The incidence and antimicrobial resistance of Shigella-attributable diarrhoea in young children in low-income and middle-income countries from the multicountry Enterics for Global Health (EFGH) Shigella Surveillance Study: a prospective, facility-based hybrid surveillance study

The EFGH multi-country study (2022–2024) assessed the burden, serotypes, and antimicrobial resistance of Shigella-associated diarrhoea in children aged 6–35 months across seven LMICs. Among ~9,500 children, Shigella was detected in 9% (culture) to 20% (qPCR), with Shigella flexneri—particularly serotypes 2a and 6—being dominant. Incidence rates varied substantially by country but were consistently high, confirming Shigella as a major contributor to childhood diarrhoeal disease. Notably, significant resistance was observed to key WHO-recommended antibiotics (ciprofloxacin, azithromycin, ceftriaxone), with considerable geographic variability. The findings highlight both the substantial disease burden and the growing AMR threat, while also indicating that leading quadrivalent vaccine candidates would cover most circulating serotypes—supporting the urgency and feasibility of vaccine development and deployment.