Sharing Shigella: Risk Factors for a Multicommunity Outbreak of Shigellosis

Shane, Andi L.; Tucker, Nicole; Crump, John A.; Mintz, Eric D.; Painter, John A.

doi:10.1001/archpedi.157.6.601-b

Cited by 18 publications

(10 citation statements)

References 3 publications

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“…Consistent with data from outbreak investigations, we found cause to believe that a large proportion of sporadic shigellosis is transmitted directly from one person to another (Brian et al, 1993;Shane et al, 2003;Garrett et al, 2006). Most childcare-associated shigellosis outbreaks are caused by S. sonnei; we found particularly high rates of S. sonnei infection among young children, and a high proportion of our S. sonnei cases reported attendance at or work in a childcare center.…”

Section: Discussionsupporting

confidence: 87%

Risk Factors for Sporadic Shigellosis, FoodNet 2005

Haley

Ong²,

Hedberg³

et al. 2010

Foodborne Pathogens and Disease

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Section: Discussionsupporting

confidence: 87%

Risk Factors for Sporadic Shigellosis, FoodNet 2005

Haley

Ong²,

Hedberg³

et al. 2010

Foodborne Pathogens and Disease

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“…Our findings are similar to those from a shigellosis outbreak in Cincinnati, Ohio, where, after the first negative convalescent culture, all 490 second convalescent cultures were also negative. 6 Our study also confirms an existing recommendation that the initial convalescent stool specimen should be collected no earlier than 48 hours after treatment completion, 5 and that any treatment should be guided by the antimicrobial susceptibility pattern of the circulating strain.…”

Section: Discussionsupporting

confidence: 85%

Convalescent Cultures for Control of Shigellosis Outbreaks

Turabelidze¹,

Bowen²,

Lin³

et al. 2010

Pediatric Infectious Disease Journal

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Background: A shigellosis outbreak in the St Louis, Missouri metropolitan area. Objective: To evaluate the utility of a second convalescent stool culture following an initial negative convalescent stool culture among persons excluded from work or childcare for shigellosis. Methods: An observational study of 219 shigellosis cases. Laboratoryconfirmed shigellosis patients who are required to submit 2 negative convalescent stool cultures before returning to childcare facilities or work and who submitted at least 1 culture were included in the study. Univariate and multivariable logistic regression analyses were performed to evaluate potential risk factors for a convalescent stool culture being positive. Results: Of 308 persons, 219 (71%) submitted at least 1 convalescent stool culture, and 164 (53%) submitted 2 negative convalescent stool cultures. Among 172 cases with Ն2 follow-up cultures, the probability that the second test result would agree with the first test result was 7% for a "positive" initial stool culture, and 100% for a "negative" stool culture. When adjusted for age, sex, and child care attendance, treated case-patients who had Shigella organisms in the first convalescent culture were more likely to have had stool collected Ͻ48 hours after the treatment completion and were more likely to have been treated with trimethoprim-sulfamethoxazole. Conclusions: Compliance is poor with statutes requiring serial negative stool cultures among certain populations with shigellosis. Absence of Shigella species in the first convalescent stool culture of patients recovering from shigellosis appears to be an adequate measure of bacteriologic cure; however, the health impacts of requiring any convalescent cultures during shigellosis outbreaks remain unclear.

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“…Because it takes only few organisms to transmit the infection, hand washing has been promoted as the single most important control measure to reduce the spread of shigellosis (23) and is especially critical in limiting the spread of shigellosis among young children in day-care centers (28). Many state health departments require exclusion of food handlers, health-care workers, child-care providers, and children who attend day care centers while they are symptomatic and until one or more negative stool cultures have been obtained (41). In these situations, appropriate antimicrobial use can greatly reduce the inconvenience and cost incurred during outbreaks, since most persons will cease to excrete Shigella within 72 h of starting appropriate antimicrobial therapy compared with carriage of up to several weeks that can occur without therapy (26).…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Antimicrobial Resistance among Shigella Isolates in the United States Tested by the National Antimicrobial Resistance Monitoring System from 1999 to 2002

Sivapalasingam

Joyce

Hoekstra

et al. 2006

Antimicrob Agents Chemother

104

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Shigella spp. infect approximately 450,000 persons annually in the United States, resulting in over 6,000 hospitalizations. Since 1999, the National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria has tested every 10th Shigella isolate from 16 state or local public health laboratories for susceptibility to 15 antimicrobial agents. From 1999 to 2002, NARMS tested 1,604 isolates. Among 1,598 isolates identified to species level, 1,278 (80%) were Shigella sonnei, 295 (18%) were Shigella flexneri, 18 (1%) were Shigella boydii, and 7 (0.4%) were Shigella dysenteriae. Overall, 1,251 (78%) were resistant to ampicillin and 744 (46%) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Prevalence of TMP-SMX-or ampicillin-and TMP-SMX-resistant Shigella sonnei isolates varied by geographic region, with lower rates in the South and Midwest regions (TMP-SMX resistance, 27% and 30%, respectively; ampicillin and TMP-SMX resistance, 25% and 22%, respectively) and higher rates in the East and West regions (TMP-SMX resistance, 66% and 80%, respectively; ampicillin and TMP-SMX resistance, 54% and 65%, respectively). Nineteen isolates (1%) were resistant to nalidixic acid (1% of S. sonnei and 2% of S. flexneri isolates); 12 (63%) of these isolates had decreased susceptibility to ciprofloxacin. One S. flexneri isolate was resistant to ciprofloxacin. All isolates were susceptible to ceftriaxone. Since 1986, resistance to ampicillin and TMP-SMX has dramatically increased. Shigella isolates in the United States remain susceptible to ciprofloxacin and ceftriaxone.

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Sharing Shigella: Risk Factors for a Multicommunity Outbreak of Shigellosis

Cited by 18 publications

References 3 publications

Risk Factors for Sporadic Shigellosis, FoodNet 2005

Risk Factors for Sporadic Shigellosis, FoodNet 2005

Convalescent Cultures for Control of Shigellosis Outbreaks

High Prevalence of Antimicrobial Resistance among Shigella Isolates in the United States Tested by the National Antimicrobial Resistance Monitoring System from 1999 to 2002

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