American Journal of Epidemiology Vol. 134, No. 6: 614-627
Copyright © 1991 by The Johns Hopkins University School of Hygiene and Public Health
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Epidemiologic Patterns of Acute Diarrhea and Endemic Shigella Infections in Children in a Poor Periurban Setting in Santiago, Chile
1Center for Vaccine Development, Division of Geographic Medicine, Department of Medicine, and Division of Infectious Diseases and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine Baltimore, MD
2Programa para el Control de la Fiebre Tifoidea e Enfermedades Entericas, Ministry of Health Santiago, Chile
3 Unidad de Microbiologia, Facultad de Medicina, Uni-versidad de Chile, Sede Oriente Santiago, Chile
Reprint requests to Dr. M. M. Levine, Center for Vaccine Development, University of Maryland School of Medicine, 10 S. Pine St., Baltimore, MD 21201
To prepare a field site for evaluating preventive interventions against endemic shigellosis, the authors followed prospectively a cohort of 360 children (90 each of children aged 0–11,12–23, 24–35, and 36–47 months) in Santa Julia, a low socioeconomic area in Santiago, Chile, from November 1986 through April 1989 with twice weekly household visits for diarrheal disease; infants replaced children who reached 60 months of age. Coprocultures on 2 consecutive days from children with diarrhea and from age-matched controls within the cohort were cultured for Shigella. Bacteriologic surveillance was also maintained in the health center and children's hospital serving Santa Julia. In this community, where all households had access to potable water (68% inside) and all but 3% had access to a toilet, but where there was marked crowding, the overall incidence of diarrheal disease in the cohort was low (2.26 episodes/12 child months of observation in children aged 0–11 months and 2.09 in those aged 12–23 months), yet Shigella infections were common. Shigella accounted for 10% of diarrheal episodes in the cohort (vs. 3.2% isolation rate in controls, p < 0.0001). The incidence of shigellosis in children aged 12–47 months was 0.16 cases per 12 child months of observation; in the first 5 years of life, a child had a 67% chance of experiencing shigellosis. Shigella sonnei, Shigella flexneri 2a, and S. (lexneri 6 caused > 79% of the infections. Shigella occurred more often in hospitalized cases of diarrhea than in age-matched cases detected in the health center or by household surveillance (p < 0.0001). An initial episode of Shigella diarrhea did not diminish overall the risk of subsequent shigellosis but did confer 72% protection (p = 0.05) against illness due to the homologous serotype. The high rate of both S. sonnei and S. flexneri shigellosis in a population with a low background rate of diarrhea makes Santa Julia an appropriate site for assessing the efficacy and effectiveness of measures to reduce Shigella infections.
diarrhea; Shigella
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