# Shigella humoral immunity during the first 2 years of life in children from endemic areas

## TL;DR

The study examines how Shigella immunity develops in young children in endemic regions, identifying a vulnerable age group and highlighting potential vaccine targets.

## Contribution

This is the first study to investigate Shigella humoral immunity in children under 2 years using a qualified multiplex assay in endemic areas.

## Key findings

- Antibody profiles in children varied by age and region, with 12–17-month-olds showing the lowest protective IgG levels.
- Older children had higher antibodies to conserved Shigella proteins, suggesting their potential as vaccine candidates.
- Geographical differences in Shigella exposure were reflected in antibody levels across study sites.

## Abstract

Shigella is a leading cause of moderate-to-severe diarrhea, primarily affecting children in impoverished regions. Disease incidence is highest in toddlers 1–2 years of age. Acquisition of immunity over time reduces the risk of infection. However, the evolution of childhood immunity resulting from Shigella exposure and the host responses that mediate protection remain poorly understood. Gaining insight into the immunological features that develop over time and prevent subsequent Shigella infection is critical for guiding vaccine design. We examined the antigenic repertoire and magnitude of humoral immunity to Shigella in children < 2 years of age from three endemic areas—Bamako, Mali, and two sites (Afar and Tigray) in Ethiopia—using a qualified multiplex assay. Serum IgG and IgA specific to Shigella proteins (IpaB, IpaC, IpaD, IpaH, and VirG) and lipopolysaccharide (LPS) from S. flexneri 2a, S. flexneri 3a, S. flexneri 6, and S. sonnei were measured in three stratified age groups: 6–8, 12–17, and 18–24 months. The youngest group (6- to 8-month-olds) exhibited similar antibody profiles across all sites. By contrast, antibody levels in the 12- to 17- and 18- to 24-month-old age groups varied by both age and site, reflecting geographical differences in Shigella endemicity and exposure. Notably, most children in the 12- to 17-month-old age group had IgG levels below the adult protective thresholds identified in controlled human infection models, identifying a critical window of vulnerability that would require intervention. Our findings underscore the importance and value of Shigella serosurveillance in children from endemic regions to inform future vaccine rollout decisions.

Shigella is a major cause of moderate-to-severe diarrhea, the most affected being young children from poor resource countries. Shigella species easily acquire antibiotic resistance, presenting a challenge to infection control. The development of vaccines for young children has been hindered by a lack of understanding of what constitutes protective immunity. Here, for the first time, we investigated the magnitude and specificity of Shigella humoral immunity evoked by natural exposure in children 6 months to 2 years old living in Mali and Ethiopia (Shigella-endemic areas) using a qualified multiplex assay. Antibody profiles varied with age and region, revealing epidemiological trends. Children 12–17 months old were identified as the most vulnerable to infection. Antibodies specific for conserved Shigella proteins were higher in older children, affirming their potential as vaccine candidates. Shigella serosurveillance is useful in guiding public health interventions.