Outbreak of Shigella sonnei infections in the Orthodox Jewish community of Antwerp, Belgium, April to August 2008.

In the beginning of April 2008 three cases of Shigella sonnei infection were identified among the Orthodox Jewish community of Antwerp, Belgium. We conducted a descriptive study and a household cohort study to identify potential risk factors. Stool samples were cultured and antibiotic susceptibility of the isolates was determined. Between April and August 2008, 42 cases were registered. All characterised isolates (n=20) shared an identical pulsed-field gel electrophoresis profile and were indistinguishable from one of the twelve main strains detected in Israel in 2008, where the index case's father had stayed before the outbreak. The secondary attack rate in households was 8.5% (95% confidence interval (CI): 4.3­12.7). Multivariate analysis identified the following risk factors for secondary spread: households with more than three children (adjusted relative risk (RR): 9.17; 95% CI: 1.21­69.13), children younger than five years (adjusted RR: 5.45; 95% CI: 2.44­12.62), and children younger than 12 years assisting in washing younger siblings (adjusted RR: 5.45; 95% CI: 2.44­12.17). Rigorous hand washing, use of disposable towels, information for parents and caregivers, and exclusion of symptomatic children from day care, preschool and school for a minimum of 48 hours were implemented.

Shigellosis outbreak linked to canteen-food consumption in a public institution: a matched case-control study.

On 13 November 2009, the authorities of Flemish Brabant, Belgium, received an alert concerning a potential outbreak of Shigella sonnei at a public institution. A study was conducted to assess the extent, discover the source and to implement further measures. We performed a matched case-control study to test an association between shigellosis and canteen-food consumption. Water samples and food handlers' faecal samples were tested. The reference laboratory characterized the retrospectively collected Shigella specimens. We found 52 cases distributed over space (25/35 departments) and time (2 months). We found a matched odds ratio of 3·84 (95% confidence interval 1·02-14·44) for canteen-food consumption. A food handler had travelled to Morocco shortly before detection of the first laboratory-confirmed case. Water samples and food handlers' faecal samples tested negative for Shigella. Confirmed cases presented PFGE profiles, highly similar to archived isolates from Morocco. Foodborne transmission associated with the canteen was strongly suspected.

Patología importada del viajero: paludismo / Important disease of the traveler: malaria

El aumento de los viajes a países en vías de desarrollo incrementa la posibilidad de importar enfermedades infecciosas a nuestro medio y obliga al médico de Atención Primaria y de los servicios de urgencias a tener un alto índice de sospecha y unos conocimientos básicos de las patologías tropicales más comunes en el enfermo que ha viajado en los últimos meses. Resulta fundamental en todo enfermo obtener información de los viajes que haya realizado. En todo paciente se deberá preguntar por el antecedente de viajes previos y a qué país, zona, tipo de actividades que realizó y qué medidas preventivas utilizó. Las consultas más frecuentes son la fiebre, la diarrea y las lesiones cutáneas

The increase of trips to developing countries increases the possibility of importing infectious diseases to our setting and requires the Primary Care physician and those in emergency services to have a high index of suspicion and basic knowledge on the most common tropical diseases in the patient who has traveled in recent months. It is fundamental in all patient to obtain information on the trips they have made. Every patient should be asked about the background of previous trials and what country, zone they went to, type of activity carried out and preventive measures used. The most frequent consultations are fever, diarrhea and skin lesions