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. 2023 Apr:129:78-95.
doi: 10.1016/j.ijid.2023.01.034. Epub 2023 Jan 31.

Consequences of Shigella infection in young children: a systematic review

Tanya E Libby  1 , Miranda L M Delawalla  2 , Fatima Al-Shimari  3 , Calman A MacLennan  4 , Kirsten S Vannice  5 , Patricia B Pavlinac  3
Affiliations

Consequences of Shigella infection in young children: a systematic review

Tanya E Libby et al. Int J Infect Dis. 2023 Apr.

Abstract

Objectives: We conducted a systematic review of the longitudinal consequences of Shigella infection in children to inform the value proposition for an effective vaccine.

Methods: We searched PubMed and Embase for studies published from January 01, 1980 to December 12, 2022 and conducted in low- and middle-income countries that included longitudinal follow-up after Shigella detection among children aged <5 years, irrespective of language. We collected data on all outcomes subsequent to Shigella detection, except mortality.

Results: Of 2627 papers identified, 52 met inclusion criteria. The median sample size of children aged <5 years was 66 (range 5-2172). Data were collected in 20 countries; 56% (n = 29) of the publications included Bangladesh. The most common outcomes related to diarrhea (n = 20), linear growth (n = 14), and the mean total cost of a Shigella episode (n = 4; range: $ 6.22-31.10). Among children with Shigella diarrhea, 2.9-61.1% developed persistent diarrhea (≥14 days); the persistence was significantly more likely among children who were malnourished, had bloody stool, or had multidrug-resistant Shigella. Cumulative Shigella infections over the first 2 years of life contributed to the greatest loss in length-for-age z-score.

Conclusion: We identified evidence that Shigella is associated with persistent diarrhea, linear growth faltering, and economic impact to the family.

Keywords: Diarrhea; Enteric; Growth faltering; Shigella; Stunting; Vaccine.

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Conflict of interest statement

Declaration of interests The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Study selection (preferred reporting items for systematic reviews and meta-analyses [PRISMA] diagram). aStudies that were excluded for “no follow-up of Shigella cases/cross-sectional outcomes only” include some studies that were longitudinal in nature, but presented outcomes cross-sectionally such that the likelihood of longitudinal outcomes given Shigella infection could not be determined (e.g., given all children with an outcome, the percent of children that had Shigella infection) either from direct interpretation of tables or through back calculations. Abbreviations: LMIC, low– or middleincome country.
Figure 2
Figure 2
Mean change or difference in LAZ by comparison group and duration of follow-up. *Shigella prevalence or quantity was assessed over a 24-month period. “High” was defined as 90th percentile and “low” as 10th percentile. Abbreviations: CI, confidence interval; LAZ, length-for-age z-score.
Figure 3
Figure 3
Examples of heterogeneity in comparison groups for outcome measurement. Abbreviations: qPCR, quantitative polymerase chain reaction.
See this image and copyright information in PMC

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