EPIDEMIOLOGIC PATTERNS OF ACUTE DIARRHEA AND ENDEMIC SHIGELLA INFECTIONS IN CHILDREN IN A POOR PERIURBAN SETTING IN SANTIAGO, CHILE
EPIDEMIOLOGIC PATTERNS OF ACUTE DIARRHEA AND ENDEMIC SHIGELLA INFECTIONS IN CHILDREN IN A POOR PERIURBAN SETTING IN SANTIAGO, CHILE
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DOI：
10.1093/oxfordjournals.aje.a116134
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发表时间：
1991-09-15
影响因子：
5
通讯作者：
LEVINE, MM
中科院分区：
文献类型：
--
作者：
FERRECCIO, C;PRADO, V;LEVINE, MM
为了准备一个评价地方性志贺菌病预防干预措施的现场，作者前瞻性地随访了360名儿童（0-11、12-23、24-35和36-47个月的儿童各90名），位于智利圣地亚哥的一个低社会经济水平地区，从1986年11月到1989年4月，每周两次对家庭进行腹泻病检查;婴儿取代了年满60个月的儿童。连续2天从腹泻儿童和年龄匹配的对照组的共培养物进行志贺氏菌培养。还在为Santa Julia服务的保健中心和儿童医院进行细菌学监测。在这个社区，所有家庭都可以获得饮用水（68%在室内），除3%外，所有家庭都可以使用厕所，但那里有明显的拥挤，队列中腹泻病的总体发病率较低（0-11个月的儿童为2.26次/12个月，12-23个月的儿童为2.09次/12个月），但志贺氏菌感染很常见。志贺氏菌占队列中腹泻发作的10%（对照组的分离率为3.2%，p < 0.0001）。在12-47个月的儿童中，志贺氏菌病的发病率为每12个观察儿童月0.16例;在生命的前5年，儿童有67%的机会经历志贺氏菌病。宋内志贺菌、福氏志贺菌2a和志贺菌S.弗氏6型引起> 79%的感染。志贺氏菌在住院腹泻病例中的发生率高于在卫生中心或家庭监测中发现的年龄匹配的病例（p < 0.0001）。志贺氏菌腹泻的初始发作并没有降低随后志贺氏菌病的总体风险，但确实提供了72%的保护（p = 0.05），防止疾病由于同源血清型。S. sonnei和S.在腹泻背景率较低的人群中，福氏志贺菌病使Santa Julia成为评估减少志贺菌感染措施的功效和有效性的适当地点。
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. flexneri 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.