Trend and disease burden of bacillary dysentery in China (1991-2000)

Abstract

Objective We aimed to determine the burden of bacillary dysentery in China, its cross-regional variations, trends in morbidity and mortality, the causative bacterial species and antimicrobial resistance patterns. Methods We extracted and integrated governmental statistics and relevant medical literature published from 1991 to 2000. Data were also collected from one general hospital each for the six provinces and Jin-an district, Shanghai, representative of six geographical regions and a modern city. Findings In 2000, 0.8-1.7 million episodes of bacillary dysentery occurred of which 0.5 to 0.7 million were treated at health-care facilities and 0.15-0.20 million patients were hospitalized. The highest morbidity and mortality rates were among the youngest and oldest age groups. Bacillary dysentery peaked during the summer months. The major causative species was Shigella flexneri (86%) and the predominant S. flexneri serotype was 2a (80%). About 74-80% of Shigella isolates remained susceptible to fluorinated quinolones. Conclusion We conclude that while morbidity and mortality due to bacillary dysentery has decreased considerably in China in the past decade due to increasing access to affordable health care and antibiotics, a considerable burden exists among the youngest and oldest age groups and in regions with low economic development. We suggest that while a vaccine would be effective for short-and medium-term control of bacillary dysentery, improved water supply, sanitation, and hygiene are likely to be required for long-term control.Bulletin of the World Health Organization 2006;84:561-568.Voir page 567 le résumé en français. En la página 567 figura un resumen en español. IntroductionGlobally, morbidity and mortality due to diarrhoea has decreased from 4.6 million deaths in 1982 to 3.3 million in 1992 to 2.5 million in 2003.1-3 A review published in 1999 reported that bacillary dysentery caused by Shigella species (S. flexneri, S. sonnei, S. boydii, and S. dyse e enteriae) remains a major source of diarr r rhoea, especially in developing countries. It also reported that of the 164.7 million episodes of shigellosis (Shigellarrelated diarrhoea) occurring worldwide each year, 163.2 million were in developing countries; however, the review included sparse data from China. 5 Even so diarrhoeal diseases remain an important public health problem. A crossrsectional survey conducted in 1988 estimated that of the 84 million diarrhoeal episodes that ocr r curred in China annually, 25% affected children less than five years of age. The survey also found that Shigella is one of the principle etiologic organisms for diarrhoea.6 A live oral Shigella vaccine which was developed and produced in China in 1997 reportedly provides 60-70% protection against S. flexneri 2a and S. sonnei infections. 7A continuing analysis of the disease burden of bacillary dysentery would be required for effective treatment and prevention policies, health prioritization debates, and cost-benefit assessments to enable rational decisions on research, ...

An eight-year study of Shigella species in Beijing, China: serodiversity, virulence genes, and antimicrobial resistance

“…All Shigella species also exhibited a very high rate of resistance (80%-90%) to older generation antimicrobials such as NAL, TET, AMP, and SXT. Although a similar pattern of resistance has been reported in our region and in other Asian countries [4,16,17], the frequency of resistance reported here is higher than frequencies observed earlier, and the trend to MDR is more pronounced [3,4]. Cephalosporins and fluoroquinolones were two popular empirical options to treat severe gastrointestinal infections caused by pathogenic bacteria.…”

“…S. flexneri 2a is still the most common in many developing countries, including China [1,4,12]. It should be noted that S. flexneri serotype 4c has remained in continuous existence over time in Beijing, although it has rarely been reported in other studies.…”

“…In China, Shigella spp. is the most frequently isolated diarrheal pathogen, accounting for up to 1.7 million episodes of bacillary dysentery annually, with an estimated 200,000 patients admitted to hospitals [4].…”

Trends and disease burden of enteric fever in Guangxi province, China, 1994–2004

“…8 After preliminary processing, the data are transferred to the national CDC, which compiles and analyses them every month. The Department of Disease Control in China's Ministry of Health issues an annual report based on these data.…”

“…The Department of Disease Control in China's Ministry of Health issues an annual report based on these data. 8 For this study, the Guangxi CDC provided census data, which we used to calculate disease incidence, and data on Vi polysaccharide vaccine.…”