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Guidelines For The Control of Shigellosis, Including Epidemics Due To Shigella Dysenteriae Type 1
Guidelines For The Control of Shigellosis, Including Epidemics Due To Shigella Dysenteriae Type 1
WHO Library Cataloguing-in-Publication Data World Health Organization. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae 1. 1.Dysenter y, Bacillar y - prevention and control 2.Shigella dysenteriae pathogenicity 3.Disease outbreaks - prevention and control 4.Guidelines I.Title.
24 ISBN 9 92 4159330X 159233 0
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GUIDELINES
SHIGELLA
DYSENTERIAE TYPE
Acknowledgement
These guidelines were prepared during a workshop held at the Centre for Health and Population Research (ICDDR,B), Dhaka, Bangladesh, on 16-18 February 2004, that was supported by the WHO Department of Child and Adolescent Health and Development, the United States Agency for International Development Global Health Bureau, the Centre for Health and Population Research and the International Vaccine Institute. Participants in this workshop were: B. Agerberth, Stockholm, Sweden; A. Aidara Kane, Geneva, Switzerland; P.K. Bardhan, Dhaka, Bangladesh; B.A. Rhida, Tunis-Belvdre, Tunisia; C. Boye, Dakar-Fann, Senegal; N. Brandes, Washington, DC, USA; R. Breiman, Dhaka, Bangladesh; D.L. Brondi, London, United Kingdom; A. Brooks, Dhaka, Bangladesh; J. Carter, Nairobi, Kenya; W. Chaicumpa, Bangkok, Thailand; C.L. Chaignat, Geneva, Switzerland; C. de la Cruz, Manila, The Philippines; H. El Bushra, Cairo, Egypt; O. Fontaine, Geneva, Switzerland; P. Grimont, Paris, France; G.H. Gudmundsson, Reykjavik, Iceland; P. Gurin, Paris, France; M. Haque, Dhaka, Bangladesh; Abid Hossain, Dhaka, Bangladesh; Anowar Hossain, Dhaka, Bangladesh; P. Kalluri, Atlanta, USA; S. Kariuku, Nairobi, Kenya; K. Keddy, Johannesburg, South Africa; Kruy Sun Lay, Phnom Penh City, Cambodia; Kwai-Lin Thong, Kuala Lumpur, Malaysia; S. Lee, Seoul, South Korea; D. Legros, Geneva, Switzerland; J.C.L. Mwansa, Lusaka, Zambia; A. Naheed, Dhaka, Bangladesh; G.B. Nair, Dhaka, Bangladesh; L.K. Ng, Winnipeg, Canada; J.B. Ndihokubwayo, Harare, Zimbabwe; S.Q. Nizami, Karachi, Pakistan; G. Nylen, Copenhagen, Denmark; A. Pach, Seoul, South Korea; Lt. Gen. D. Raghunath, Bangalore, India; R. Raqib, Dhaka, Bangladesh; N. Rollins, Durban, South Africa; D.A. Sack, Dhaka, Bangladesh; C. Sadorge, Paris, France; M.A. Salam, Dhaka, Bangladesh; L. von Seidlein, Seoul, South Korea; K. Seonghan, Seoul, South Korea; D. Steele, Geneva, Switzerland; K.A. Talukder, Dhaka, Bangladesh; S. Wiseman, Washington, DC, USA; and S. Yamasaki, Osaka, Japan. Special thanks to Dr D. Legros for preparing the draft of these guidelines and to Dr N.F. Pierce for editing them.
TABLE
OF CONTENTS
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Table of contents
Introduction ............................................................................................... 1 Epidemiology ............................................................................................. 2 The organism ...................................................................................................... 2 Disease burden .................................................................................................... 2 Endemic shigellosis ........................................................................................ 2 Epidemics caused by Sd1 .............................................................................. 3 The disease .......................................................................................................... 3 Mode of transmission ................................................................................... 3 Clinical presentation ..................................................................................... 3 Risk factors for severe disease and death ..................................................... 3 Diagnosis ........................................................................................................ 4 Differential diagnosis .................................................................................... 5 Shigellosis and HIV/AIDS ............................................................................ 5 Surveillance ......................................................................................................... 5 Reporting cases and detecting outbreaks of bloody diarrhoea ................... 5 Laboratory surveillance ................................................................................. 5 Prevention .................................................................................................. 7 Health education ................................................................................................ 7 Hand-washing ..................................................................................................... 7 Water supply ....................................................................................................... 8 Disposal of human waste ................................................................................... 8 Breastfeeding ....................................................................................................... 9 Food safety .......................................................................................................... 9 Vaccines ............................................................................................................... 9 Management of patients with bloody diarrhoea ...................................... 11 Antimicrobial therapy ...................................................................................... 11 Rehydration, feeding and other supportive care............................................. 13 Preventing and treating dehydration .......................................................... 14 Feeding ......................................................................................................... 14 Other supportive measures ......................................................................... 14 Treatment of complications ............................................................................. 15 Hypokalemia, hyponatremia and hypoglycemia ....................................... 15 Convulsions ................................................................................................. 15 Encephalopathy ........................................................................................... 16 Toxic megacolon .......................................................................................... 16
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GUIDELINES
SHIGELLA
DYSENTERIAE TYPE
Haemolytic-uraemic syndrome ................................................................... 16 Intestinal perforation .................................................................................. 16 Rectal prolapse ............................................................................................. 16 Preventing the spread of Shigella in health facilities ....................................... 16 Sd1 outbreak preparedness and response ................................................ 18 Sd1 outbreak preparedness .............................................................................. 18 National treatment policy ........................................................................... 19 Training health professionals ...................................................................... 19 Stockpiling emergency supplies .................................................................. 19 Alert and confirmation of an outbreak ...................................................... 20 Response to an Sd1 outbreak .......................................................................... 20 Patient care .................................................................................................. 21 Routine preventive measures ...................................................................... 21 Specific preventive measures for epidemics ............................................... 22 Epidemiological and laboratory surveillance ............................................. 23 Ineffective control measures ....................................................................... 24 After an outbreak ..................................................................................... 26 Selected references ................................................................................... 27 Annexes Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Annex Template for Investigation Report .............................................. 29 Some International Reference Laboratories ............................... 31 Specimen Collection and Transport Methods ............................ 33 Laboratory Identification of Shigella ........................................... 37 Antimicrobial Susceptibility Testing of Shigella ......................... 39 Health Education Messages ........................................................ 43 Making Water Safe for Drinking ................................................ 45 Building a VIP Latrine ................................................................. 47 Rules for Safe Preparation of Food ............................................. 48 Treatment Regimens for Ciprofloxacin and Zinc ....................... 49 Classification and Treatment of Dehydration ............................ 50 Preparation of Home Made Oral Rehydration Solution ........... 51 Feeding Practices During and After Diarrhoea .......................... 52 Preparation of Disinfecting Solutions ........................................ 53 Check List for Epidemic Control ................................................ 54 List of Supplies Needed for the Management of 100 Patients .................................................................................. 60 Annex 17 - List of Supplies for Laboratory Identification of Sd1 During an Outbreak ..................................................................... 61 Annex 18 - Funeral Precautions ...................................................................... 62 Annex 19 - Daily Report Form and Hospital Admission Register ............... 63 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 -
TABLE
OF CONTENTS
Tables Table 1: Table 2: Table 3: Table Table Table Table Table Table Table Figures Figure 1: Management of shigellosis ............................................................. 12 Species and serogroups of Shigella .................................................... 2 Shigellosis: disease summary ............................................................ 4 Collection and transport of stool samples and testing antimicrobial sensitivity ................................................................... 6 4: Preventive measures ........................................................................ 10 5: Antimicrobials for treatment of shigellosis .................................... 12 6: Antimicrobials that should not be used for treatment of infections with Shigella ............................................................... 13 7: Supportive care ............................................................................... 15 8: Chlorine solutions for disinfection ................................................ 17 9: Sd1 outbreak preparedness ............................................................. 21 10: Response to an Sd1 outbreak ......................................................... 25
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GUIDELINES
SHIGELLA
DYSENTERIAE TYPE
Introduction
Shigellosis is an acute invasive enteric infection caused by bacteria belonging to the genus Shigella; it is clinically manifested by diarrhoea that is frequently bloody. Shigellosis is endemic in many developing countries and also occurs in epidemics causing considerable morbidity and mortality. Among the four species of Shigella, Shigella dysenteriae type 1 (Sd1) is especially important because it causes the most severe disease and may occur in large regional epidemics. Major obstacles to the control of shigellosis include the ease with which Shigella spreads from person to person and the rapidity with which it develops antimicrobial resistance. These guidelines are intended to assist national health authorities, public health officers and health-care providers, including members of international agencies and nongovernmental organizations (NGO), in their efforts to control both endemic and epidemic shigellosis. The text describes the epidemiology, clinical features and management of the disease, and measures to prepare for and control epidemics caused by Sd1. The following definitions apply to terms used in this document: