STUDIES OF THE EPIDEMIOLOGY OF PEDIATRIC SHIGELLOSIS IN BANGLADESH

这一实地项目的目的是评估流行病学 儿童志贺氏菌病发生的模式和决定因素 孟加拉农村研究现场的居民，他们有一个 记录了最近接触到的一名患有志贺氏菌的社区居民 痢疾。该项目需要1934名5岁以下儿童参加。 年龄，来自240个社区的1335个家庭，有一个居民 世卫组织在1周内提出治疗志贺氏菌痢疾 启动了积极的邻里监视。后续装配 在这些儿童中，每个人都受到了密集的积极监视 一个月的时间。这项监测在基线上包括社会人口学。 特征，确定饮食和人体测量状况，以及 对受试者进行血清维生素A的测定，并根据 确定与以下疾病相关的症状病史的系统计划 腹泻，并收集粪便样本进行微生物检测 人物刻画。到目前为止，对数据的分析表明， 志贺氏菌腹泻的发生与年龄有关(以#年最高 生命的第三年)，营养状况(发育迟缓的人更高 儿童)，季节(夏季季风季最低 月)和母乳喂养状况(母乳喂养的儿童较低， 甚至长达36个月的婴儿)。厕所的存在与此无关 风险，因为存在不卫生的绞刑 厕所增加了风险，而卫生间的存在略有增加 降低了风险。有趣的是，乳房的保护作用 喂食几乎完全可归因于罹患 停药后最初3个月内发生的志贺氏菌病 母乳喂养。 目前正在进行分析，以确定频率和决定因素 志贺氏菌腹泻从急性向慢性和向 评估维生素A缺乏作为急性和慢性疾病危险因素的作用 持续性志贺氏菌病。

The purpose of this field project is to evaluate the epidemiological patterns and determinants of pediatric shigellosis occurring among residents in a research field site in rural Bangladesh who have had a documented recent exposure to a neighborhood resident having Shigella dysentery. The project entailed assembly of 1934 children under 5 years of age, from 1335 families residing in 240 neighborhoods having a resident who presented for treatment of documented Shigella dysentery within 1 week of the initiation of active neighborhood surveillance. Following assembly of these children, each was followed with intensive active surveillance for one month. This surveillance included, at baseline, sociodemographic characterization, ascertainment of dietary and anthropometric status, and measurement of serum vitamin A. Subjects were visited according to a systematic schedule to ascertain symptomatic histories related to diarrhea, and to collect fecal specimens for microbiological characterization. Analyses of the data thus far have demonstrated that the occurrence of Shigella diarrhea was related to age (being highest in the third year of life), nutritional status (being higher in stunted children), season (being lowest during the monsoon season in the summer months), and breast-feeding status (being lower among breast-fed children, even up to 36 months of age). The presence of a latrine was not related to the risk, due to the fact that the presence of an unsanitary hanging latrine elevated the risk, while the presence of a sanitary slightly depressed the risk. Interestingly, the protective effect of breast feeding was almost entirely attributable to the increase in risk of shigellosis which occurred during the initial 3 months following cessation of breast feeding. Analyses are now in progress to determine the frequency and determinants of the progression of Shigella diarrhea from acute to chronic form and to assess the role of vitamin A deficiency as a risk factor for acute and persistent shigellosis.