Shigella dysenteriae serotype 1 in west Africa: intervention strategy for an outbreak in Sierra Leone

Lancet. 2003 Aug 30;362(9385):705-6. doi: 10.1016/S0140-6736(03)14227-4.


In November 1999, a Médecins Sans Frontières team based in the southeastern part of Sierra Leone reported an increased number of cases of bloody diarrhoea. Shigella dysenteriae serotype 1 (Sd1) was isolated in the early cases. A total of 4218 cases of dysentery were reported in Kenema district from December, 1999, to March, 2000. The overall attack rate was 7.5%. The attack rate was higher among children younger than 5 years than in the rest of the population (11.2% vs 6.8%; relative risk=1.6; 95% CI 1.5-1.8). The case fatality was 3.1%, also higher for children younger than 5 years (6.1% vs 2.1%; relative risk=2.9; 95% CI 2.1-4.1]). Among 583 patients regarded at increased risk of death who were treated with ciprofloxacin in isolation centres, case fatality was 0.9%. A 5-day ciprofloxacin regimen, targeted to the most severe cases of bloody diarrhoea, was highly effective. This is the first time a large outbreak caused by Sd1 has been reported in west Africa.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Infective Agents / therapeutic use*
  • Ciprofloxacin / therapeutic use*
  • Disease Outbreaks / prevention & control*
  • Dysentery, Bacillary / diagnosis
  • Dysentery, Bacillary / drug therapy*
  • Dysentery, Bacillary / epidemiology*
  • Humans
  • Serotyping
  • Shigella dysenteriae / classification
  • Sierra Leone / epidemiology


  • Anti-Infective Agents
  • Ciprofloxacin