Epidemiology of Shigella sonnei and Shigella flexneri in the Global Pediatric Diarrhea Surveillance network, 2017-2022
- 1Independent Researcher
Abstract
BackgroundShigella is a leading cause of diarrhea in children in low- and middle-income countries (LMICs). Optimizing the impact of vaccines necessitates an accurate characterization of Shigella serotype prevalence. We describe the burden, epidemiology and characteristics of S. sonnei and S. flexneri diarrhea in the Global Pediatric Diarrhea Surveillance (GPDS) network.
MethodsGPDS is a World Health Organization-coordinated surveillance network investigating the etiology of hospitalized diarrhea among children aged <5 years. GPDS enrolls children hospitalized with diarrhea at 38 sentinel surveillance sites in 31 LMICs. Randomly selected stool specimens from these children were tested by quantitative polymerase chain reaction to detect a broad range of enteropathogens as well as to identify S. sonnei and S. flexneri serotypes. We estimated pathogen-specific attributable fractions and incidence of diarrheal hospitalizations.
ResultsDuring 2017-2022, GPDS enrolled 70,750 children aged <5 years hospitalized with diarrhea, of which 16,458 (23.3%) were randomly selected for qPCR testing. Globally, Shigella caused 9.8% (95% Confidence Interval [CI]: 8.4, 11.3) of hospitalized diarrhea, with 28.3% of cases occurring in children aged [≤]12 months. The estimated attributable incidence of Shigella-associated diarrhea hospitalizations decreased from 1.27 (95% CI: 0.95, 1.64) per 1,000 child years in 2017-2018 to 0.88 (0.67, 1.10) in 2021-2022. Among typeable Shigella cases, 34.8% were S. sonnei, 24.2% were S. flexneri 2a, and 9.9% were S. flexneri 1b. Vaccines currently in development would cover an estimated 59.0% to 72.2% of cases.
ConclusionsThese findings support the role of Shigella as an important cause of the most severe diarrhea in young children. The breadth of homotypic protection provided by Shigella vaccines in clinical development varied by region, and these broadly representative data can aid in prioritization. Non-dysenteric Shigella could not be readily differentiated from other causes of hospitalized diarrhea based on clinical characteristics.
Related
- Fecal biomarkers to characterize intestinal inflammation among children with medically attended diarrhea across six low-resource settings: Findings from the Enterics for Global Health (EFGH) Shigella surveillance study
- Etiology and incidence of diarrhea requiring hospitalization in children under 5 years of age in 31 low- and middle-income countries: Findings from the Global Pediatric Diarrhea Surveillance network, 2017–2022
- Oral rehydration salts utilization in pediatric diarrhea management among Chinese pediatricians: a national survey
- Central role of vapBC toxin-antitoxin system expression in the pathogenicity and antimicrobial resistance of Shigella sonnei isolates from pediatric diarrheal patients.
- Respiratory pathogen epidemiology in children under 5 years hospitalized with acute respiratory infections in Qingdao, China: a retrospective, single-center, repeated cross-sectional surveillance study
BibTeX
@misc{liu2026epidemiology,
title = {{Epidemiology of Shigella sonnei and Shigella flexneri in the Global Pediatric Diarrhea Surveillance network, 2017-2022}},
author = {J. Liu and M. Lewontin and S. E. Elwood and S. S. Iyer and S. Antoni and G. Rey-Bonito and C. Ortiz and G. Weldegebriel and J. Biey and J. M. Mwenda and R. Pastore and D. Videbaek and S. Singh and E. Njambe and L. Sangal and D. Dhongde and V. Grabovac and J. Logronio and K. Fahmy and A. Ghoniem and G. Armah and F. E. Dennis and M. L. Seheri and N. Magagula and K. Rakau-Nondela and T. M. Fumian and I. T. A. Maciel and E. Samoilovich and G. Semeiko and T. Varghese and S. Thomas and J. E. Bines and D. Li and F. Kabir and E. R. Houpt and M. N. Mulders and H. M. Soeters and J. A. Platts-Mills},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.14.26363009},
url = {https://www.medrxiv.org/content/10.64898/2026.09.14.26363009v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Epidemiology of Shigella sonnei and Shigella flexneri in the Global Pediatric Diarrhea Surveillance network, 2017-2022
AU - J. Liu
AU - M. Lewontin
AU - S. E. Elwood
AU - S. S. Iyer
AU - S. Antoni
AU - G. Rey-Bonito
AU - C. Ortiz
AU - G. Weldegebriel
AU - J. Biey
AU - J. M. Mwenda
AU - R. Pastore
AU - D. Videbaek
AU - S. Singh
AU - E. Njambe
AU - L. Sangal
AU - D. Dhongde
AU - V. Grabovac
AU - J. Logronio
AU - K. Fahmy
AU - A. Ghoniem
AU - G. Armah
AU - F. E. Dennis
AU - M. L. Seheri
AU - N. Magagula
AU - K. Rakau-Nondela
AU - T. M. Fumian
AU - I. T. A. Maciel
AU - E. Samoilovich
AU - G. Semeiko
AU - T. Varghese
AU - S. Thomas
AU - J. E. Bines
AU - D. Li
AU - F. Kabir
AU - E. R. Houpt
AU - M. N. Mulders
AU - H. M. Soeters
AU - J. A. Platts-Mills
PY - 2026
DA - 2026/09/14
PB - medRxiv
DO - 10.64898/2026.09.14.26363009
UR - https://www.medrxiv.org/content/10.64898/2026.09.14.26363009v1
AB - BackgroundShigella is a leading cause of diarrhea in children in low- and middle-income countries (LMICs). Optimizing the impact of vaccines necessitates an accurate characterization of Shigella serotype prevalence. We describe the burden, epidemiology and characteristics of S. sonnei and S. flexneri diarrhea in the Global Pediatric Diarrhea Surveillance (GPDS) network. MethodsGPDS is a World Health Organization-coordinated surveillance network investigating the etiology of hospitalized diarrhea among children aged <5 years. GPDS enrolls children hospitalized with diarrhea at 38 sentinel surveillance sites in 31 LMICs. Randomly selected stool specimens from these children were tested by quantitative polymerase chain reaction to detect a broad range of enteropathogens as well as to identify S. sonnei and S. flexneri serotypes. We estimated pathogen-specific attributable fractions and incidence of diarrheal hospitalizations. ResultsDuring 2017-2022, GPDS enrolled 70,750 children aged <5 years hospitalized with diarrhea, of which 16,458 (23.3%) were randomly selected for qPCR testing. Globally, Shigella caused 9.8% (95% Confidence Interval [CI]: 8.4, 11.3) of hospitalized diarrhea, with 28.3% of cases occurring in children aged [≤]12 months. The estimated attributable incidence of Shigella-associated diarrhea hospitalizations decreased from 1.27 (95% CI: 0.95, 1.64) per 1,000 child years in 2017-2018 to 0.88 (0.67, 1.10) in 2021-2022. Among typeable Shigella cases, 34.8% were S. sonnei, 24.2% were S. flexneri 2a, and 9.9% were S. flexneri 1b. Vaccines currently in development would cover an estimated 59.0% to 72.2% of cases. ConclusionsThese findings support the role of Shigella as an important cause of the most severe diarrhea in young children. The breadth of homotypic protection provided by Shigella vaccines in clinical development varied by region, and these broadly representative data can aid in prioritization. Non-dysenteric Shigella could not be readily differentiated from other causes of hospitalized diarrhea based on clinical characteristics.
ER -