EFGH- Enterics for Global Health

Shigella Surveillance Study-2022

Neyama Alladin, Farah Naz Qamar, Muhammad Tahir Yousafzai, Dr. Momin Kazi ,Dr. Sadia Shakoor, Dr. Sonia Qureshi

Introduction
In low- and middle-income countries, nearly one third of children experience at
least one episode of Shigella-attributable diarrhea during their first 2 years of life.
In addition to it being a leading cause of diarrhea, this enteric bacterium is also
associated with linear growth faltering, a precursor to stunting. Stunting is a
marker of vulnerability to childhood infection, decreased vaccine efficacy and
lifelong morbidity. Currently, several promising Shigella vaccines are in
development. Eventual Phase 2b/3 Shigella vaccine trials will require a consortium
of potential vaccine trial sites in settings with a high incidence of Shigella-
attributed medically-attended diarrhea, high participant retention, and the
¿ confirmed 𝑆h𝑖𝑔𝑒𝑙𝑙𝑎 cases enrolled
laboratory capacity to confirm Shigella infection. 𝐂𝐫𝐮𝐝𝐞 𝐈𝐧𝐜𝐢𝐝𝐞𝐧𝐜𝐞 =
Defined population ¿ × Time
+

A1=Proportion who seek care at EFGH facility
(among those with watery diarrhea)
A2=Proportion who seek care at EFGH facility
(among those with dysentery)
Time=Period of time recruiting takes place (i.e.
24 months)
B1=Proportion enrolled (among those who sought care
at the EFGH facility with watery diarrhea)
B2=Proportion enrolled (among those who sought care
at the EFGH facility with dysentery)
Defined population size=Estimated # of children aged 6-
35 months living in the pre-defined catchment area

Outcomes
 
 
 
 
Primary Aims
 
1. Determine the incidence of Shigella-attributed MAD in children 6 to 35 months of age in each of the EFGH country

Objectives sites.
Secondary Aims

2. Determine the incidence of Shigella MAD by serotype, severity definition, laboratory method (culture vs. qPCR), age,
• EFGH study aims to determine the incidence and consequences of medically and by season.
attended Shigella diarrhea within the country sites. 3. Describe the prevalence of resistance to commonly used antibiotics in Shigella isolates in each EFGH country site.
4. Determine the risk of death, hospitalization, persistent diarrhea, diarrhea recurrence, and linear growth faltering in the
• Determine the incidence of Shigella-attributed medically-attended diarrhea in 3 months following an episode of Shigella MAD.
children 6 to 35 months of age in each of the EFGH country sites. 5. Compare various severity definitions in their ability to distinguish Shigella from non-Shigella attributable diarrhea and
ability to predict risk of death or hospitalization in the subsequent 3 months.
6. Quantify the cost incurred by families and health care systems due to Shigella morbidity and mortality.

Methodology 7. Identify optimal laboratory methods for Shigella culture by:

a. comparing the isolation rate of Shigella between two transport media for rectal swabs (Cary-Blair and modified
Figure 1. Laboratory processing of rectal swab specimens Buffered Glycerol Saline [BGS])
• The Enterics for Global Health (EFGH) Shigella surveillance study b. comparing the isolation rate of Shigella between two fecal sample types (rectal swabs and whole stool) among
the subset of children who produced whole stool in The Gambia and Bangladesh country sites.
will employ cross-sectional and longitudinal study designs to
establish updated incidence rates and document consequences of
Shigella diarrhea within 7 country sites in Africa, Asia, and Latin
America.
• Over a two-year period, the EFGH study will enroll 9,800 children
Results awaited
(1,400 per country site) between 6-35 months with medically-
attended diarrhea.
• Our study will take place in the pediatric OPD and IPD wards at six Conclusion
medical facilities -of Karachi namely, Abbasi Shaheed Hospital,
Sindh Government Hospital Korangi No.5, Sindh Government
Through this multi-country surveillance network, selected EFGH sites
Hospital-Ibrahim Hyderi, Bhains Colony VPT Center, Ali Akbar will be ready to quickly implement rigorous and efficient vaccine trials
Shah VPT center and Khidmat-e-Alam medical Center.
• The Healthcare Utilization component will be done in randomized
and provide critical data to policy makers about the relative importance of
clusters within the three main catchment areas of Karachi, Bin Qasim this vaccine-preventable disease, accelerating the time to vaccine
Town, Malir and Nazimabad Town to cover a of 100,000 Population availability and uptake among children in high Shigella burden settings.
approximately.
Acknowledgements : Bill and Malinda Gates Foundation & Sabin Vaccine Institute.