Outbreak of Shigella sonnei infections in the Orthodox Jewish community of Antwerp, Belgium, April to August 2008

In the beginning of April 2008 three cases of Shigella sonnei infection were identified among the Orthodox Jewish community of Antwerp, Belgium. We conducted a descriptive study and a household cohort study to identify potential risk factors. Stool samples were cultured and antibiotic susceptibility of the isolates was determined. Between April and August 2008, 42 cases were registered. All characterised isolates (n=20) shared an identical pulsed-field gel electrophoresis profile and were indistinguishable from one of the twelve main strains detected in Israel in 2008, where the index case's father had stayed before the outbreak. The secondary attack rate in households was 8.5% (95% confidence interval (CI): 4.3-12.7). Multivariate analysis identified the following risk factors for secondary spread: households with more than three children (adjusted relative risk (RR): 9.17; 95% CI: 1.21-69.13), children younger than five years (adjusted RR: 5.45; 95% CI: 2.44-12.62), and children younger than 12 years assisting in washing younger siblings (adjusted RR: 5.45; 95% CI: 2.44-12.17). Rigorous hand washing, use of disposable towels, information for parents and caregivers, and exclusion of symptomatic children from day care, preschool and school for a minimum of 48 hours were implemented.