Shigellosis Outbreak Investigation - Mizan Tepi University Southern Ethiopia, February, 2019

  • Water or foodborne
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Background:
Shigellosis is the second leading cause of diarrheal mortality accounting for a million deaths worldwide nearly all in developing countries due to poor sanitation. On February 7th, 2019 Mizan Tepi University reported diarrheal cases among students. We investigated to confirm the outbreak, describe the magnitude, and determine possible risk factors of the outbreak.
Methods:
A study was conducted at Mizan Tepi University main campus using a 1:2 case-control study with 150 study participants (50 cases and 100 controls) from Feb 08-20, 2019 among students. A case was any person from the campus with an acute onset of diarrhea between January 29 to February 20, 2019 and a control was any person from the campus not meeting the case definition. Data was collected using a structured questionnaire. Bi-variate & multi-variable analysis was done to identify risk factors . Stool culture with antimicrobial susceptibility testing (AST) and testing of water samples from the drinking water reservoir and Shonga River (which cross the campus) for coli-forms was done.
Results:
We identified a total of 468 cases with Shigella flexeneriin 64% (9/14) of cultured stool samples, sensitive only to Ciprofloxacin. The attack rate was 8.6% without deaths. The reservoir and Shonga river were positive for fecal coliforms. Sharing a dorm with a case (AOR=4.14: 95% CI: 1.4-12.0), contact with a diarrheal case (AOR=3.8: 1.3-11.2) and history of cafeteria water consumption (AOR= 3.5: 95% CI: 1.1-11.24) were associated with increased odds of illness. Drinking bottled water (AOR=0.18, 95% CI: 0.06-0.56) and hand washing following toilet use (AOR=0.28, 95% CI: 0.08-0.9) during the outbreak period reduced odds of infection. Students reported cafeteria staff using Shonga River water to clean plates and utensils during piped water interruption.
Conclusion
Contamination of the cafeteria water supply is the likely source of the outbreak with secondary spread among students. Regular hand washing with soap and avoiding food preparation by sick person are recommended to prevent person to person transmission. Chlorination of the water reservoir, avoiding use of river water by the cafeteria staff, regular supervision of food handling and preparation, and providing hand washing at latrines are recommended to prevent future outbreaks.

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