Departments of Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA; Departments of Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
Vaccine. 2017 Dec 14;35(49 Pt A):6783-6789. doi: 10.1016/j.vaccine.2017.07.036. Epub 2017 Jul 29.
The Global Enteric Multicenter Study (GEMS) demonstrated that Shigella and enterotoxigenic Escherichia coli (ETEC) producing heat stable toxin (ST) (either alone or in combination with heat labile toxin) are among the most important pathogens associated with moderate-to-severe diarrhea (MSD) in children younger than 5years of age living in developing countries. To inform the design of vaccines and other interventions, we reviewed published data and new results from GEMS characterizing the burden of Shigella and ST-ETEC infections. Clinical parameters were assessed to examine the value of various case definitions as indicators of MSD associated with Shigella and ST-ETEC for use in clinical trials. We discussed advantages and disadvantages of culture-based and culture-independent molecular diagnostics for detecting clinically and epidemiologically relevant disease. Shigella serotyping data from GEMS were examined to identify desirable components of Shigella and ETEC vaccines likely to confer broad protection. These findings can inform the development and implementation of vaccines to prevent these important infections among infants and children in developing countries.
全球肠病多中心研究（GEMS）表明，志贺菌和产肠毒性大肠埃希菌（ETEC）产生热稳定毒素（ST）（单独或与不耐热毒素联合）是与发展中国家 5 岁以下儿童中度至重度腹泻（MSD）相关的最重要病原体之一。为了为疫苗和其他干预措施的设计提供信息，我们回顾了已发表的数据和 GEMS 的新结果，这些结果描述了志贺菌和 ST-ETEC 感染的负担。评估了临床参数，以检查各种病例定义作为与志贺菌和 ST-ETEC 相关的 MSD 指标的价值，用于临床试验。我们讨论了用于检测具有临床和流行病学意义的疾病的基于培养和非培养的分子诊断的优缺点。我们检查了 GEMS 的志贺菌血清分型数据，以确定可能提供广泛保护的志贺菌和 ETEC 疫苗的理想成分。这些发现可以为发展中国家婴儿和儿童中预防这些重要感染的疫苗的开发和实施提供信息。
