US Travelers Affected In Multi-Country Shigella Outbreak

An outbreak of diarrhea-causing infections has been affecting travelers from different countries, including some from the U.S.

There have been 258 cases recorded in the outbreak as of Feb. 16, according to the European Center for Disease Prevention and Control (ECDC). Of them, 221 were confirmed Shigella sonnei infections, while 37 are possible cases.

All the cases so far have reportedly been linked to Cabo Verde (Cape Verde) off the west coast of Africa, with the shigellosis cases being logged among travelers from 10 EU/EEA countries, the U.K. and the U.S.

The highest number of cases have been logged in the U.K. with 95 cases, the Netherlands with 47, Sweden with 42, France with 31, and 14 in Belgium. Finland has logged nine cases and Germany has five. There have been four cases each from Czechia, Denmark and the U.S., while Portugal has logged two cases and Norway one.

The cases have actually been logged from as far back as September 2022, the ECDC noted. However, the outbreak reportedly "evolved rapidly" towards the end of the year in November and December. And the analysis of 106 human isolates revealed a "genetically compact cluster." This suggests, the agency said, that the illnesses may have come from a "common source."

Although a common means of exposure had yet to be identified as of the announcement, investigations are already ongoing in Cabo Verde, as per the ECDC.

So far, many of the cases have reported staying in "all-inclusive hotels" in the Santa Maria region on the island of Sal. With the most recent cases being from January 2023, health authorities are concerned over a potential "ongoing moderate risk" for travelers.

"Multiple modes of transmission are plausible, and the most likely way is through food, including via infected food handlers," noted the ECDC. "However, person-to-person transmission is also possible. "

Shigella bacteria can cause shigellosis, with most people who get it experiencing diarrhea, stomach cramps and fever, according to the U.S. Centers for Disease Control and Prevention (CDC). It can spread "easily" as it only takes a "small number" of the bacteria for someone to get sick.

People get sick by swallowing the bacteria, for instance by touching an infected surface and then touching their mouths. It can also be contracted by consuming contaminated water or food that's prepared by someone with the infection.

Those who get it may continue spreading it even after the diarrhea has stopped. This is why proper hand washing with soap and water is key to preventing its spread. Each year, Shigella bacteria cause some 450,000 infections in the U.S. with $93 million in medical costs.

There have been concerns about antibiotic resistance in Shigella infections. Such is the case in the current outbreak, wherein there are reportedly indications of resistance to some antibiotics.

"ECDC encourages public health authorities in the EU/EEA to increase awareness among healthcare professionals on the possibility of Shigella infections among people that recently travelled to Cabo Verde," the agency noted. "Together with WHO/Europe, ECDC is in regular contact with authorities in Cabo Verde to support investigations on the sources of infection and to increase awareness among healthcare professionals in the country."