Observational studyThe Lancet. Microbe2025
Epidemiology of Shigella species and serotypes in children: a retrospective substudy of the MAL-ED observational birth cohort study.
Observational study in The Lancet. Microbe, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Review
- Bacteriophage Sf14 survival under simulated gastrointestinal conditions.bioRxiv : the preprint server for biology · 2026Article
- Global distribution and genomic characteristics ofInfectious medicine · 2026Article
- Robust performance of culture, real-time PCR, and genomic approaches for shigella serotyping in a pediatric surveillance cohort.PLoS neglected tropical diseases · 2026Article
- The consequences ofEClinicalMedicine · 2026Article
- The Burden and Genomic Characterization ofmedRxiv : the preprint server for health sciences · 2026Article
- Article
- The incidence and antimicrobial resistance of Shigella-attributable diarrhoea in young children in low-income and middle-income countries from the multicountry Enterics for Global Health (EFGH) Shigella Surveillance Study: a prospective, facility-based hybrid surveillance study.The Lancet. Global health · 2026Article
- Development of a NovelVaccines · 2026Article
- Robust Performance of Culture, qPCR, and Genomic Approaches for Shigella Serotyping in a Pediatric Surveillance Cohort.medRxiv : the preprint server for health sciences · 2026Article
- Development and evaluation of a dual-target glycoconjugate againstFrontiers in immunology · 2026Article
- Development of an 8-valentFrontiers in immunology · 2026Article
- Evaluation of the performance and feasibility of RLDT in detectingmedRxiv : the preprint server for health sciences · 2025Article
- Epidemiological Characteristics, Antibiotic Resistance Patterns and Genomic Analysis ofAntibiotics (Basel, Switzerland) · 2025Article
- Severe Multi-organ dysfunction secondary to Shigella flexneri encephalopathy (Ekiri Syndrome): a case report and review of the literature.BMC infectious diseases · 2025Review
- Review
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24 authors.
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Abstract
backgroundShigellosis is a leading cause of diarrhoea in children globally. We aimed to assess the burden of specific Shigella species and Shigella flexneri serotypes, characterise their clinical syndromes and natural immunity, and evaluate their relevance as causes of diarrhoea and linear growth faltering.
methodsIn the MAL-ED birth cohort study, children younger than 17 days were enrolled from Nov 3, 2009, to Feb 29, 2012, in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, Tanzania, and South Africa and were followed up for 2 years. In this retrospective substudy, we retested Shigella quantitative PCR-positive diarrhoeal and non-diarrhoeal stool samples with molecular subtyping assays. We estimated the prevalence of specific Shigella species and serotypes, estimated their associations with diarrhoea and clinical characteristics using generalised linear mixed models, estimated their associations with linear growth using linear regression, and used longitudinal infection data to estimate protection due to previous infection using the Andersen and Gill extension of the Cox model.
findings1715 children (874 [51·0%] male and 841 [49·0%] female) with complete follow-up to 2 years provided 45 835 stool samples collected between age 0 and 2 years. 1294 (75·5%) children had at least one Shigella detection in a non-diarrhoeal or asymptomatic stool and 507 (29·6%) had at least one Shigella-attributed diarrhoea episode. In this substudy, we were able to type 1202 samples. The most common species and serotypes were Shigella sonnei (366 [30·4%] of 1202), S flexneri 2a (250 [20·8%]), and S flexneri 6 (296 [24·6%]). The associations of S flexneri and S sonnei detection with diarrhoea versus asymptomatic control stools were similar. Compared with diarrhoea episodes attributable to S flexneri, those attributable to S sonnei were less likely to be bloody (prevalence ratio 0·36 [95% CI 0·23 to 0·56]) or severe (prevalence ratio 0·58 [0·35 to 0·96]). The associations between asymptomatic Shigella infections and impaired linear growth at age 2 years were stronger for S flexneri than S sonnei (S flexneri length-for-age Z score difference -0·18 [95% CI -0·29 to -0·07] and S sonnei length-for-age Z score difference -0·07 [-0·21 to 0·07]). Examination of longitudinal infections showed that previous S sonnei infection was associated with a lower hazard of subsequent S sonnei diarrhoea (calibrated hazard ratio 0·41 [95% CI 0·19 to 0·90]). Otherwise, evidence for homotypic or heterotypic natural immunity was not apparent.
interpretationThis study provides data on prevailing Shigella species and serotypes in settings with a high burden of disease, underscoring the importance of asymptomatic S flexneri infection on growth impairment and the severity of S flexneri diarrhoea. Upcoming Shigella vaccines might need to induce immune responses that improve upon those produced by natural infection.
fundingBill & Melinda Gates Foundation.
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