Consequences of Shigella infection in young children: a systematic review.

OBJECTIVE: We conducted a systematic review of the longitudinal consequences of Shigella infection in children to inform the value proposition for an effective vaccine. METHODS: We searched PubMed and Embase for studies published from January 1, 1980, to December 12, 2022, conducted in low- and middle-income countries, that included longitudinal follow-up after Shigella detection among children <5 years of age, irrespective of language. We collected data on all outcomes subsequent to Shigella detection except mortality. RESULTS: Of 2,627 papers identified, 52 met inclusion criteria. The median sample size of children aged <5 years was 66 (range 5-2172). Data were collected in 20 countries; 56% (n=29) of the publications included Bangladesh. The most common outcomes related to diarrhea (n=20), linear growth (n=14), and the mean total cost of a Shigella episode (n=4; range: $6.22 to $31.10 USD). Among children with Shigella diarrhea, 2.9% to 61.1% developed persistent diarrhea (>=14 days); persistence was significantly more likely among children who were malnourished, had bloody stool, or had multi-drug resistant Shigella. Cumulative Shigella infections over the first two years of life contributed to the greatest loss in length-for-age z-score. CONCLUSIONS: We identified evidence that Shigella is associated with persistent diarrhea, linear growth faltering, and economic impact to the family.