Shigella sonnei Outbreak Investigation During a Municipal Water Crisis-Genesee and Saginaw Counties, Michigan, 2016

Am J Public Health. 2020 Jun;110(6):842-849. doi: 10.2105/AJPH.2020.305577. Epub 2020 Apr 16.

Abstract

Objectives. To investigate a shigellosis outbreak in Genesee County, Michigan (including the City of Flint), and Saginaw County, Michigan, in 2016 and address community concerns about the role of the Flint water system.Methods. We met frequently with community members to understand concerns and develop the investigation. We surveyed households affected by the outbreak, analyzed Shigella isolate data, examined the geospatial distribution of cases, and reviewed available water quality data.Results. We surveyed 83 households containing 158 cases; median age was 10 years. Index case-patients from 55 of 83 households (66%) reported contact with a person outside their household who wore diapers or who had diarrhea in the week before becoming ill; results were similar regardless of household drinking water source. Genomic diversity was not consistent with a point source. In Flint, no space-time clustering was identified, and average free chlorine residual values remained above recommended levels throughout the outbreak period.Conclusions. The outbreak was most likely caused by person-to-person contact and not by the Flint water system. Consistent community engagement was essential to the design and implementation of the investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cities
  • Disease Outbreaks / statistics & numerical data*
  • Drinking Water / microbiology*
  • Dysentery, Bacillary* / epidemiology
  • Dysentery, Bacillary* / microbiology
  • Dysentery, Bacillary* / transmission
  • Female
  • Humans
  • Infant
  • Male
  • Michigan / epidemiology
  • Middle Aged
  • Shigella sonnei* / classification
  • Shigella sonnei* / genetics
  • Shigella sonnei* / isolation & purification
  • Water Quality
  • Water Supply*
  • Young Adult

Substances

  • Drinking Water