Diarrhea Case Surveillance in the Enterics for Global Health Shigella Surveillance Study: Epidemiologic Methods

Hannah E. Atlas, Bakary Conteh, Md Taufiqul Islam, Khuzwayo C. Jere, Richard Omore, Doh Sanogo, Francesca Schiaffino, Mohammad Tahir Yousafzai, Naveed Ahmed, Alex O. Awuor, Henry Badji, Jennifer Cornick, Erika Feutz, Sean R. Galagan, Fadima C. Haidara, Bri'Anna Horne, Md Ismail Hossen, Aneeta Hotwani, Eric R. Houpt, Abdoulie F. JallowMehrab Karim, Adama Mamby Keita, Youssouf Keita, Farhana Khanam, Jie Liu, Thandizo Malemia, Alhagie Manneh, Christine J. McGrath, Dilruba Nasrin, Maureen Ndalama, John Benjamin Ochieng, Billy Ogwel, Maribel Paredes Olortegui, Loyda Fiorella Zegarra Paredes, Tackeshy Pinedo Vasquez, James A. Platts-Mills, Syed Qudrat-E-Khuda, Sonia Qureshi, Md Nazmul Hasan Rajib, Elizabeth T. Rogawski McQuade, Shazia Sultana, Sharon M. Tennant, Kirkby D. Tickell, Desiree Witte, Pablo Peñataro Yori, Nigel A. Cunliffe, M. Jahangir Hossain, Margaret N. Kosek, Karen L. Kotloff, Firdausi Qadri, Farah Naz Qamar, Milagritos D. Tapia, Patricia B. Pavlinac

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background. Shigella is a leading cause of acute watery diarrhea, dysentery, and diarrhea-attributed linear growth faltering, a precursor to stunting and lifelong morbidity. Several promising Shigella vaccines are in development and field efficacy trials will require a consortium of potential vaccine trial sites with up-to-date Shigella diarrhea incidence data. Methods. The Enterics for Global Health (EFGH) Shigella surveillance study will employ facility-based enrollment of diarrhea cases aged 6–35 months with 3 months of follow-up to establish incidence rates and document clinical, anthropometric, and financial consequences of Shigella diarrhea at 7 country sites (Mali, Kenya, The Gambia, Malawi, Bangladesh, Pakistan, and Peru). Over a 24-month period between 2022 and 2024, the EFGH study aims to enroll 9800 children (1400 per country site) between 6 and 35 months of age who present to local health facilities with diarrhea. Shigella species (spp.) will be identified and serotyped from rectal swabs by conventional microbiologic methods and quantitative polymerase chain reaction. Shigella spp. isolates will undergo serotyping and antimicrobial susceptibility testing. Incorporating population and healthcare utilization estimates from contemporaneous household sampling in the catchment areas of enrollment facilities, we will estimate Shigella diarrhea incidence rates. Conclusions. This multicountry surveillance network will provide key incidence data needed to design Shigella vaccine trials and strengthen readiness for potential trial implementation. Data collected in EFGH will inform policy makers about the relative importance of this vaccine-preventable disease, accelerating the time to vaccine availability and uptake among children in high-burden settings.

Original languageEnglish
Pages (from-to)S6-S16
JournalOpen Forum Infectious Diseases
Issue numberSupplement_1
Publication statusPublished - 1 Mar 2024


  • children
  • diarrhea
  • enterics
  • Shigella
  • vaccine


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