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 在孟加拉国农村的一个研究现场， 有记录表明最近接触了一个患有志贺氏菌的邻居 痢疾。1934名5岁以下儿童，来自240个社区 有一个居民谁提出治疗记录志贺氏菌 在开始积极的社区监测后1周内发生痢疾， Lance，集合起来。这些孩子中的每一个都接受了密集的 积极监测一个月，有系统的时间表， 确定与腹泻相关的症状史，并收集粪便 用于微生物表征的样本。分析已经 表明志贺菌腹泻的发生与年龄有关 （在生命的第三年最高），营养状况（ 发育不良儿童的发病率较高），季节（季风期间发病率最低 夏季）和母乳喂养状况（ 在母乳喂养的儿童中，甚至在36个月以下）。的存在 厕所与风险无关，因为 不卫生的悬挂式厕所会增加风险， 一个卫生的厕所稍微降低了风险。人的风险降低 母乳喂养的儿童比非母乳喂养的儿童几乎 这完全是由于痢疾风险的增加， 发生在停乳后的最初3个月内 喂食当宿主和环境因素结合起来考虑时 作为儿童志贺氏菌病的预测因子，只有营养不良，年龄， 和喂养方式为主要危险因素。维生素A的状态不是 与志贺氏菌病的风险有关。未来的分析将侧重于 志贺氏菌感染儿童持续腹泻的决定因素

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 neighbor- hood resident having Shigella dysentery. 1934 children under 5 years of age, from 240 neighborhoods having a resident who presented for treatment of documented Shigella dysentery within 1 week of the initiation of active neighborhood surveil- lance, were assembled. Each of these children was followed with intensive active surveillance for one month, with a systematic schedule to ascertain symptomatic histories related to diarrhea, and to collect fecal specimens for microbiological characterization. Analyses 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 latrine slightly depressed the risk. The lower risk of shigellosis in breast-fed than in non-breast fed children was almost entirely attributable to the increase in risk of shigrlosis which occurred during the initial 3 months following cessation of breast feeding. When host and environmental factors are considered conjointly as predictors of pediatric shigellosis, only nutritional stunting, age, and feeding mode dominate as risk factors. Vitamin A status was not related to the risk of shigellosis. Future analyses will focus on determinants of persistent diarrhea among Shigella-infected children.