Burden and risk factors of Shigella sonnei shigellosis among children aged 0–59 months in hyperendemic communities in Israel

Abstract

A B S T R A C TObjectives: Ultraorthodox Jewish populations living in towns with good sanitary infrastructure but with conditions of crowding have been the epicenter of Shigella sonnei shigellosis outbreaks. In this study, the incidence and risk factors of S. sonnei shigellosis in children living in an ultraorthodox community were determined. Methods: Data for the years 2000-2013 for all reported culture-proven S. sonnei shigellosis cases in children aged 0-59 months in the city of Elad were compared with data for the rest of the sub-district. Environmental factors obtained through parental interviews were evaluated for 78 incident cases of S. sonnei shigellosis and 141 community controls, matched by age, sex, and neighborhood. Conditional logistic regression models were performed. Results: Cyclic epidemics of S. sonnei shigellosis occurred every 2 years. The mean annual incidence was 10.0 per 1000 children in Elad (95% confidence interval 7.9-12.6) vs. 3.8 per 1000 children (95% confidence interval 3.3-4.4) in the sub-district (p < 0.001). Concurrent diarrheal disease in family members, having the same person in the daycare center responsible for food handling and changing diapers, and more rooms and sinks in the center, were positively associated with S. sonnei shigellosis, while children's hand-washing before meals was inversely associated. Conclusions: The burden of S. sonnei shigellosis in ultraorthodox communities is high. Enhanced hygiene interventions are required for epidemic control.

Persistent Transmission of Shigellosis in England Is Associated with a Recently Emerged Multidrug-Resistant Strain of Shigella sonnei

“…Studies of ultraorthodox Jewish communities in Israel and abroad (34) have shown that in regions of endemicity the incidence of S. sonnei shigellosis follows a cyclical pattern, with epidemics occurring every 2 years. The timing of these cyclical epidemics of S. sonnei shigellosis are attributed to the waning rate of natural immunity to the organism (33,34). It is likely that a similar phenomenon occurs among GBMSM; natural exposure to Shigella species through intensive shigellosis epidemics in the GBMSM community may also increase immunity levels in individuals belonging to sexual networks.…”

Serum IgG antibodies toShigellalipopolysaccharide antigens – a correlate of protection against shigellosis

“…The low inoculum required to cause shigellosis (100-1000 organisms) 22 facilitates transmission of the disease, and explains the frequent failure of adequate sanitary and hygienic measures to prevent shigellosis, 12 even in high-income countries. 19,23 Therefore, the development of an efficacious Shigella vaccine is highly desirable and particularly needed for young children residing in LMICs and other regions with high disease burden.…”

Persistent transmission of shigellosis in England is associated with a recently emerged multi-drug resistant strain ofShigella sonnei

“…The timing of these cyclical epidemics of S. sonnei shigellosis are attributed to the waning rate of natural immunity to the organism [30,31]. It is likely that a similar phenomenon occurs among GBMSM; natural exposure to Shigella spp.…”

“…Studies of ultraorthodox Jewish communities in Israel and abroad [31] have shown that in endemic regions the incidence of S. sonnei shigellosis follows a cyclic pattern with epidemics every 2 years.…”