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Prospective study of diarrheal disease in a cohort of Vietnamese children along the Red River

, : Prospective study of diarrheal disease in a cohort of Vietnamese children along the Red River. Abstracts of the General Meeting of the American Society for Microbiology 101: 272

Data on diarrhea rates and pathogens worldwide is essential to rational development of enteric bacterial vaccines, but none are available for many areas, including Indochina. We prospectively studied diarrhea incidence in a cohort of Vietnamese children <5 years of age in northern Vietnam for 1 year. 1655 children enrolled. Passive surveillance was supplemented by active surveillance during 1 month each in wet and dry seasons. Standard microbiologic culture methods were used to detect Salmonella, Shigella, Campylobacter, pathogenic E. coli, Vibrio, Aeromonas and Plesiomonas. Overall 2160 cases occurred (1.31 cases/child-year); median duration of illness 2 days (range 1-9 days); mean max. number stools/day 4.3 (SD 1.4). 7% of cases had blood, 22% fever and 64% abdominal pain. Shigella was associated with fever, blood, and mucus; whereas Campylobacter was associated with less risk of fever or emesis. Peak rates of diarrhea occurred in children <12 mos. Rates ranged from 3.25 cases/ch-yr in children <1 year old, to 0.68 cases/ch-yr in 4-year-olds. A pathogen was isolated in 22.4% of cases. Campylobacter, Shigella and ETEC were most commonly isolated. Rates detected by active surveillance were about twice that detected passively. S. flexneri was the most common Shigella serogroup (65%), followed by S. boydii (17%), S. sonnei (11%) and S. dysenteriae (7%). S. flexneri serotypes 6, 4, 1 and Y were most common, but 40% were untypable. Antibiotic resistance to commonly employed agents was common, with the exception of quinolones. Campylobacter resistance to ciprofloxacin was present in 7% of isolates. This study is the 1st from Vietnam to evaluate diarrhea incidence and quinolone resistance among Shigella, ETEC and Campylobacter. These data point out important regional differences in pathogen prevalence and resistance patterns that must be considered in vaccine development strategies and diarrhea treatment in Southeast Asia. Shigella vaccine development strategies targeting S. flexneri 2a, S. sonnei and S. dysenteriae 1 will have little impact on diarrhea rates in Vietnam. Quinolones remain useful for dysenteric illness in Vietnam.


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