3b (28%). A total of 90-95% of S. sonne/ and S. flexneri isolates were resistant to tetracycline and co-trimoxazole. In contrast to S. sonnei isolates, more than 90% of the S. flexneri isolates were also resistant to ampicillin and chloramphenicol (P < 0.0001). Conclusion: Estimates of incidence of Shigella infection in the community are 10-fold to 100-fold greater than those found from routine government surveillance. The high prevalence of Shigella strains resistant to multiple antibiotics adds urgency to the development of a vaccine to protect against shigellosis in this region of Thailand.
AB - Objective: To estimate incidence of shigellosis in the Kaengkhoi district, Saraburi Province, Thailand. Methods: Population-based surveillance of shigellosis based in treatment centres. The detected rates of treated shigellosis were corrected for the number of cases missed due to the low sensitivity of microbiological culture methods and participants' use of health-care providers not participating in the study. Findings: The overall uncorrected incidence of shigellosis was 0.6/1000 population per year (95% confidence interval (CI) = 0.5-0.8). The unadjusted incidence of treated shigellosis was highest among children less than 5 years old (4/1000 children per year; 95% CI = 3-6) and significantly lower among people aged ≥ 5 years (0.3/1000 population per year; 95% CI = 0.2-0.5; P < 0.001). Adjusting for cases likely to be missed as a result of culture and surveillance methods increased estimates approximately five times. The majority of Shigella isolates (122/146; 84%) were S. sonnei; the rest were S. flexneri. Of the 22 S. flexneri isolates, the three most frequently encountered serotypes were 2a (36%), 1b (23%) and 3b (28%). A total of 90-95% of S. sonne/ and S. flexneri isolates were resistant to tetracycline and co-trimoxazole. In contrast to S. sonnei isolates, more than 90% of the S. flexneri isolates were also resistant to ampicillin and chloramphenicol (P < 0.0001). Conclusion: Estimates of incidence of Shigella infection in the community are 10-fold to 100-fold greater than those found from routine government surveillance. The high prevalence of Shigella strains resistant to multiple antibiotics adds urgency to the development of a vaccine to protect against shigellosis in this region of Thailand.
KW - Bacillary/epidemiology/microbiology
KW - Diarrhea/epidemiology
KW - Drug resistance, Microbial
KW - Dysentery
KW - Epidemiologic surveillance
KW - Health facilities
KW - Shigella flexneri
KW - Shigella sonnei
KW - Shigella/isolation and purification
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M3 - Article
C2 - 16283050
AN - SCOPUS:26944478953
SN - 0042-9686
VL - 83
SP - 739
EP - 746
JO - Bulletin of the World Health Organization
JF - Bulletin of the World Health Organization
IS - 10
ER -