Muzembo Basilua Andre, Kitahara Kei, Mitra Debmalya, Ohno Ayumu, Khatiwada Januka, Dutta Shanta, Miyoshi Shin-Ichi
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
Collaborative Research Centre of Okayama University for Infectious Diseases at ICMR-NICED, Kolkata, India.
J Travel Med. 2023 Feb 18;30(1). doi: 10.1093/jtm/taac132.
Shigella remains one of the most common causes of diarrhoea in South Asia. Current estimates of the prevalence of Shigella are critical for guiding control measures. We estimated the prevalence of Shigella species and serogroups in South Asia.
We performed a systematic review using PubMed, EMBASE, Google Scholar and Web of Science for peer-reviewed studies published between 2000 and 19 June 2022. We also manually searched the reference lists of the reviewed studies to identify additional studies. We included studies that detected the presence of Shigella in stool by culture or polymerase chain reaction (PCR). Studies associated with outbreaks were excluded. Two investigators independently reviewed the studies, extracted the data and performed quality assessment. A random-effects meta-analysis was performed to determine the pooled prevalence of Shigella.
Our search yielded 5707 studies, of which 91 studies from five South Asian countries were included in the systematic review, 79 in the meta-analysis of Shigella prevalence and 63 in the meta-analysis of Shigella serogroups prevalence. The pooled prevalence of Shigella was 7% [95% confidence interval (CI): 6-7%], with heterogeneity (I2 = 98.7; P < 0.01). The prevalence of Shigella was higher in children aged <5 years (10%; 95% CI: 8-11%), in rural areas (12%; 95% CI: 10-14%) and in studies using PCR (15%; 95% CI: 11-19%). Shigella flexneri (58%) was the most abundant serogroup, followed by Shigella sonnei (19%), Shigella boydii (10%) and Shigella dysenteriae (9%). Shigella flexneri 2a was the most frequently isolated serotype (36%), followed by serotype 3a (12%), serotype 6 (12%) and serotype 1b (6%). The prevalence of non-typeable Shigella was 10.0%.
Although the prevalence of Shigella in South Asia remains generally high, it varies by age group and geographical area, with data lacking in some countries. Effective Shigella vaccines would be advantageous for both endemic communities and travellers.
志贺氏菌仍然是南亚腹泻最常见的病因之一。目前对志贺氏菌流行率的估计对于指导控制措施至关重要。我们估计了南亚地区志贺氏菌属及血清群的流行率。
我们使用PubMed、EMBASE、谷歌学术和科学网对2000年至2022年6月19日发表的同行评审研究进行了系统综述。我们还手动检索了综述研究的参考文献列表以识别其他研究。我们纳入了通过培养或聚合酶链反应（PCR）检测粪便中志贺氏菌的研究。排除与疫情相关的研究。两名研究人员独立评审研究、提取数据并进行质量评估。进行随机效应荟萃分析以确定志贺氏菌的合并流行率。
我们的检索产生了5707项研究，其中来自五个南亚国家的91项研究纳入了系统综述，79项纳入志贺氏菌流行率的荟萃分析，63项纳入志贺氏菌血清群流行率的荟萃分析。志贺氏菌的合并流行率为7%[95%置信区间（CI）：6 - 7%]，存在异质性（I² = 98.7；P < 0.01）。5岁以下儿童（10%；95% CI：8 - 11%）、农村地区（12%；95% CI：10 - 14%）以及使用PCR的研究（15%；95% CI：11 - 19%）中志贺氏菌的流行率较高。福氏志贺氏菌（58%）是最主要的血清群，其次是宋内志贺氏菌（19%）、鲍氏志贺氏菌（10%）和痢疾志贺氏菌（9%）。福氏志贺氏菌2a是最常分离出的血清型（36%），其次是血清型3a（12%）、血清型6（12%）和血清型1b（6%）。不可分型志贺氏菌的流行率为10.0%。
尽管南亚地区志贺氏菌的流行率总体上仍然很高，但因年龄组和地理区域而异，一些国家缺乏相关数据。有效的志贺氏菌疫苗对地方社区和旅行者都将是有益的。
