A new surveillance report from the European Centre for Disease Prevention and Control (ECDC) shows a slight increase in reported Shigella infections in Europe, with a significant increase in the United Kingdom and concerning levels of resistance to several antibiotics.

For 2019, 30 European Union/European Economic Area countries reported 8,448 confirmed shigellosis cases. The overall notification rate of 2.2 cases per 100,000 population was slightly higher than in 2018. The highest notification rate was observed in children under 5 years of age (4.8 cases per 100,000), followed by men ages 25 to 44 (3.7 cases per 100,000). The most confirmed cases were in the United Kingdom (3,207, up from 2,617 in 2018).

Shigellosis is a gastrointestinal disease caused by one of the four species of Shigella bacteria (Shigella sonnei, S flexneri, S boydii, and S dysenteriae). While it is commonly associated with exposure to food or water that has been contaminated by human feces, infections can also occur through oral and anal sex. Of the 8,448 confirmed cases, transmission via food was the most commonly reported (572), followed by sex (142), and person-to-person transmission (87, excluding mother-to-child and sexual transmission).

Antibiotic susceptibility testing of S sonnei and S flexneri isolates showed high resistance to ampicillin and trimethoprim-sulfamethoxazole in both species (45.6% to 88.2%), along with considerable resistance to ciprofloxacin (25.5% to 36.9%).  

ECDC officials attribute the rise in Shigella infections in England, particularly in men ages 25 to 44, to increased transmission among men who have sex with men (MSM). Antibiotic-resistance rates have also been extremely high in this group.

"In general, prevention of infection and control of outbreaks relies on good personal and environmental hygiene practices to prevent faecal-oral transmission, particularly during sexual activities," the ECDC said. "Targeted information campaigns to increase awareness of shigellosis could help reduce the spread of infection among risk groups."

Prevention of infection and control of outbreaks relies on good personal and environmental hygiene practices.

An ECDC report in February noted an increase in extensively drug-resistant S sonnei infections in the United Kingdom and elsewhere in Europe and warned that the risk of spread among networks of MSM who engage in high-risk sexual practices, such as oral-anal contact, could be high in the coming months

Following the November identification of vaccine-derived poliovirus type 2 (VDPV2) in an Indonesian boy who developed acute flaccid paralysis (AFP), investigators also found the virus in three healthy children, the World Health Organization (WHO) said yesterday.

In an update, the WHO said genetic sequencing tests on samples from the patient and three healthy children have now confirmed transmission, meeting the criteria needed for the event to be classified as a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak.

The three children aren't close contacts with the original patient, were from the same community in Aceh province, and are all asymptomatic. The boy with AFP had not been vaccinated, had no travel history, and had not had contact with people who had traveled.

Indonesia's last polio flare-up was in 2019, when a circulating vaccine-derived poliovirus type 1 (cVDPV1) outbreak was reported in Papua province.

The WHO said Aceh province has very low polio vaccination coverage and that Indonesia's health ministry on Nov 28 launched an immunization campaign targeting 1.2 million children under age 13 years in the province. More campaigns are planned for other provinces in the first months of 2023.

Other countries are grappling with recent evidence of cVDPV2, including the United States, the United Kingdom, and Israel.