March 24, 2026
Primary Results of the Enterics for Global Health (EFGH) Study on Shigella Burden and Antibiotic Resistance in Children Published in The Lancet Global Health
The Enterics for Global Health (EFGH) study, funded by the Gates Foundation, has found that Shigella—a leading cause of childhood diarrhea worldwide—poses a far greater threat than previously described. The study documents both a substantial disease burden in young children and rapidly increasing resistance to commonly used, and recommended, antibiotics.
These findings, now published by The Lancet Global Health, underscore the need for vaccine development and strengthened antimicrobial resistance (AMR) monitoring globally.
Conducted from June 2022 to August 2024, the EFGH study enrolled 9,476 children aged 6–35 months with acute diarrhea across Kenya, Malawi, Mali, The Gambia, Bangladesh, Pakistan, and Peru. This large-scale, prospective surveillance effort used both microbiologic culture and quantitative PCR (qPCR) to identify Shigella infections and to measure antibiotic resistance patterns. Its hybrid design combined facility‑based surveillance, household population mapping, and assessment of healthcare‑seeking patterns also generated robust and comparable incidence estimates.
Shigella was detected in 20% of children tested by qPCR and 9.3% by culture with incidence rates ranging from 2.7-26.9 Shigella diarrhea cases per 100 child-years. High levels of antibiotic resistance were documented, including resistance to the leading WHO-recommended antibiotics for treating dysentery: Ciprofloxacin, Azithromycin, Ceftriaxone. These patterns reflect escalating AMR risks, leaving fewer effective treatment options for children in high‑burden settings. The study’s findings arrive as potential Shigella vaccine candidates advance in development, which target the most frequently observed serotypes.
“EFGH shows how rigorous data and strong multinational partnerships can accelerate progress against diseases that disproportionately affect children,” stated Dr. Patricia Pavlinac, Coordinating Primary Investigator. “But this is only the beginning. Vaccines must still be tested for safety and efficacy, antibiotic resistance must be vigilantly monitored, and treatment guidelines updated to protect children from this debilitating and all-too-common disease.”
The EFGH study also answers critical questions to eventual Shigella vaccine trial design: such as what are the optimal disease severity definitions to use to capture the most vaccine preventable forms of Shigella disease and what sample types and media should be used to identify Shigella. These findings were recently published in The Journal Of Infectious Diseases and Journal of Clinical Microbiology.
The message is clear: Shigella is placing an unacceptable burden on young children, and rising resistance is rapidly eroding the tools available to treat Shigella diarrhea. These findings strongly point to the demand for investment in vaccines and other lifesaving interventions to protect the world’s most vulnerable children.