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Journal of Clinical Microbiology, September 2003, p. 4238-4245, Vol. 41, No. 9
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.9.4238-4245.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Cohort Study of Guinean Children: Incidence, Pathogenicity, Conferred Protection, and Attributable Risk for Enteropathogens during the First 2 Years of Life

Palle Valentiner-Branth,1,2* Hans Steinsland,3,4 Thea K. Fischer,2,3,4 Michael Perch,1 Flemming Scheutz,5 Francisco Dias,4 Peter Aaby,1 Kåre Mølbak,2,6 and Halvor Sommerfelt2,3

Bandim Health Project,1 The National Public Health Laboratory, Bissau, Guinea-Bissau,4 Department of Epidemiology Research, Danish Epidemiology Science Centre,2 Department of Gastrointestinal Infections and Parasitology,5 Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark,6 Centre for International Health, University of Bergen, Norway3

Received 16 March 2003/ Returned for modification 7 May 2003/ Accepted 25 June 2003

We recruited 200 children shortly after birth and collected stool specimens weekly, irrespective of whether the children had diarrhea, until up to 2 years of age. All children were recruited during the first year of the study and were monitored for a median of 18.4 months. To measure pathogenicity, the odds ratio for diarrhea, adjusted for age, sex, and coinfections with other enteropathogens, was determined by logistic regression. Standard estimation of the population attributable risk indicated that rotavirus, enterotoxigenic Escherichia coli that produced only the heat-stable toxin ST, Isospora spp., Cryptosporidium parvum, Shiga toxin (Stx)-producing E. coli (STEC), and Shigella spp. or enteroinvasive E. coli were the most important contributors to diarrhea in this population. Stx2- but not Stx1-producing STEC strains were pathogenic. Enteroaggregative E. coli, diffusely adherent E. coli, and attaching-and-effacing E. coli strains, which were the most commonly isolated microorganisms, were not associated with diarrhea. For most of the microorganisms, primary infections did not confer protection against reinfection with the same organism, but some conferred protection against diarrhea from reinfection.

* Corresponding author. Mailing address: Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. Phone: 45-32683608. Fax: 45-32683165. E-mail: pvb{at}ssi.dk.

Journal of Clinical Microbiology, September 2003, p. 4238-4245, Vol. 41, No. 9
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.9.4238-4245.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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