{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:58:40Z","timestamp":1792821520644,"version":"4.5.0"},"reference-count":80,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Infections from\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/enteroinvasive\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (EIEC) are considered leading causes of diarrheal disease globally. However, there is a notable paucity of studies from Caribbean nations to guide regional public health interventions. A case\u2013control study was conducted as part of a cross-sectional healthcare study in Haiti. Households were identified using a geospatially randomized method, and families with children under 5 years of age were consented and enrolled. Rectal swabs from child participants were tested for\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/EIEC via real-time polymerase chain reaction testing using the invasion plasmid antigen H gene target. Two case definitions were used: \u201cdiarrheal symptom\u201d (DS) cases were defined as those reporting DSs \u22647 days ago; \u201cacute diarrhea\u201d (AD) cases were defined as those who also presented with \u22653 loose stools in the past 24 hours and onset &lt;7 days ago. A total of 568 households were enrolled, and samples from 732 children were analyzed. The rates of\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/EIEC detection were 11% (22\/193) and 6% (33\/539) among DS cases and controls, respectively, and 19% (8\/43) and 7% (47\/689) among AD cases and controls, respectively.\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/EIEC was attributed to DS in 6% (95% CI: 0.4%\u201311%) of cases and AD in 13% (95% CI: 0%\u201325%) of cases. The adjusted odds of having DS increased by 84% (adjusted odds ratio [aOR] = 1.84; 95% CI: 1.02\u20133.27) and AD increased by 183% (aOR = 2.83; 95% CI: 1.14\u20136.36) when\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/EIEC was detected. The rates of bloody diarrhea were minimal (&lt;1%; 6\/732). In the present case\u2013control study, the detection of\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/EIEC was common and attributed to symptomatic disease. These results align with previous global health studies.\n                    <jats:italic>Shigella<\/jats:italic>\n                    spp.\/EIEC represent an important public health target for intervention once the security situation improves in Haiti.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0183","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T17:44:33Z","timestamp":1762278273000},"page":"31-37","source":"Crossref","is-referenced-by-count":1,"title":["Diarrheal Disease Attributed to Shigella spp. and Enteroinvasive Escherichia coli among Children at Households in Haiti: A Case\u2013Control Study"],"prefix":"10.4269","volume":"114","author":[{"given":"Ishae","family":"Sriguha","sequence":"first","affiliation":[{"name":"Department of Environmental and Global Health, University of Florida, Gainesville, Florida;"},{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saradiya R.","family":"Kuyt","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youseline","family":"Cajusma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilee","family":"Cato","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Brinkley","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Abu","family":"Sayeed","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health, University of Florida, Gainesville, Florida;"},{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stace","family":"Maples","sequence":"additional","affiliation":[{"name":"Stanford Geospatial Center, Stanford University, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valery Madsen","family":"Beau De Rochars","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T.","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony T.","family":"Maurelli","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantale","family":"Baril","sequence":"additional","affiliation":[{"name":"Universit\u00e9 d\u2019\u00c9tat d\u2019Haiti- Facult\u00e9 de M\u00e9decine et de Pharmacie, Port-au-Prince, Haiti"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly B.","family":"Klarman","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health, University of Florida, Gainesville, Florida;"},{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health, University of Florida, Gainesville, Florida;"},{"name":"Department of Pediatrics, University of Florida, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"3027","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"1004","article-title":"Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition","volume":"95","author":"Pinkerton","year":"2016"},{"key":"b3","series-title":"Int J Infect Dis","first-page":"78","article-title":"Consequences of Shigella infection in young children: A systematic review","volume":"129","author":"Libby","year":"2023"},{"key":"b4","series-title":"Lancet Glob Health","first-page":"e321","article-title":"Burden of enterotoxigenic Escherichia coli and Shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: A modelling analysis","volume":"7","author":"Anderson","year":"2019"},{"key":"b5","series-title":"PLoS One","first-page":"e58437","article-title":"Use of population-based surveillance to define the high incidence of shigellosis in an urban slum in Nairobi, Kenya","volume":"8","author":"Njuguna","year":"2013"},{"key":"b6","series-title":"EcoSal Plus","article-title":"A brief history of Shigella.","volume":"8","author":"Lampel","year":"2018"},{"key":"b7","series-title":"J Food Prot","first-page":"1618","article-title":"Development of a multiplex real-time PCR assay with internal amplification control for the detection of Shigella species and enteroinvasive Escherichia coli.","volume":"73","author":"Deer","year":"2010"},{"key":"b8","series-title":"Lancet","first-page":"801","article-title":"Shigellosis","volume":"391","author":"Kotloff","year":"2018"},{"key":"b9","series-title":"Nat Rev Microbiol","first-page":"409","article-title":"Antimicrobial-resistant Shigella: Where do we go next?","volume":"21","author":"Baker","year":"2023"},{"key":"b10","series-title":"Infect Drug Resist","first-page":"3137","article-title":"Shigella: Antibiotic-resistance mechanisms and new horizons for treatment","volume":"12","author":"Ranjbar","year":"2019"},{"key":"b11","article-title":"Epidemiological Alert: Emergence and Spread of Shigella sonnei with Extreme Resistance to Antibiotics: Potential Risk for Latin America and the Carribean.","year":"2022"},{"key":"b12","series-title":"Lancet","first-page":"1291","article-title":"Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: A reanalysis of the GEMS case-control 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Shigella flexneri ipaC and ipaH gene sequences for the general identification of Shigella spp. and enteroinvasive Escherichia coli.","volume":"27","author":"Venkatesan","year":"1989"},{"key":"b17","series-title":"BMJ Open","first-page":"e047367","article-title":"Opportunities to catalyse improved healthcare access in pluralistic systems: A cross-sectional study in Haiti","volume":"11","author":"Klarman","year":"2021"},{"key":"b18","article-title":"Levels & Trends in Child Mortality.","year":"2023"},{"key":"b19","article-title":"Immunization Country Profiles.","year":"2024"},{"key":"b20","series-title":"PLOS Glob Public Health","first-page":"e0001863","article-title":"Prevalence of diarrheagenic Escherichia coli and impact on child health in Cap-Haitien, Haiti","volume":"3","author":"Diaz","year":"2023"},{"key":"b21","series-title":"Am J Trop Med Hyg","first-page":"752","article-title":"Spectrum of outpatient illness in a school-based cohort in Haiti, with a focus on diarrheal pathogens","volume":"92","author":"Beau De Rochars","year":"2015"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"511","article-title":"Importance of cholera and other etiologies of acute diarrhea in post-earthquake Port-au-Prince, Haiti","volume":"90","author":"Charles","year":"2014"},{"key":"b23","article-title":"Model IMCI Handbook: Integrated Management of Childhood Illness.","year":"2005"},{"key":"b24","series-title":"Lancet Planet Health","first-page":"e297","article-title":"Monitoring of diverse enteric pathogens across environmental and host reservoirs with TaqMan array cards and standard qPCR: A methodological comparison study","volume":"5","author":"Lappan","year":"2021"},{"key":"b25","series-title":"Front Cell Infect Microbiol","first-page":"351","article-title":"High-throughput multiparallel enteropathogen detection via nano-liter qPCR","volume":"10","author":"Grembi","year":"2020"},{"key":"b26","series-title":"FEMS Immunol Med Microbiol","first-page":"81","article-title":"Quantitative real-time PCR using TaqMan and SYBR Green for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, tetQ gene and total bacteria","volume":"39","author":"Maeda","year":"2003"},{"key":"b27","series-title":"Eur J Epidemiol","first-page":"715","article-title":"Estimating and displaying population attributable fractions using the R package: GraphPAF","volume":"39","author":"Ferguson","year":"2024"},{"key":"b28","series-title":"Am J Epidemiol","first-page":"904","article-title":"Estimating the population attributable risk for multiple risk factors using case-control data","volume":"122","author":"Bruzzi","year":"1985"},{"key":"b29","article-title":"R: A Language and Environment for Statistical Computing.","year":"2024"},{"key":"b30","series-title":"Bull World Health Organ","first-page":"11","article-title":"The development of MUAC-for-age reference data recommended by a WHO Expert 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changes","volume":"220","author":"Alexandrova","year":"2019"},{"key":"b35","series-title":"Eur J Microbiol Immunol (Bp)","first-page":"197","article-title":"Molecular differentiation of Shigella spp. from enteroinvasive E. coli.","volume":"6","author":"L\u00f8bersli","year":"2016"},{"key":"b36","series-title":"Sleisenger and Fordtran\u2019s Gastrointestinal and Liver Disease","first-page":"1843","author":"Giannella","year":"2010"},{"key":"b37","article-title":"What\u2019s the Significance of Enteroinvasive E. coli (EIEC), Enteropathogenic E. coli (EPEC), and Enteroaggregative E. coli (EAEC) in Stool?","year":"2019"},{"key":"b38","series-title":"Am J Trop Med Hyg","first-page":"528","article-title":"High prevalence of enteroinvasive Escherichia coli isolated in a remote region of northern coastal Ecuador","volume":"76","author":"Vieira","year":"2007"},{"key":"b39","series-title":"J Clin Microbiol","first-page":"951","article-title":"Defining the phylogenomics of Shigella species: A pathway to diagnostics","volume":"53","author":"Sahl","year":"2015"},{"key":"b40","series-title":"Foodborne Pathog Dis","first-page":"400","article-title":"Multiplex polymerase chain reaction for identification of Shigellae and four Shigella species using novel genetic markers screened by comparative genomics","volume":"14","author":"Kim","year":"2017"},{"key":"b1","series-title":"Lancet","first-page":"3027","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"1004","article-title":"Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition","volume":"95","author":"Pinkerton","year":"2016"},{"key":"b3","series-title":"Int J Infect Dis","first-page":"78","article-title":"Consequences of Shigella infection in young children: A systematic review","volume":"129","author":"Libby","year":"2023"},{"key":"b4","series-title":"Lancet Glob Health","first-page":"e321","article-title":"Burden of enterotoxigenic Escherichia coli and Shigella non-fatal diarrhoeal infections in 79 low-income and lower middle-income countries: A modelling analysis","volume":"7","author":"Anderson","year":"2019"},{"key":"b5","series-title":"PLoS One","first-page":"e58437","article-title":"Use of population-based surveillance to define the high incidence of shigellosis in an urban slum in Nairobi, Kenya","volume":"8","author":"Njuguna","year":"2013"},{"key":"b6","series-title":"EcoSal Plus","article-title":"A brief history of Shigella.","volume":"8","author":"Lampel","year":"2018"},{"key":"b7","series-title":"J Food Prot","first-page":"1618","article-title":"Development of a multiplex real-time PCR assay with internal amplification control for the detection of Shigella species and enteroinvasive Escherichia coli.","volume":"73","author":"Deer","year":"2010"},{"key":"b8","series-title":"Lancet","first-page":"801","article-title":"Shigellosis","volume":"391","author":"Kotloff","year":"2018"},{"key":"b9","series-title":"Nat Rev Microbiol","first-page":"409","article-title":"Antimicrobial-resistant Shigella: Where do we go next?","volume":"21","author":"Baker","year":"2023"},{"key":"b10","series-title":"Infect Drug Resist","first-page":"3137","article-title":"Shigella: Antibiotic-resistance mechanisms and new horizons for treatment","volume":"12","author":"Ranjbar","year":"2019"},{"key":"b11","article-title":"Epidemiological Alert: Emergence and Spread of Shigella sonnei with Extreme Resistance to Antibiotics: Potential Risk for Latin America and the Carribean.","year":"2022"},{"key":"b12","series-title":"Lancet","first-page":"1291","article-title":"Use of quantitative molecular diagnostic methods to identify causes of diarrhoea in children: A reanalysis of the GEMS case-control study","volume":"388","author":"Liu","year":"2016"},{"key":"b13","series-title":"Lancet Glob Health","first-page":"e1309","article-title":"Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: A reanalysis of the MAL-ED cohort study","volume":"6","author":"Platts-Mills","year":"2018"},{"key":"b14","series-title":"Infect Immun","first-page":"2362","article-title":"Investigating the relatedness of enteroinvasive Escherichia coli to other E. coli and Shigella isolates by using comparative genomics","volume":"84","author":"Hazen","year":"2016"},{"key":"b15","series-title":"Clin Microbiol Rev","first-page":"134","article-title":"Molecular pathogenesis of Shigella spp.: Controlling host cell signaling, invasion, and death by type III secretion","volume":"21","author":"Schroeder","year":"2008"},{"key":"b16","series-title":"J Clin Microbiol","first-page":"2687","article-title":"Use of Shigella flexneri ipaC and ipaH gene sequences for the general identification of Shigella spp. and enteroinvasive Escherichia coli.","volume":"27","author":"Venkatesan","year":"1989"},{"key":"b17","series-title":"BMJ Open","first-page":"e047367","article-title":"Opportunities to catalyse improved healthcare access in pluralistic systems: A cross-sectional study in Haiti","volume":"11","author":"Klarman","year":"2021"},{"key":"b18","article-title":"Levels & Trends in Child Mortality.","year":"2023"},{"key":"b19","article-title":"Immunization Country Profiles.","year":"2024"},{"key":"b20","series-title":"PLOS Glob Public Health","first-page":"e0001863","article-title":"Prevalence of diarrheagenic Escherichia coli and impact on child health in Cap-Haitien, Haiti","volume":"3","author":"Diaz","year":"2023"},{"key":"b21","series-title":"Am J Trop Med Hyg","first-page":"752","article-title":"Spectrum of outpatient illness in a school-based cohort in Haiti, with a focus on diarrheal 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Microbiol","first-page":"81","article-title":"Quantitative real-time PCR using TaqMan and SYBR Green for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, tetQ gene and total bacteria","volume":"39","author":"Maeda","year":"2003"},{"key":"b27","series-title":"Eur J Epidemiol","first-page":"715","article-title":"Estimating and displaying population attributable fractions using the R package: GraphPAF","volume":"39","author":"Ferguson","year":"2024"},{"key":"b28","series-title":"Am J Epidemiol","first-page":"904","article-title":"Estimating the population attributable risk for multiple risk factors using case-control data","volume":"122","author":"Bruzzi","year":"1985"},{"key":"b29","article-title":"R: A Language and Environment for Statistical Computing.","year":"2024"},{"key":"b30","series-title":"Bull World Health Organ","first-page":"11","article-title":"The development of MUAC-for-age reference data recommended by a WHO Expert 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