Shigella infection in children and adults: a formidable foe

Mortality from diarrhoeal diseases overall and from Shigella-associated diarrhoeal diseases specifically have declined substantially during the past 30 years. Global reductions in malnutrition and measles incidence, and increased access to oral rehydration, antibiotics, and micronutrients undoubtedly have contributed to these trends. The near disappearance of Shigella dysenteriae type 1 infections since the late 1990s is another important factor. Although this strain contributes minimally to endemic shigellosis, it is capable of causing large devastating epidemics and pandemics—particularly in conditions of extreme overcrowding, poor sanitation and hygiene, and high density of houseflies (Musca domestica)—that are often triggered by social upheaval or natural disaster.