The seroincidence of childhood Shigella sonnei infection in Ho Chi Minh City, Vietnam

Background: Shigella sonnei is a pathogen of growing global importance as a cause of diarrhoeal illness in childhood, particularly in transitional low-middle income countries (LMICs). Here, we sought to determine the incidence of childhood exposure to S. sonnei infection in a contemporary transitional LMIC population, where it represents the dominant Shigella species. Methods: Participants were enrolled between the age of 12–36 months between June and December 2014. Baseline characteristics were obtained through standardized electronic questionnaires, and serum samples were collected at 6-month intervals over two years of follow-up. IgG antibody against S. sonnei O-antigen (anti-O) was measured using an enzyme-linked immunosorbent assay (ELISA). A four-fold increase in ELISA units (EU) with convalescent IgG titre >10.3 EU was taken as evidence of seroconversion between timepoints. Results: A total of 3,498 serum samples were collected from 748 participants; 3,170 from the 634 participants that completed follow-up. Measures of anti-O IgG varied significantly by calendar month (p = 0.03). Estimated S. sonnei seroincidence was 21,451 infections per 100,000 population per year (95% CI 19,307–23,834), with peak incidence occurring at 12–18 months of age. Three baseline factors were independently associated with the likelihood of seroconversion; ever having breastfed (aOR 2.54, CI 1.22–5.26), history of prior hospital admission (aOR 0.57, CI 0.34–0.95), and use of a toilet spray-wash in the household (aOR 0.42, CI 0.20–0.89). Conclusions: Incidence of S. sonnei exposure in Ho Chi Minh City is substantial, with significant reduction in the likelihood of exposure as age increases beyond 2 years. Author summary: Bacteria belonging to the genus Shigella are a leading cause of childhood diarrhea globally. In Vietnam and other transitional low-middle income countries (LMIC), S. sonnei has recently emerged as the dominant Shigella species, displacing S. flexneri, which usually predominates in industrializing regions. Little is known about the epidemiology of S. sonnei and how common infection is amongst children in such settings. In this study, we used regular blood sampling from a large cohort of children in Ho Chi Minh City over a two year period to examine changes in antibody concentrations against S. sonnei, using this to detect evidence of exposure to the bacteria. Importantly, this approach allowed us to identify exposures irrespective of whether the children had experienced symptoms or not. Our findings showed that exposure to S. sonnei was common in this cohort, with the highest incidence of exposure occurring in children observed between the ages of 12 months and 18 months. This is the first study of its kind to describe the epidemiology of S. sonnei infection in a LMIC setting and will be useful in informing future vaccine development and deployment strategies against this important pathogen.