Shigellosis in Southeast Asia: A systematic review and meta-analysis

Basilua Andre Muzembo; Kei Kitahara; Debmalya Mitra; Ayumu Ohno; Januka Khatiwada; Shanta Dutta; Shin-Ichi Miyoshi

doi:10.1016/j.tmaid.2023.102554

Shigellosis in Southeast Asia: A systematic review and meta-analysis

Travel Med Infect Dis. 2023 Mar-Apr:52:102554. doi: 10.1016/j.tmaid.2023.102554. Epub 2023 Feb 16.

Authors

Basilua Andre Muzembo¹, Kei Kitahara², Debmalya Mitra³, Ayumu Ohno², Januka Khatiwada⁴, Shanta Dutta⁵, Shin-Ichi Miyoshi⁶

Affiliations

¹ Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan. Electronic address: andersonbasilua@yahoo.fr.
² Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India.
³ Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India.
⁴ Social Work Institute, Nakhu-4, Kathmandu, Nepal.
⁵ Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India.
⁶ Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.

PMID: 36792021
DOI: 10.1016/j.tmaid.2023.102554

Abstract

Background: Southeast Asia is attractive for tourism. Unfortunately, travelers to this region are at risk of becoming infected with Shigella. We conducted a meta-analysis to provide updates on Shigella prevalence in Southeast Asia, along with their serogroups and serotypes.

Methods: We conducted a systematic search using PubMed, EMBASE, and Web of Science for peer-reviewed studies from 2000 to November 2022. We selected studies that detected Shigella in stools by culture or polymerase chain reaction (PCR). Two reviewers extracted the data using a standardized form and performed quality assessments using the Joanna Briggs Institute checklist. The random effects model was used to estimate the pooled prevalence of Shigella.

Results: During our search, we identified 4376 studies. 29 studies (from six Southeast Asian countries) were included in the systematic review, 21 each in the meta-analysis of the prevalence of Shigella (Sample size: 109545) and the prevalence of Shigella serogroups. The pooled prevalence of Shigella was 4% (95% CI: 4-5%) among diarrhea cases. Shigella sonnei was the most abundant serogroup in Thailand (74%) and Vietnam (57%), whereas Shigella flexneri was dominant in Indonesia (72%) and Cambodia (71%). Shigella dysenteriae and Shigella boydii were uncommon (pooled prevalence of 1% each). The pooled prevalence of Shigella was 5% (95% CI: 4-6%) in children aged <5 years. The pooled prevalence showed a decreasing trend comparing data collected between 2000-2013 (5%; 95% CI: 4-6%) and between 2014-2022 (3%; 95% CI: 2-4%). Shigella prevalence was 6% in studies that included participants with mixed pathogens versus 3% in those without. Shigella flexneri serotype 2a was the most frequently isolated (33%), followed by 3a (21%), 1b (10%), 2b (3%), and 6 (3%).

Conclusions: This study provides compelling evidence for the development of effective Shigella vaccines for residents of endemic regions and travellers to these areas.

Keywords: Diarrhea; Dysentery; Shiga toxin; Shigella flexneri; Shigella sonnei; Shigella vaccine; Travel.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Child
Dysentery, Bacillary* / epidemiology
Humans
Indonesia
Shigella dysenteriae
Shigella flexneri
Shigella*