Bulletin of the World Health Organization

Trend and disease burden of bacillary dysentery in China (1991–2000)

Xuan-yi Wang, Fangbiao Tao, Donglou Xiao, Hyejon Lee, Jacqueline Deen, Jian Gong, Yuliang Zhao, Weizhong Zhou, Weiming Li, Bing Shen, Yang Song, Jianming Ma, Zheng-mao Li, Zijun Wang, Pu-yu Su, Nayoon Chang, Jun-hong Xu, Pei-ying Ouyang, Lorenz von Seidlein, Zhi-yi Xu, & John D Clemens

ABSTRACT

OBJECTIVE

We aimed to determine the burden of bacillary dysentery in China, its cross-regional variations, trends in morbidity and mortality, the causative bacterial species and antimicrobial resistance patterns.

METHODS

We extracted and integrated governmental statistics and relevant medical literature published from 1991 to 2000. Data were also collected from one general hospital each for the six provinces and Jin-an district, Shanghai, representative of six geographical regions and a modern city.

FINDINGS

In 2000, 0.8–1.7 million episodes of bacillary dysentery occurred of which 0.5 to 0.7 million were treated at health-care facilities and 0.15–0.20 million patients were hospitalized. The highest morbidity and mortality rates were among the youngest and oldest age groups. Bacillary dysentery peaked during the summer months. The major causative species was Shigella flexneri (86%) and the predominant S. flexneri serotype was 2a (80%). About 74–80% of Shigella isolates remained susceptible to fluorinated quinolones.

CONCLUSION

We conclude that while morbidity and mortality due to bacillary dysentery has decreased considerably in China in the past decade due to increasing access to affordable health care and antibiotics, a considerable burden exists among the youngest and oldest age groups and in regions with low economic development. We suggest that while a vaccine would be effective for short- and medium-term control of bacillary dysentery, improved water supply, sanitation, and hygiene are likely to be required for long-term control.

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