title: Resistant Shigella strains in refugees, August-October 2015, Greece.
abstract: Shigellosis is endemic in most developing countries and thus a known risk in refugees and internally displaced persons. In 2015, a massive influx of refugees into Greece, due to the political crisis in the Middle East, led to the development of appropriate conditions for outbreaks of communicable diseases as shigellosis. We present a cluster of 16 shigellosis cases in refugees, detected by the implementation of a syndromic notification system in one transit centre in Athens, between 20 August and 7 October 2015. Both Shigella flexneri (n = 8) and S. sonnei (n = 8) were identified, distributed in various serotypes. All tested isolates (n = 13) were multidrug resistant; seven were CTX-M-type extended-spectrum β-lactamase producers. Our results indicate lack of a potential common source, although pulsed-field gel electrophoresis typing results revealed small clusters in isolates of the same serotype indicating possible limited person-to-person transmission without identifying secondary community cases related to the refugees. To prevent the spread of shigellosis, empirical antibiotic treatment as well as environmental hygiene measures were implemented. The detection of multi-drug resistance is important for determining the appropriate empirical antibiotic treatment for the more severe cases, while at the same time real-time typing is useful for epidemiological investigation and control measures.
authors.affiliation: Department of Epidemiological Surveillance and Intervention,Hellenic Centre for Disease Control and Prevention (HCDCP),Athens,Greece.
authors.forename: T
authors.identifier: http://orcid.org/0000-0001-9559-7476
authors.initials: T
authors.lastname: Georgakopoulou
authors.affiliation: National Reference Centre for Salmonella and Shigella,National School of Public Health & Central Public Health Laboratory,Hellenic Centre for Diseases Control and Prevention,Vari,Greece.
authors.forename: G
authors.initials: G
authors.lastname: Mandilara
authors.affiliation: Department of Epidemiological Surveillance and Intervention,Hellenic Centre for Disease Control and Prevention (HCDCP),Athens,Greece.
authors.forename: K
authors.initials: K
authors.lastname: Mellou
authors.affiliation: National Reference Centre for Salmonella and Shigella,National School of Public Health & Central Public Health Laboratory,Hellenic Centre for Diseases Control and Prevention,Vari,Greece.
authors.forename: K
authors.initials: K
authors.lastname: Tryfinopoulou
authors.affiliation: Department of Epidemiological Surveillance and Intervention,Hellenic Centre for Disease Control and Prevention (HCDCP),Athens,Greece.
authors.forename: A
authors.initials: A
authors.lastname: Chrisostomou
authors.affiliation: Department of Epidemiological Surveillance and Intervention,Hellenic Centre for Disease Control and Prevention (HCDCP),Athens,Greece.
authors.forename: H
authors.initials: H
authors.lastname: Lillakou
authors.affiliation: Department of Hygiene and Epidemiology,University of Thessaly,Larissa,Greece.
authors.forename: C
authors.initials: C
authors.lastname: Hadjichristodoulou
authors.affiliation: National Reference Centre for Salmonella and Shigella,National School of Public Health & Central Public Health Laboratory,Hellenic Centre for Diseases Control and Prevention,Vari,Greece.
authors.forename: A
authors.initials: A
authors.lastname: Vatopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004405:Dysentery, Bacillary / Q000382:microbiology*; D005260:Female; D006115:Greece; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D012036:Refugees; D012763:Shigella flexneri / Q000187:drug effects* / Q000302:isolation & purification; D012764:Shigella sonnei / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Greece; Shigella; refugees