Shigella In NY: State Monitoring Drug-Resistant Stomach Infection

NEW YORK — Public health officials are monitoring a rise in extensively drug-resistant Shigella infections that can cause severe bouts with inflammatory diarrhea. The bacteria is easily spread, and the Centers for Disease Control and Prevention is asking health care providers in New York and others to report cases to local or state health departments.

The New York State Department of Health has not recorded a case of antibiotic-resistant shigellosis in more than a year, but is monitoring the situation, a spokeswoman told Patch.

The CDC advisory covers a rise in cases of antibiotic-resistant shigellosis since it first became known in 2015.

The stomach bug, which causes the diarrheal condition known as shigellosis, poses a “serious public health threat,” the CDC said in a public health alert.

Antimicrobial-resistant Shigella infections have been rising since 2016 nationwide. An estimated 242,000 antimicrobial-resistant Shigella infections occur in the United States each year, according to the CDC. In 2022, about 5 percent of infections were caused by the more drug-resistant strain, compared to 0 percent in 2015, the agency said. Between Jan. 1, 2015, and Jan. 22, 2023, the CDC received reports of 239 resistant Shigella isolates.

Since 2015, four cases of drug-resistant shigellosis have been identified in New York residents, with the most recent being more than a year ago, state health officials said. They shared the alert issued by the Centers for Disease Control and Prevention to providers across the state, instructing them on what to do if they suspect they are seeing an antibiotic-resistant case of shigellosis.

With the exception of 2012, incidence rates of shigellosis in the state, excluding NYC, remained relatively stable over the five-year period from 2011-15, according to the health department website. In 2012, the Hudson Valley and much of Long Island experienced greater than a 10-fold increase in incidence rates, due, in large part, to four outbreaks that occurred there and in central New York. One outbreak occurred in a group home, two in daycare facilities, and one in an elementary school, state officials said.

Of the 2,096 shigellosis cases that occurred over the five year period: 16.4 percent were hospitalized; and 0.1 percent resulted in death.

New York health officials said small children are at the highest risk of acquiring shigellosis. As fecal-oral is the most common mode of transmission, preschool children, particularly those in daycare settings, are an especially vulnerable group for acquiring and spreading disease. The higher rate of infection among female adults 18 to 39 years of age is consistent with caregivers of young children being at increased risk for direct contact with fecal matter (e.g., changing diapers, bathing young children) at home or in congregate settings.

Historically in the United States, the illness has predominantly affected children ages 1-4, but the CDC said it has observed an increase in cases of antimicrobial-resistant Shigella among adults, especially gay and bisexual men, people experiencing homelessness, international travelers and people living with HIV.

Shigella spreads when infected fecal matter enters the mouth or the nose, according to the CDC. That can happen during sexual activity, but also because of poor hand-washing after diaper changes, unsanitary food handling or swimming in contaminated water.

Symptoms — diarrhea, sometimes with blood in it, along with severe stomach cramps and fever — are typically seen within one to four days of exposure. Symptoms are unpleasant, but usually subside within a week. The symptoms are sometimes confused with those of food poisoning.

About 6,400 U.S. patients require hospitalization for Shigella every year, according to the CDC. Death is rare, but people who are immunocompromised, including those with untreated HIV or people undergoing chemotherapy for cancer, are more susceptible.

On Tuesday, the CDC held an emergency call with the Colorado Department of Public Health and Environment and the U.K. Health Security Agency to alert doctors that the new form of the bacterium doesn’t respond to usual antibiotic treatments.

“We do not have all the answers today,” Dr. Louise Francois Watkins, a medical officer at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said on the call, adding she is unable to recommend a specific treatment.

In January, the U.K. Health Security Agency said an outbreak of nearly 200 cases of drug-resistant Shigella likely stemmed from a single infection, which health officials said illustrates how quickly infections can spread and the importance of infection control.

The European Centre for Disease Prevention and Control also issued a Shigella alert Friday that said about 221 cases of the illness and 37 suspected cases in 10 countries in Europe, the United States and the United Kingdom had been linked to travel in Cabo Verde, West Africa.

The source of the common infection has not yet been identified given the multiple ways it could have been spread, the European health agency said.

To learn more about shigellosis, visit the New York Health Department’s dedicated webpage here.