Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
PLoS One. 2013 Apr 29;8(4):e62029. doi: 10.1371/journal.pone.0062029. Print 2013.
Shigellosis continues to be a public health challenge for developing countries, including Bangladesh. The aim of the study is to demonstrate recent changes in Shigella sero-groups and their geographical diversity.
Data were extracted from data archive of four diarrheal disease surveillance systems. A 2% sub sample from urban Dhaka Hospital (2008-2011; n = 10,650), and 10% from urban Mirpur Treatment Centre (2009-2011; n = 3,585), were enrolled systematically; whereas, all patients coming from the Health and Demographic Surveillance System area in rural Matlab (2008-2011; n = 6,399) and rural Mirzapur (2010-2011; n = 2,812) were included irrespective of age, sex, and disease severity. A fresh stool specimen was collected for identification of Shigella spp. Of them, 315 (3%) were positive for Shigella in Dhaka, 490 (8%) from Matlab, 109 (3%) from Mirpur and 369 (13%) from Mirzapur and considered as analyzable sample size.
Among all Shigella isolates regardless of age, significant decreases in percentage of S. flexneri over time was observed in Mirpur (55→29%; p value of χ(2)-for trend = 0.019) and Mirzapur (59→47%; p = 0.025). A non-significant decrease was also seen in Dhaka (58→48%), while in Matlab there was a non-significant increase (73→81%). Similar patterns were observed among under-5 children at all sites. Emergence of S. sonnei was found in Dhaka (8→25%; p<0.001) and Mirpur (10→33%; p = 0.015), whereas it decreased in Mirzapur (32→23%; p = 0.056). The emergence of S. boydii was seen in all ages in Mirzapur [(3→28%; p<0.001); (3→27%; p<0.001)]. On the other hand, we saw non-significant percent reductions in S. boydii in Dhaka [overall (25→16%); under-5 (16→9%)]. Decreasing rates of Shigella dysenteriae were observed in Matlab, Mirpur and Mirzapur; whereas, in Dhaka it remained unchanged.
Emergence of S. sonnei and S. boydii as important infectious diarrhea etiologies and variations in geographical diversity underscore the need for monitoring, with possible implications for vaccine development.
志贺菌感染仍是包括孟加拉国在内的发展中国家的公共卫生挑战。本研究旨在展示志贺菌血清群的近期变化及其地理多样性。
从四个腹泻病监测系统的数据档案中提取数据。对来自达卡医院（2008-2011 年；n=10650）的 2%的城市亚抽样和来自米尔普尔治疗中心（2009-2011 年；n=3585）的 10%的城市亚抽样进行系统纳入；而农村 Matlab 的所有患者（2008-2011 年；n=6399）和农村米尔扎普尔（2010-2011 年；n=2812）无论年龄、性别和疾病严重程度如何，都被纳入进来。采集新鲜粪便标本以鉴定志贺菌属。在达卡，315 份（3%）粪便标本检测出志贺菌阳性，Matlab 有 490 份（8%），米尔普尔有 109 份（3%），米尔扎普尔有 369 份（13%），这些标本被认为是可分析的样本量。
在所有志贺菌分离株中，无论年龄大小，均观察到 Mirpur（55→29%；趋势 χ(2)-检验值 = 0.019）和 Mirzapur（59→47%；p=0.025）中福氏志贺菌的百分比显著下降。在达卡（58→48%）和 Matlab（73→81%）也观察到非显著下降。所有地点的 5 岁以下儿童均出现类似模式。在达卡（8→25%；p<0.001）和米尔普尔（10→33%；p=0.015）中发现宋内志贺菌的出现，而在米尔扎普尔（32→23%；p=0.056）中则减少。在米尔扎普尔所有年龄组中均观察到博伊迪志贺菌的出现[（3→28%；p<0.001）；（3→27%；p<0.001）]。在达卡，我们观察到博伊迪志贺菌的百分比非显著降低[总体（25→16%）；5 岁以下（16→9%）]。在 Matlab、米尔普尔和米尔扎普尔均观察到痢疾志贺菌的发生率下降，而在达卡则保持不变。
宋内志贺菌和博伊迪志贺菌的出现成为重要的感染性腹泻病因，地理多样性的变化突出表明需要进行监测，这可能对疫苗开发产生影响。
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