Case management of a multidrug-resistant Shigella dysenteriae serotype 1 outbreak in a crisis context in Sierra Leone, 1999-2000.

Journal article

From December 1999 to the end of February 2000, 4218 cases of dysentery were reported in Kenema district, southeastern Sierra Leone, by a Médecins Sans Frontières team operating in this region. Shigella dysenteriae serotype 1 was isolated from the early cases. The overall attack rate was 7.5% but higher among children under 5 years (11.2%) compared to the rest of the population (6.8%) (RR = 1.6; 95% CI 1.5-1.8). The case fatality ratio was 3.1%, and higher for children under 5 years (6.1% vs. 2.1%) (RR = 2.9; 95% CI 2.1-4.1). A case management strategy based on stratification of affected cases was chosen in this resource-poor setting. Patients considered at higher risk of death were treated with a 5 day ciprofloxacin regimen in isolation centres. Five hundred and eighty-three cases were treated with a case fatality ratio of 0.9%. Patients who did not have signs of severity when seen by health workers were given hygiene advice and oral rehydration salts. This strategy was effective in this complex emergency.

Authors: Guerin, P; Brasher, C; Baron, E; Mic, D; Grimont, F

• Publication status: Published
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene
• Volume: 98
• Issue: 11
• Pages: 635-643
• Publication date: 2004-11-01
• DOI: 10.1016/j.trstmh.2004.01.005
• EISSN: 1878-3503
• ISSN: 0035-9203
• Language: English
• Keywords: Middle Aged; Child; Animals; Adolescent; Sierra Leone; Shigella dysenteriae; Disease Outbreaks; Drug Resistance; Adult; Aged; Sex Distribution; Age Distribution; Female; Humans; Child, Preschool; Male; Serotyping; Dysentery, Bacillary; Aged, 80 and over; Ciprofloxacin; Anti-Infective Agents