Diarrhoeal disease and other pathogen

1
Diarrhoeal disease and other pathogen

• Inácio Mandomando, BSc

2
Diarrhoea in developing countries

• Diarrhoea is 2nd cause of mortality in children
  lt5 yrs old in developing countries
• 18 of 10.6 million each year
• Data on etiology and the burden of diarrhoeal
  disease are scarce in developing countries
• Increasing antimicrobial resistance

3
Diarrhoea in Manhiça

• Accounts for 20 of paediatric addmission
• 4th cause of death in children aged 12-59 months

4
Aetiology of diarrhea in Manhiça
5
E. Coli pathotypes
6
Shigella Salmonella

• Shigellosis is an important health problem
• 165 million episodes of diarrhoea worldwide
• 163 million occur in developing countries
• 69 of all cases and 61 of 1.1 million death in
  children lt5 years of age
• Typhoid fever caused 21.6 million cases, with
  216.5 thousands death in 2000

7
Shigella Results
8

• Shigella spp accounts for 8 of all cases of
  diarrhoea
• Shigella spp accounts for 25 of all dysentery

9
Shigella serogroups distribution
10
Shigella flexneri serotypes
11
Minimum community incidence rates of Shigella

 
Incidence rates per 100.000 children year at
risk
12
Shigella clinical findings
Shigellosis case fatality rate 0.9
13
Shigella spp seasonality
14
Antimicrobial resistance of Shigella strains
15
Salmonella Results
16
Salmonella serotypes distribution
17
Minimum community incidence rates of Salmonella
Incidence rates per 100.000 children year at
risk
18
Salmonella Clinical findings
19
Salmonella spp seasonality
20
Antimicrobial resistance of Salmonella strains
21
Conclusions

• Shigellosis is an important health problem with
  high incidence in children aged 1-4 yrs
• The incidence of S. Typhi is low in this
  community, however non typhi Salmonella play
  important role with high incidence rates in
  children lt1yr
• Shigella and Salmonella strains are loosing
  susceptibility to most common and inexpensive
  antibiotics available in developing countries
• Description of Shigella serotypes in developing
  countries would determine the potential efficacy
  of a vaccine

22
Future research
Aetiology of diarrhoeal disease among children
0-59 months in Sub-saharan Africa and Asia
23
Goal

• To set priorities for enteric vaccine development
  and design vaccines for broad coverage

24
Primary objective

• To estimate the burden, microbiologic etiology
  and adverse clinical consequences of severe
  diarrhea among children 0-59 months of age

25
Personnel involved

• CISM
• Betuel Sigaúque
• Xavier Valles
• Mateu Espasa
• Jahit Sacarlal
• Eusébio Macete
• Fatima Abacassamo
• Mariano Sitaúbe
• António Langa
• Ariel Nhacolo
• Delino Nhalungo
• Pedro Alonso

• Centro de Salud Internacional de Barcelona
• Sergi Sanz
• Joaquim Ruiz
• Llourenç Quinto
• Joaquim Gascon
• Center for Vaccine Development
• Mike Levine
• Karen Kotloff

26
Collaborators and funding
Centro de Investigação em Saude da Manhiça
(CISM) CVD University of Maryland Johns Hopkins
School of Public Health Hospital Clinic de
Barcelona BMGF