December 2, 2023

Drug Resistant Shigella Outbreak Strikes 32 States

An outbreak of drug-resistant shigellosis originating with travel outside the U.S. then spreading here sickened 157 people in 32 states and Puerto Rico between May 2014 and February 2015, according to a new report from the Centers for Disease Control and Prevention (CDC). A related outbreak in San Francisco sickened another 86 people. At least 19 people were hospitalized.

Shigella bacteriaTests performed by the CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory determined Shigella strains from this cluster of illnesses were resistant to ciprofloxacin, the antibiotic recommended for treatment of shigellosis, the illness caused by the Shigella bacteria. In the U.S., about 500,000 cases of shigellosis are reported each year. This disease is spread via the fecal-oral route meaning food or drinks contaminated with microscopic amounts of feces from an infected person are ingested by someone else. Symptoms of shigellosis illness include diarrhea, abdominal pain, vomiting, and fever. Most people get sick about two to three days after exposure.

In this outbreak, 157 cases were reported from 32 states. Most of them were reported from three states: Massachusetts (45), California (25) and Pennsylvania (18). In the related outbreak, which included a large number of homeless people in San Francisco, 86 additional cases were reported.

Of the 40 patients were exposed during travel, 22 had been in the Dominican Republic, many of whom stayed at resorts in Punta Cana.  Four were in Haiti, eight were in India and three were in Morocco.

The median age was 34.  The median duration of illness was seven days.

The CDC advises that travelers be aware of the food safety risks associated with travel to some countries. Careful hand washing and strict adherence to  food and water precautions can reduce the risk of illness. Use of over-the-counter medications such as Pepto Bismal or Immodium can be effective treatments of  mild or moderate travelers’ diarrhea.


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