Diarrheal disease attributed to Shigella spp. and Enteroinvasive Escherichia coli among children at households in rural Haïti: A case-control study

Infections from Shigella spp. and Enteroinvasive Escherichia coli (EIEC) are considered leading causes of symptomatic diarrheal disease, globally. However, there is a paucity of case-control studies from Caribbean nations to guide regional public health priorities and interventions. A case-control study was conducted within a larger cross-sectional healthcare study in Haiti. Participant households were identified using a geospatially randomized method; families with children under 5 years were consented and enrolled. Rectal swabs from child participants were tested for Shigella spp./EIEC by qPCR using the ipaH target. Two case-definitions were used: diarrheal symptom (DS) cases were defined as those reporting diarrheal symptoms [&le;]7 days ago; acute diarrhea (AD) cases were defined as those reporting diarrheal symptoms [&le;]7 days ago with [&ge;]3 loose stools in the past 24 hours and onset <7 days ago. Of 868 households screened, 568 were enrolled with 794 participating children; samples from 732 children were analyzed. Rates of Shigella spp./EIEC. detection among DS cases and controls were 11.4% (22/193) and 6.1% (33/539), respectively. Rates of detection among AD cases and controls were 18.6% (8/43) and 6.8% (47/689), respectively. The adjusted odds of having DS increased by 84% (aOR=1.84; 95%CI 1.02 to 3.27) and having AD increased by 183% (aOR=2.83; 95%CI 1.14 to 6.36) when Shigella spp./EIEC was detected. The attributable fractions for DS and AD were 5.62% (95%CI 0.44% to 10.9%) and 12.6% (95%CI 0% to 25.3%), respectively. Rates of bloody diarrhea (dysentery) were minimal (<1%, 6/732). Within this case-control study in Haiti, Shigella spp./EIEC detection was common and attributed to symptomatic disease. These results align with prior global health studies. Shigella spp./EIEC represent an important public health target for intervention once the security situation in Haiti stabilizes. AUTHOR SUMMARYGlobal studies outside the Caribbean have identified a group of closely related enteric pathogens (Shigella spp., Enteroinvasive Escherichia coli (EIEC)) as a leading cause of diarrheal disease. This group can be associated with short-term (e.g., bloody diarrhea) or long-term (e.g., malnutrition, stunting) health impacts. Within the Caribbean, there is a lack of information to guide public health policy on enteric pathogens, especially in Haiti. Therefore, we conducted a case-control study where we identified households with children under 5 years, gathered data on diarrhea symptoms, and collected stool swabs. We tested the stools using a sensitive molecular assay (ipaH qPCR). Shigella spp./EIEC detection was common among both children with and without diarrhea, yet more common among, and attributed to, those with symptomatic diarrheal disease. These results align with prior global health studies and represent an opportunity for high-impact public health action when the security situation in Haiti stabilizes.