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      Shigellosis Outbreak Associated with Contaminated Well Water in a Rural Elementary School: Sichuan Province, China, June 7–16, 2009

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          Abstract

          Objectives

          We investigated a shigellosis outbreak in an elementary school to identify the source of infection, mode of transmission and risk factors for illness.

          Methods

          In a case-control investigation, we compared the source of drinking water, consumption of untreated well water and suspected food items, and hygienic habits between case-students and randomly selected asymptomatic control-students, frequency-matched by class on a 1∶1 ratio.

          Results

          18% of the 533 students and no teachers developed Shigella. 52%(44/85) of case-students and 17% (12/71) of control-students drank untreated well water (OR = 2.3, 95% CI = 1.1–5.8); 47% (n = 40/85) of case-students and 14% (10/71) of control-students drank untreated water from Well A (OR = 3.7, 95% CI = 1.3–11). The odds ratio increased with the amount of untreated Well A water consumed (p = 0.035, χ 2 test for trend). Rectal swabs from 5 of 6 case-students and water from Well A yielded Shigella flexneri 2b.

          Conclusions

          This shigellosis outbreak was caused by drinking untreated water from a well polluted by Shigella flexneri 2b.

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          Most cited references15

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          Ten great public health achievements--United States, 1900-1999.

          (1999)
          During the 20th century, the health and life expectancy of persons residing in the United States improved dramatically. Since 1900, the average lifespan of persons in the United States has lengthened by >30 years; 25 years of this gain are attributable to advances in public health. To highlight these advances, MMWR will profile 10 public health achievements (see box) in a series of reports published through December 1999.
          Article 0 comments Cited 141 times – based on 0 reviews     Review now
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            Waterborne transmission and the evolution of virulence among gastrointestinal bacteria.

            Shawn Ewald (1991)
            Diarrhoeal diseases are primary contributors to millions of deaths annually. Yet, little is known about the evolutionary reasons for the differences in virulence among gastrointestinal pathogens. Applying the comparative, cost/benefit approach of evolutionary biology this paper proposes that waterborne transmission should favour evolution towards high virulence. This hypothesis is supported by a cross-specific test, which shows that waterborne transmission is strongly correlated with the virulence of bacterial gastrointestinal pathogens of humans. Alternative explanations of this correlation are not supported by available data. These findings bear on public health policy because they draw attention to a previously unrecognized long-range benefit gained from purification of water supplies; diarrhoeal pathogens may evolve to lower levels of virulence.
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              Utility of a polymerase chain reaction diagnostic system in a study of the epidemiology of shigellosis among dysentery patients, family contacts, and well controls living in a shigellosis-endemic area.

              P Echeverria, O Sethabutr, Paul Gaudio … (1997)
              Polymerase chain reaction (PCR) diagnostic methods have rarely been used in epidemiologic studies of Shigella and enteroinvasive Escherichia coli (EIEC) infections. In this study, amplification of the invasion plasmid antigen H (ipaH) gene by PCR and standard culture methods was used to identify Shigella species or EIEC among 154 patients with dysentery, 154 age-matched controls, and family contacts in Thailand. The ipaH PCR system increased the detection of Shigella species and EIEC from 58% to 79% among patients with dysentery and from 6% to 22% among 527 family contacts; 75% of infections in family members were asymptomatic. Detection of the ipaH gene was statistically associated with dysentery. Household contacts of patients with shigellosis diagnosed only by PCR had significantly higher rates of shigellosis than household contacts of patients who did not have Shigella or EIEC infections. Detection of the ipaH gene by PCR is far more sensitive than detection by standard culture and is highly correlated with evidence of Shigella transmission among family contacts.
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                Author and article information

                Contributors
                Martyn Kirk: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2012
                Publication date (Electronic): 10 October 2012
                Volume: 7
                Issue: 10
                Electronic Location Identifier: e47239
                Affiliations
                [1 ]Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, People’s Republic of China
                [2 ]Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, People’s Republic of China
                [3 ]Sichuan Provincial Center for Disease Control and Prevention, Chengdu, People’s Republic of China
                [4 ]Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
                The Australian National University, Australia
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: FH LL HM. Performed the experiments: FH KH LL WS. Analyzed the data: FH KH HM. Contributed reagents/materials/analysis tools: LZ. Wrote the paper: FH HM BZ.

                Article
                Publisher ID: PONE-D-12-11421
                DOI: 10.1371/journal.pone.0047239
                PMC ID: 3468462
                PubMed ID: 23071767
                SO-VID: dc309269-2012-46a7-9610-fff8a4d48ff7
                Copyright statement: Copyright @ 2012
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 23 April 2012
                Date accepted : 11 September 2012
                Page count
                Pages: 4
                Funding
                This investigation was supported by the Program for Zhejiang Leading Team of Science and Technology Innovation, and the General Funds for Emergency Public Health Response from the Ministry of Health of China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Mathematics
                Subject: Statistics
                Subject: Biostatistics
                Subject: Medicine
                Subject: Epidemiology
                Subject: Disease Informatics
                Subject: Epidemiological Methods
                Subject: Infectious Disease Epidemiology
                Subject: Pediatric Epidemiology
                Subject: Infectious Diseases
                Subject: Bacterial Diseases
                Subject: Shigellosis
                Subject: Shigellosis Infections
                Subject: Infectious Disease Control

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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