Home
- Destinations
- Vaccinations
- News & Announcements
- Travel Notices
- Diseases
- Yellow Book
- Find a Clinic
- Specific Groups & Settings
- Seasonal Flu & Travel
- Earthquake, Tsunami, and Radiation Release in Japan: Travel Information
- Traveling with Children
- Special Needs
- Disaster Relief
- Avian Flu & Travel
- Air & Cruise Ship Travel
- Air Travel Information For Travelers
- Cruise Ship Information for Travelers
- For Industry: Air
- CDC Measles Guidance for Commercial Aircraft Operators
- Interim Guidance for Protecting Travelers on Commercial Aircraft Serving Haiti During the Cholera Outbreak
- Reporting Onboard Deaths or Illnesses to CDC
- Onboard Death and Illness Response Tool for Cabin Crew
- Onboard Death and Illness Reporting Tool for Pilots
- CDC Guidance for Commercial Aircraft Operators: Seasonal Influenza
- Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft
- For Industry: Cruise Ships
- Stay Healthy & Safe
- Illness & Injury Abroad
- Resources & Training
- Travel Podcasts
- RSS Feeds
Chapter 3Infectious Diseases Related To Travel
Shigellosis
Anna Bowen, Katharine A. Schilling, Eric Mintz
INFECTIOUS AGENT
Shigellosis is an acute infection of the intestine caused by bacteria in the genus Shigella. There are 4 species of Shigella: Shigella dysenteriae, S. flexneri, S. boydii, and S. sonnei (also referred to as group A, B, C, and D, respectively). Several distinct serotypes are recognized within the first 3 species. Disease severity varies according to species and serotype. S. dysenteriae serotype 1 (Sd1) is the agent of epidemic dysentery, while S. sonnei is a common cause of mild diarrheal illness.
MODE OF TRANSMISSION
Transmission occurs via the fecal-oral route, either indirectly through contaminated food, water, or fomites, or via direct person-to-person contact. As few as 10 organisms are sufficient to cause infection. Only humans and higher primates carry Shigella. Outbreaks have been traced to contaminated produce and other foods, contaminated drinking water, swimming in contaminated water, and sexual contact between men. In the United States, outbreaks of S. sonnei infection among young children in daycare settings are common.
EPIDEMIOLOGY
Worldwide, Shigella is estimated to cause 80–165 million cases and 600,000 deaths annually. Shigella spp. are endemic in temperate and tropical climates. Shigella sonnei is found most frequently in industrialized countries, while S. flexneri more commonly affects people in the developing world. Shigella spp. are an uncommon cause of travelers’ diarrhea among travelers to Mexico but are common among travelers to Asia. Shigella spp. are found in the stools of 5%–18% of patients with travelers’ diarrhea. A FoodNet study found that approximately 26% of US residents with sporadic shigellosis reported international travel in the week before symptom onset.
CLINICAL PRESENTATION
Disease onset occurs 12–96 hours after exposure. The symptoms of shigellosis range from mild to severe and typically last 4–7 days. The disease is characterized by watery, bloody or mucoid diarrhea, fever, stomach cramps, and nausea. On rare occasions, patients experience toxemia, vomiting, tenesmus, postinfectious arthritis, hemolytic uremic syndrome (after infection with Shiga toxin–producing strains), or seizures (young children).
DIAGNOSIS
Shigellosis is confirmed through culture of a stool specimen or rectal swab. To effectively isolate Shigella, samples must be processed rapidly, because Shigella cannot survive outside the body for long periods of time. Shigella isolates may then be speciated and serotyped and their antimicrobial susceptibilities determined.
TREATMENT
In healthy people, shigellosis will typically resolve within 4–7 days, even without treatment. Antimicrobial treatment, when given early in the course of illness, can shorten the duration of symptoms and of carriage. Because multidrug resistance among Shigella strains is common, empiric treatment should begin with a fluoroquinolone (for adults and, if infection is acquired in regions with high rates of multidrug resistance, children) or ceftriaxone (for children) until information about antimicrobial susceptibility is available. Resistance to fluoroquinolones has been reported, more often among Shigella isolates acquired in south and east Asia.
PREVENTIVE MEASURES FOR TRAVELERS
No vaccines are available for Shigella. The best defense against shigellosis is thorough, frequent handwashing and strict adherence to standard food and water safety recommendations, as described in Chapter 2, Food and Water Precautions.
BIBLIOGRAPHY
- American Academy of Pediatrics. Shigella infections. In: Pickering L, Baker CJ, Long SS, McMillan JA, editors. Red Book: 2009 report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009. p. 593–96.
- American Public Health Association. Shigellosis. In: Heymann DL, editor. Control of communicable diseases manual. 19 ed. Washington, DC: American Public Health Association; 2008. p. 556–60.
- CDC. Shigella surveillance: annual summary, 2006. Atlanta: CDC; 2008. Available from: www.cdc.gov/ncidod/DBMD/phlisdata/shigtab/2006/ShigellaAnnualSummary2006.pdf.
- Dutta S, Dutta P, Matsushita S, Bhattacharya SK, Yoshida S. Shigella dysenteriae serotype 1, Kolkata, India. Emerg Infect Dis. 2003 Nov;9(11): 1471–4.
- Gaynor K, Park SY, Kanenaka R, Colindres R, Mintz E, Ram PK, et al. International foodborne outbreak of Shigella sonnei infection in airline passengers. Epidemiol Infect. 2009 Mar;137(3): 335–41.
- Haley CC, Ong KL, Hedberg K, Cieslak PR, Scallan E, Marcus R, et al. Risk factors for sporadic shigellosis, FoodNet 2005. Foodborne Pathog Dis. 2010 Jul;7(7):741–7.
- Kotloff KL, Winickoff JP, Ivanoff B, Clemens JD, Swerdlow DL, Sansonetti PJ, et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ. 1999;77(8):651–66.
- Ram PK, Crump JA, Gupta SK, Miller MA, Mintz ED. Part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984–2005. Epidemiol Infect. 2008 May;136(5):577–603.
- von Seidlein L, Kim DR, Ali M, Lee H, Wang X, Thiem VD, et al. A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology. PLoS Med. 2006 Sep;3(9):e353.
Contact Us:
- Centers for Disease Control and Prevention
1600 Clifton Rd
Atlanta, GA 30333 - 800-CDC-INFO
(800-232-4636)
TTY: (888) 232-6348 - New Hours of Operation
8am-8pm ET/Monday-Friday
Closed Holidays - Contact CDC-INFO