Epidemiology of Shigella sonnei and Shigella flexneri in the Global Pediatric Diarrhea Surveillance network, 2017–2022
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Shigella is a leading cause of diarrhea in children in low- and middle-income countries (LMICs). Optimizing the impact of vaccines necessitates an accurate characterization of Shigella serotype prevalence. We describe the burden, epidemiology and characteristics of S. sonnei and S. flexneri diarrhea in the Global Pediatric Diarrhea Surveillance (GPDS) network. Methods GPDS is a World Health Organization-coordinated surveillance network investigating the etiology of hospitalized diarrhea among children aged <5 years. GPDS enrolls children hospitalized with diarrhea at 38 sentinel surveillance sites in 31 LMICs. Randomly selected stool specimens from these children were tested by quantitative polymerase chain reaction to detect a broad range of enteropathogens as well as to identify S. sonnei and S. flexneri serotypes. We estimated pathogen-specific attributable fractions and incidence of diarrheal hospitalizations. Results During 2017–2022, GPDS enrolled 70,750 children aged <5 years hospitalized with diarrhea, of which 16,458 (23.3%) were randomly selected for qPCR testing. Globally, Shigella caused 9.8% (95% Confidence Interval [CI]: 8.4, 11.3) of hospitalized diarrhea, with 28.3% of cases occurring in children aged ≤12 months. The estimated attributable incidence of Shigella -associated diarrhea hospitalizations decreased from 1.27 (95% CI: 0.95, 1.64) per 1,000 child years in 2017–2018 to 0.88 (0.67, 1.10) in 2021–2022. Among typeable Shigella cases, 34.8% were S. sonnei , 24.2% were S. flexneri 2a, and 9.9% were S. flexneri 1b. Vaccines currently in development would cover an estimated 59.0% to 72.2% of cases. Conclusions These findings support the role of Shigella as an important cause of the most severe diarrhea in young children. The breadth of homotypic protection provided by Shigella vaccines in clinical development varied by region, and these broadly representative data can aid in prioritization. Non-dysenteric Shigella could not be readily differentiated from other causes of hospitalized diarrhea based on clinical characteristics.
Source: medRxiv
Authors: Jie Liu, Myra Lewontin, Sarah E. Elwood, Shilpa S. Iyer, Sébastien Antoni, Gloria Rey-Benito, Claudia Ortiz, Goitom Weldegebriel, Joseph Biey, Jason M. Mwenda, Roberta Pastore, Dovile Videbaek, Simarjit Singh, Emmanuel Njambe, Lucky Sangal, Deepak Dhongde, Varja Grabovac, Josephine Logronio, Kamal Fahmy, Amany Ghoniem, George Armah, Francis E. Dennis, Mapaseka L. Seheri, Nonkululeko Magagula, Kebareng Rakau-Nondela, Tulio M. Fumian, Irene T.A. Maciel, Elena Samoilovich, Galina Semeiko, Tintu Varghese, Sarah Thomas, Julie E. Bines, Dandi Li, Furqan Kabir, Eric R. Houpt, Mick N. Mulders, Heidi M. Soeters, James A. Platts-Mills, the Global Pediatric Diarrhea Surveillance network
Institutions: Qingdao University, University of Virginia, World Health Organization, World Health Organization Regional Office for the Americas, World Health Organization Regional Office for Africa, World Health Organization Regional Office for Europe, World Health Organization Regional Office for South-East Asia, World Health Organization Regional Office for the Western Pacific, World Health Organization Regional Office for the Eastern Mediterranean, University of Ghana, Noguchi Memorial Institute for Medical Research, Sefako Makgatho Health Sciences University, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Christian Medical College, Vellore, Murdoch Children's Research Institute, Chinese Center For Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Aga Khan University
Language: English
Subfield: Food Science
Domain: Life Sciences
Open Access status: green
Funder: World Health Organization
OpenAlex ID: W7213324796