{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T05:04:42Z","timestamp":1790485482000,"version":"4.1.0"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,9,1]]},"abstract":"<jats:p>OBJECTIVE. Our goal was to estimate the impact of a Shigella vaccine in an area where shigellosis is endemic by characterizing the disease burden and antibiotic-resistance profiles of isolates and by determining the prevalence of Shigella flexneri serotypes.<\/jats:p>\n               <jats:p>PATIENTS AND METHODS. We conducted a 43-month-long prospective, community-based diarrheal disease surveillance in 442 children &amp;lt;72 months of age in the Peruvian Amazon between October 1, 2002, and April 15, 2006.<\/jats:p>\n               <jats:p>RESULTS. The incidence of diarrheal disease was 4.38 episodes per child-year. The incidence rate for shigellosis was 0.34 episodes per child-year in children &amp;lt;72 months of age and peaked in children between 12 and 23 months at 0.43 episodes per child-year. Maternal education at or beyond the primary grade level, piped water supply, weight-for-age z score, and improved water-storage practices were the most significant determinants of disease in this community with living conditions comparable to many rural areas in the developing world.<\/jats:p>\n               <jats:p>CONCLUSIONS. Children living in this region had a 20-fold higher rate of disease incidence detected by active surveillance as those recently estimated by passive detection. Most symptomatic disease was caused by S flexneri, although the diversity of serotypes will require a multivalent vaccine to have a significant impact on the burden of disease caused by shigellosis. Several other public health disease-control interventions targeted at water source and improved storage, nutritional interventions, and improved maternal education seem to have a greater impact than a univalent S flexneri 2a vaccine.<\/jats:p>","DOI":"10.1542\/peds.2008-0458","type":"journal-article","created":{"date-parts":[[2008,8,19]],"date-time":"2008-08-19T00:16:16Z","timestamp":1219104976000},"page":"e541-e549","source":"Crossref","is-referenced-by-count":64,"title":["Epidemiology of Highly Endemic Multiply Antibiotic-Resistant Shigellosis in Children in the Peruvian Amazon"],"prefix":"10.1542","volume":"122","author":[{"given":"Margaret","family":"Kosek","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland"},{"name":"Biomedical Research, AB PRISMA Morona 452, Iquitos, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo Pen\u0303ataro","family":"Yori","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland"},{"name":"Biomedical Research, AB PRISMA Morona 452, Iquitos, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William K.","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maribel Paredes","family":"Olortegui","sequence":"additional","affiliation":[{"name":"Biomedical Research, AB PRISMA Morona 452, Iquitos, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Gilman","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland"},{"name":"Biomedical Research, AB PRISMA Morona 452, Iquitos, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Perez","sequence":"additional","affiliation":[{"name":"Naval Medical Research Center Detachment, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar Banda","family":"Chavez","sequence":"additional","affiliation":[{"name":"Biomedical Research, AB PRISMA Morona 452, Iquitos, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graciela Meza","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Regional Health Department, Loreto, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Burga","sequence":"additional","affiliation":[{"name":"Naval Medical Research Center Detachment, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Hall","sequence":"additional","affiliation":[{"name":"Naval Medical Research Center Detachment, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,9,1]]},"reference":[{"key":"2021120905245499900_R1","unstructured":"Kosek M, Bern C, Guerrant RL. 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