Epidemiology and Infection

Review Article

Part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984–2005

P. K. RAMa1a2 c1, J. A. CRUMPa2, S. K. GUPTAa2, M. A. MILLERa3 and E. D. MINTZa2

a1 School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA

a2 Enteric Diseases Epidemiology Branch, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA

a3 Fogarty International Center, National Institutes of Health, Bethesda, MD, USA


The global incidence of Shigella infection has been estimated at 80–165 million episodes annually, with 99% of episodes occurring in the developing world. To identify contemporary gaps in the understanding of the global epidemiology of shigellosis, we conducted a review of the English-language scientific literature from 1984 to 2005, restricting the search to low and medium human development countries. Our review yielded 11 population-based studies of Shigella burden from seven countries. No population-based studies have been conducted in sub-Saharan Africa or in low human development countries. In studies done in all age groups, Shigella incidence varied from 0·6 to 107 episodes/1000 person-years. S. flexneri was the most commonly detected subgroup in the majority of studies. Case-fatality rates ranged from 0% to 2·6% in population-based studies and from 0% to 21% in facility-based studies. This review highlights the large gaps in data on the burden of Shigella infections for low human development index countries and, more specifically, for sub-Saharan Africa.

(Accepted June 30 2007)

(Online publication August 09 2007)


c1 Author for correspondence: P. K. Ram, M.D., Research Assistant Professor, Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Rm. 273 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA. (Email: pkram@buffalo.edu)