A Sustained Epidemic of Shigellosis in Isfahan Province, 2015

Document Type: Original Article

Authors

1 Associate Professor, Epidemiology & Biostatistics Dept., School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

2 Environment Research Committee, and Student Research Committee, Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Environmental Health Engineering Department & Environment Research Center, School of Health & Passive Defense Centre Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Introduction: Shigellosis is a contagious disease with acute symptoms. Delay in detecting the disease transmission way would lead to rapid spread among the community, like what happened in Isfahan Provincein April 2015. The study aimed at evaluating the Shigella bacteria transmission medium in the outbreak that occurred in Isfahan Province, Iran.
Methods: Due to evidences reported by the university health deputy, the beginning of the Isfahan shigellosis outbreak was on April 17th, and the first records of all 8600 cases were reported on April 18th. Through the interviews with Shahreza's hospitalized cases, a wedding ceremony held on April 16th with 67 guests, most of whom were affected by diarrhea. Therefore, a cross-sectional study was designed to report, overall, the Epidemic of Shigellosis and a historical cohort in order to investigate the causes of the diarrhea based on wedding ceremony data. The guest list and their phone numbers were collected from the ceremony host. Data were collected through a phone call interview.
Data analyses were done by STATA13. The relative risk was calculated with 95% confidence interval using logistic regression.
Results:The response rate of the guests following up was 72% (48 of 67 guests), with 33 individuals suffering from diarrhea and 30 having eaten vegetables. Patients were from both sexes and all age groups. The relative risk of diarrhea for vegetable consumers was 4.1 (95% CI: 1.5 – 11.3, p=0.006).
Conclusion: Findings have provided strong evidences against Shigella contaminated vegetables as a risk factor and transmission agent for individuals who got diarrhea in Shigellosis outbreak of Isfahan Province in April 2015.

Keywords


  1. Brooks GF, Carroll KC, Butel JC, Morse SA, Mietzner TA. Jawetz Melnick & Adelbergs Medical Microbiology. 26th ed. New York: McGraw-Hill Education; 2013.
  2. Kim HJ, Youn SK, Lee S, Choi YH. Epidemiological characteristics of imported shigellosis in Korea, 2010-2011. Osong Public Health Res Perspect 2013; 4(3):159-65.
  3. Mandell G, Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases E-Book. Elsevier Health Sciences; 2014.
  4. Niyogi SK. Increasing antimicrobial resistance-an emerging problem in the treatment of shigellosis. Clinical Microbiology and Infection 2007; 13(12):1141-3.
  5. 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.
  6. Philpott DJ, Edgeworth JD, Sansonetti PJ. The pathogenesis of Shigella flexneri infection: lessons from in vitro and in vivo studies. Philos Trans R Soc Lond B Biol Sci 2000; 355(1397): 575–86.
  7. Lee LA, Shapiro CN, Hargrett-Bean N, Tauxe RV. Hyperendemic shigellosis in the United States: a review of surveillance data for 1967-1988. J Infect Dis 1991; 164(5):894-900.
  8. Bhattacharya SK, Sur D, Mahalanabis D. Public health significance of shigellosis. Indian Pediatr 2012; 49(4):269-70.
  9. Gomez HF, Ochoa TJ, Herrera-Insua I, Carlin LG, Cleary TG. Lactoferrin protects Rabbits from Shigella flexneri-Induced inflammatory enteritis. Infect Immun 2002; 70(12): 7050–3.
  10. Krilov LR, Barone SR, Mandel FS, Cusack TM, Gaber DJ, Rubino JR. Impact of an infection control program in a specialized preschool. Am J Infect Control 1996; 24(3):167-73.
  11. Heier BT, Nygard K, Kapperud G, Lindstedt BA, Johannessen GS, Blekkan H. Shigella sonnei infections in Norway associated with sugar peas, May-June 2009. Euro Surveill. 2009; 14(24). pii: 19243.
  12. Lewis HC, Ethelberg S, Olsen KE, Nielsen EM, Lisby M, Madsen SB, et al. Outbreaks of Shigella sonnei infections in Denmark and Australia linked to consumption of imported raw baby corn. Epidemiol Infect 2009; 137(3):326-34.
  13. Keene WE, McAnulty JM, Hoesly FC, Williams LP, Jr., Hedberg K, Oxman GL, et al. A swimming-associated outbreak of hemorrhagic colitis caused by Escherichia coli O157:H7 and Shigella sonnei. N Engl J Med 1994; 331(9):579-84.