Abstract

PIP: The epidemiologic and clinical aspects of a major Shigella dysenteriae epidemic resistant to all available drugs that occurred in Western Rwanda in 1981-82 are analyzed. About 5% of the population was affected. In total, there were 11,801 cases of dysentery, with an average of 833 cases/month. The course of the epidemic was independent from seasonal variations. In children under 5 years of age, the majority (61%) of dysentery cases involved males; at all other ages, however, there was a female preponderance. The duration of illness averaged 1 week. Since no effective chemotherapy could be found, treatment consisted of general supportive measures and rehydration. The overall case fatality rate 6%, with higher rates among children (12%) and adult men (9%). Dehydration and fever were the 2 signs most frequently associated with a fatal outcome. 33 women followed in this study were pregnant while suffering from dysentery. 5 abortions, 3 premature deliveries, and 1 intrauterine death were recorded, suggesting that epidemic dysentery poses a serious risk to pregnant women. Disease transmission was primarily through direct contact. Health education is the most effective way to improve hygienic conditions among the peasant population of Rwanda and to decrease the risk of infection.