Biennial hyperepidemic shigellosis in an observant Jewish community

Abstract

We aimed to study patterns of shigellosis in a large observant Jewish community in Israel and to describe local interventions during outbreaks. Surveillance data from the Ministry of Health were used to calculate incidence rates in 1998-2006, both in the city of Bene Beraq and the Tel Aviv district. Information on isolates was collected from the bacteriological laboratory of a community hospital. Public notices and educational conferences conveyed a message to increase personal hygiene and keep ill children at home. During a 9-year period, a clear biennial pattern of outbreaks was noticed. Annual incidence rates ranged between 18 and 353/100,000 population. Shigellosis outbreaks tended to occur in the winter and were attributed to clonally related Shigella sonnei strains. Outbreaks in Bene Beraq preceded those in the other cities of Tel Aviv district, suggesting propagation of disease. In this population with highly endemic as well as superimposed outbreaks of shigellosis, short-term interventions had no lasting effect on prevention; future studies should focus on community-based programmes to avoid anticipated outbreaks.

The Epidemiological Influence of Climatic Factors on Shigellosis Incidence Rates in Korea

“…There have been limited studies on winter patterns of shigellosis seasonality, and they have failed to clearly identify the mechanism underlying these winter patterns [ 37 , 38 ]. From 1978–1988, winter patterns of shigellosis seasonality were observed in Milwaukee, United States and were attributed to the lack of appropriate sanitary control in daycare centers in major cities during the winter [ 38 ].…”

Outbreak of Shigella sonnei infections in the Orthodox Jewish community of Antwerp, Belgium, April to August 2008

“…Provided that the same protocol is used, it allows comparison of strains detected in different outbreak. The genetic relatedness of the strains in this study provides strong evidence that this cluster was a single outbreak and associated with recurrent endemic shigellosis in Israel [10,12].…”

“…showed that between 1998 and 2006, outbreaks of shigellosis followed a biennial pattern in Israel with annual rates that ranged from 18 to 353 cases per 100,000 population [12]. Also in 2009 outbreaks of S. sonnei in Israel were still continuing [10].…”

“…Visiting friends and relatives in areas with higher risk of shigellosis might be the seeding event leading to shigellosis outbreaks in especially susceptible communities. This is the case for Jewish communities in Antwerp that are more susceptible due to the high number of children in the families, the many social contacts, living in a relatively small community, and the frequent contact with relatives who live in areas of higher endemic prevalence of shigellosis, like certain neighbourhoods in London or Israel [11,12].…”

Outbreak of Shigella sonnei in Montréal’s ultra-Orthodox Jewish community, 2015

“…Shigellosis outbreaks are cyclical within the UOJC in Montréal, having occurred at different intensities at approximately 1-to 5-year intervals ( Table 5) [2][3][4][5][6][7][8][9]. The regular recurrence of shigellosis in the UOJC is caused by the spread of the infectious agent as a result of travel to other similar communities with high prevalence of the disease or through chronic carriers who serve as a reservoir (2,5,10). The periodicity of Shigella outbreaks in the UOJC may be due to persistent low endemicity that generates an outbreak when a new cohort of young children with no previous shigellosis enters daycare or school (3).…”