Weekly releases (1997–2007) - Volume 6, Issue 33, 15 August 2002

Shigellosis is an acute bacterial disease of the large and small intestine caused by one of four shigella species. Shigella serotypes are transmitted by direct or indirect faecal-oral contact, and outbreaks of shigellosis are traditionally associated with conditions of crowding or where personal hygiene is poor, such as prisons, day care centres, and psychiatric institutions. Outbreaks among men who have sex with men (MSM) have become more common in recent years, along with increases in high risk sexual behaviour, sexually transmitted infections, and HIV (1-5). Shigellosis in MSM was first described in San Francisco in 1974 (6). By the early 1980s, shigella infections in men supplanted cycles of shigellosis in more traditionally recognised risk groups, suggesting the importance of shigella infections transmitted by MSM (7).

Consistent with other Western European states, the numbers and rates of bacterial and viral sexually transmitted infections (STIs) in England, Wales, and Northern Ireland have been increasing since the mid-1990s (1). Recently released figures (collected on the national KC60 statistical returns) on diagnoses made in genitourinary medicine (GUM) clinics in England, Wales, and Northern Ireland show that this increase has continued throughout 2001. In 2001, genital chlamydial infection became the most common STI seen in GUM clinics with a total of 71 055 diagnoses. This is the first time in 30 years that a bacterial STI has been the most commonly diagnosed STI and may reflect increased incidence as well as increased awareness and case-finding

The outbreak of legionnaires’ disease in north west England has resulted in two more deaths since 7 August, bringing the total number of deaths in this outbreak to three (1). At 2 pm on 15 August 2002 the outbreak control team was aware of 116 confirmed cases of legionnaires’ disease that fit the standard case definition. At present the observed case-fatality rate of 2.7% is considerably lower than the rate observed in previous outbreaks in the United Kingdom.

Variant Creutzfeldt-Jakob disease (vCJD) has been confirmed in a resident of Saskatchewan, Canada (1). The patient, a man under the age of 50, was first notified to the Canadian national CJD surveillance system at Health Canada in April 2002 when his clinical presentation, age, and history of residence in the United Kingdom (UK) led Canadian doctors to suspect vCJD. Post-mortem examination of brain tissues by experts in Canada and the UK has now confirmed the diagnosis of vCJD. Since 1998, when the national CJD surveillance system was launched, all suspect cases of CJD are reported to Health Canada through a national network of specialist physicians. Incidence data are also shared with European and other allied countries as part of the Collaborative Study Group of CJD (EUROCJD, http://www.eurocjd.ed.ac.uk/euroindex.htm). This patient is the first case of vCJD reported in Canada, which together with 6 cases reported in France and one each in the Republic of Ireland, Italy and USA, brings the total number of cases with onset outside the UK to 10 (personal communication National CJD Surveillance Unit, Edinburgh).