A cohort study to define the age-specific incidence and risk factors of Shigella diarrhoeal infections in Vietnamese children: a study protocol

Abstract

BackgroundShigella spp. are one of the most common causes of paediatric dysentery globally, responsible for a substantial proportion of diarrhoeal disease morbidity and mortality, particularly in industrialising regions. Alarming levels of antimicrobial resistance are now reported in S. flexneri and S. sonnei, hampering treatment options. Little is known, however, about the burden of infection and disease due to Shigella spp. in the community.Methods/DesignIn order to estimate the incidence of this bacterial infection in the community in Ho Chi Minh City, Vietnam we have designed a longitudinal cohort to follow up approximately 700 children aged 12–60 months for two years with active and passive surveillance for diarrhoeal disease. Children will be seen at 6 month intervals for health checks where blood and stool samples will be collected. Families will also be contacted every two weeks for information on presence of diarrhoea in the child. Upon report of a diarrhoeal disease episode, study nurses will either travel to the family home to perform an evaluation or the family will attend a study hospital at a reduced cost, where a stool sample will also be collected. Case report forms collected at this time will detail information regarding disease history, risk factors and presence of disease in the household.Outcomes will include (i) age-specific incidence of Shigella spp. and other agents of diarrhoeal disease in the community, (ii) risk factors for identified aetiologies, (iii) rates of seroconversion to a host of gastrointestinal pathogens in the first few years of life. Further work regarding the longitudinal immune response to a variety of Shigella antigens, host genetics and candidate vaccine/diagnostic proteins will also be conducted.DiscussionThis is the largest longitudinal cohort with active surveillance designed specifically to investigate Shigella infection and disease. The study is strengthened by the active surveillance component, which will likely capture a substantial proportion of episodes not normally identified through passive or hospital-based surveillance. It is hoped that information from this study will aid in the design and implementation of Shigella vaccine trials in the future.

Gastroenteritis in Japanese Females Caused by Shigella flexneri without Definite Infection Route: A Case Report and Mini-Review of Literature

“…The majority of S. flexneri is sensitive to 3rd generation cephalosporins, and quinolones, especially ciprofloxacin, are commonly employed in the treatment of shigellosis [36,46]. However, in recent years, some Shigella strains have rapidly developed resistance to antimicrobial agents [9,23,46,48]. For example, more than 80.0% of isolates of S. flexneri have proven resistant to ampicillin, nalidixic acid, and tetracycline; and in China from 2004 to 2014, Shigella isolates were highly resistant to nalidixic acid (89%), ampicillin (89%), tetracycline (88%), and sulfamethoxazole (83%).…”

Novel multiplex real-time PCR assays reveal a high prevalence of diarrhoeagenic Escherichia coli pathotypes in healthy and diarrhoeal children in the South of Vietnam

“…We excluded children if they had suspected or con rmed intussusception at the time of enrolment [43]. Controls were healthy children between the age of 12-60 months enrolled in diarrhoeal disease cohort in District 8 in HCMC from 2014 to 2016 [17]. The enrolled children attended HVH for routine health check every six months.…”

Quantifying antimicrobial access and practices for paediatric diarrheal disease in an urban community setting in Southeast Asia

“…were estimated from a prospective diarrheal cohort conducted between 2014 and 2016 that actively 181 followed 748 children in residing District 8 23 . The proportion of parents or caregivers seeking 182 pharmacies as their first choice iii) was derived from the self-reported behaviour survey of parents 183 and caregivers.…”

“…The proportion of parents or caregivers seeking 182 pharmacies as their first choice iii) was derived from the self-reported behaviour survey of parents 183 and caregivers. To quantify the likelihood of prescribing antimicrobials for diarrheal treatment at a 184 pharmacy or a hospital, we used data from the pharmacy behaviour study and the prospective cohort 185 study 23 , respectively. We estimated antimicrobial use for diarrheal treatment for both watery and 186 mucoid diarrhoea.…”