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From December 1999 to the end of February 2000, 4218 cases of dysentery were reported in Kenema district, southeastern Sierra Leone, by a Médecins Sans Frontières team operating in this region. Shigella dysenteriae serotype 1 was isolated from the early cases. The overall attack rate was 7.5% but higher among children under 5 years (11.2%) compared to the rest of the population (6.8%) (RR = 1.6; 95% CI 1.5-1.8). The case fatality ratio was 3.1%, and higher for children under 5 years (6.1% vs. 2.1%) (RR = 2.9; 95% CI 2.1-4.1). A case management strategy based on stratification of affected cases was chosen in this resource-poor setting. Patients considered at higher risk of death were treated with a 5 day ciprofloxacin regimen in isolation centres. Five hundred and eighty-three cases were treated with a case fatality ratio of 0.9%. Patients who did not have signs of severity when seen by health workers were given hygiene advice and oral rehydration salts. This strategy was effective in this complex emergency.

Original publication

DOI

10.1016/j.trstmh.2004.01.005

Type

Journal article

Journal

Trans R Soc Trop Med Hyg

Publication Date

11/2004

Volume

98

Pages

635 - 643

Keywords

Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Animals, Anti-Infective Agents, Child, Child, Preschool, Ciprofloxacin, Disease Outbreaks, Drug Resistance, Dysentery, Bacillary, Female, Humans, Male, Middle Aged, Serotyping, Sex Distribution, Shigella dysenteriae, Sierra Leone