title: A prolonged outbreak of Shigella sonnei infections in traditionally observant Jewish communities in North America caused by a molecularly distinct bacterial subtype.
abstract: During 1994-1996, Shigella sonnei outbreaks occurred in 8 North American traditionally observant Jewish communities. These communities remain relatively separate from neighboring populations while maintaining close contact by travel with coreligionists in other cities. Epidemiologic investigations suggested community-to-community transmission via travel. Outbreak-related and control isolates of S. sonnei from each city were subtyped by pulsed-field gel electrophoresis (PFGE) to confirm an epidemiologic linkage between outbreaks. Forty-three (94%) of 46 outbreak-related isolates had closely related PFGE patterns, constituting a single subtype; 33 (94%) of 35 control isolates demonstrated unrelated PFGE patterns. Several patterns differing by < or = 3 bands were identified within the outbreak subtype; one of these accounted for 65% of outbreak isolates. Hence, a single subtype of S. sonnei caused an international outbreak involving 8 traditionally observant Jewish communities, but not neighboring populations, over a 2-year period, suggesting sustained propagation of the epidemic strain between communities.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. qzs32@cdc.gov
authors.forename: J
authors.initials: J
authors.lastname: Sobel
authors.forename: D N
authors.initials: DN
authors.lastname: Cameron
authors.forename: J
authors.initials: J
authors.lastname: Ismail
authors.forename: N
authors.initials: N
authors.lastname: Strockbine
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.forename: P S
authors.initials: PS
authors.lastname: Diaz
authors.forename: B
authors.initials: B
authors.lastname: Westley
authors.forename: M
authors.initials: M
authors.lastname: Rittmann
authors.forename: J
authors.initials: J
authors.lastname: DiCristina
authors.forename: H
authors.initials: H
authors.lastname: Ragazzoni
authors.forename: R V
authors.initials: RV
authors.lastname: Tauxe
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
mesh_terms: D004269:DNA, Bacterial / Q000302:isolation & purification; D004196:Disease Outbreaks; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000635:transmission; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D007585:Jews; D007599:Judaism; D008826:Microbial Sensitivity Tests; D009656:North America / Q000453:epidemiology; D012764:Shigella sonnei / Q000145:classification / Q000302:isolation & purification
chemical_list: D004269:DNA, Bacterial