title: International foodborne outbreak of Shigella sonnei infection in airline passengers.
abstract: During 22-24 August 2004, an outbreak of Shigella sonnei infection affected air travellers who departed from Hawaii. Forty-seven passengers with culture-confirmed shigellosis and 116 probable cases who travelled on 12 flights dispersed to Japan, Australia, 22 US states, and American Samoa. All flights were served by one caterer. Pulsed-field gel electrophoresis of all 29 S. sonnei isolates yielded patterns that matched within one band. Food histories and menu reviews identified raw carrot served onboard as the likely vehicle of infection. Attack rates for diarrhoea on three surveyed flights with confirmed cases were 54% (110/204), 32% (20/63), and 12% (8/67). A total of 2700 meals were served on flights with confirmed cases; using attack rates observed on surveyed flights, we estimated that 300-1500 passengers were infected. This outbreak illustrates the risk of rapid, global spread of illness from a point-source at a major airline hub.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA , USA. kate.gaynor@doh.hawaii.gov
authors.forename: K
authors.initials: K
authors.lastname: Gaynor
authors.forename: S Y
authors.initials: SY
authors.lastname: Park
authors.forename: R
authors.initials: R
authors.lastname: Kanenaka
authors.forename: R
authors.initials: R
authors.lastname: Colindres
authors.forename: E
authors.initials: E
authors.lastname: Mintz
authors.forename: P K
authors.initials: PK
authors.lastname: Ram
authors.forename: P
authors.initials: P
authors.lastname: Kitsutani
authors.forename: M
authors.initials: M
authors.lastname: Nakata
authors.forename: S
authors.initials: S
authors.lastname: Wedel
authors.forename: D
authors.initials: D
authors.lastname: Boxrud
authors.forename: D
authors.initials: D
authors.lastname: Jennings
authors.forename: H
authors.initials: H
authors.lastname: Yoshida
authors.forename: N
authors.initials: N
authors.lastname: Tosaka
authors.forename: H
authors.initials: H
authors.lastname: He
authors.forename: M
authors.initials: M
authors.lastname: Ching-Lee
authors.forename: P V
authors.initials: PV
authors.lastname: Effler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000401:Aircraft; D002648:Child; D002675:Child, Preschool; D018552:Daucus carota / Q000382:microbiology*; D004196:Disease Outbreaks; D004405:Dysentery, Bacillary / Q000453:epidemiology*; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005506:Food Contamination; D005511:Food Handling; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology*; D006254:Hawaii; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014195:Travel