Abstract
An outbreak of Shigella sonnei that occurred in the ultra-Orthodox Jewish community (UOJC) was the subject of an investigation and response by the Montréal Regional Public Health Department (DRSP), who collaborated with several health and community partners. A total of 27 confirmed cases were reported in this outbreak, which lasted from February to June 2015. The epidemic curve was compatible with a point source with secondary person-to-person transmission. In 11 of the 27 cases, pulsed-field gel electrophoresis (PFGE) analysis of strains found a single PFGE pattern newly identified in Quebec. Almost all strains tested showed resistance to ampicillin and trimethoprim-sulfamethoxazole (TMP/SMX). All the cases resided in Montréal Centre-West. Most of the cases were under 5 years old and attended a daycare centre, an environment recognized to be conducive to the transmission of enteric diseases. DRSP sent timely information to families, daycare and school stakeholders, community partners and synagogues in the UOJC, which helped reduce the transmission of shigellosis in the community.
Highlights
On March 25, 2015, the Montréal Regional Public Health Department detected a statistically significant space-time cluster of 7 cases of shigellosis reported in the previous 12 days using SaTScanTM analytical software
A case was defined as a Montréal resident belonging to the ultra-Orthodox Jewish community (UOJC), with no history of recent travel abroad and with a laboratory confirmation of S. sonnei infection, reported to the Montréal Regional Public Health Department between January 1 and August 31, 2015
Between February 19 and June 1, 2015, 27 confirmed cases of S. sonnei occurred in the Montréal UOJC. This represented 79% (27/34) of all confirmed cases of S. sonnei reported in the area for the same period
Summary
The other 4 cases had contracted the infection while travelling, and there were no links between them Prior to this cluster, on February 25, there had been a report of a case in a daycare centre in this community; this child’s symptoms had begun on February 19. In December 2014 [1], New York City issued a public health alert regarding an outbreak involving 43 cases of Shigella sonnei affecting two similar communities. Because members of the UOJC regularly travel between Montréal and New York, it was important to investigate a possible link between the two outbreaks. The objectives of this investigation were to further characterize the S. sonnei outbreak in the UOJC, develop hypotheses and guide the Montréal Regional Public Health Department’s potential interventions. An investigation report was written to share intervention strategies and to serve as a reference document for similar investigations
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