Antibiotic resistance has contributed to more prolonged and widespread outbreaks. Accurate numbers for the annual incidence of shigellosis are difficult to obtain. Although Shigella is a common cause of diarrhoeal disease, it is not easy to isolate, and patients with milder symptoms often do not seek medical attention and are therefore missed.
An estimated 188 million cases of shigellosis occurred globally in 2010, with 62.3 million of these in children aged <5 years.[6]Kotloff KL, Riddle MS, Platts-Mills JA, et al. Shigellosis. Lancet. 2018 Feb 24;391(10122):801-12.
http://www.ncbi.nlm.nih.gov/pubmed/29254859?tool=bestpractice.com
In 2016, Shigella was the second most common cause of diarrhoea-related mortality worldwide and was responsible for over 212,000 deaths.[2]Khalil IA, Troeger C, Blacker BF, et al. Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990-2016. Lancet Infect Dis. 2018 Nov;18(11):1229-40.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30475-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/30266330?tool=bestpractice.com
Mortality rates are highest for children under the aged 5 years, and in countries with lower sociodemographic indices.[2]Khalil IA, Troeger C, Blacker BF, et al. Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990-2016. Lancet Infect Dis. 2018 Nov;18(11):1229-40.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30475-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/30266330?tool=bestpractice.com
The notification rate of Shigella infection in England and Wales was 4.9 notifications per 100,000 in 2019, a total of 3270 infections.[7]European Centre for Disease Prevention and Control. Shigellosis. Oct 2022 [internet publication].
https://www.ecdc.europa.eu/sites/default/files/documents/shigellosis-annual-epidemiological-report-2019.pdf
Non-travel associated Shigella infection among adults has increased in the UK and accounts for the majority of reported cases.[8]Public Health England. Shigellosis: public health management and questionnaire. 30 November 2017 [internet publication].
https://www.gov.uk/government/publications/shigellosis-public-health-management-and-questionnaire
This may be related to increased sexual transmission among men who have sex with men.[9]Public Health England; Infection and infectious diseases: update on the epidemiology of Shigella in adults in London; 2012 to 2016. May 2017 [internet publication].
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/621210/Shigella_in_adults_London_2012_to_2016.pdf
Between 2013 and 2015, the incidence of Shigella increased by 7% in the US, and was estimated at 4.6 cases per 100,000.[10]Marder EP, Cieslak PR, Cronquist AB, et al. Incidence and trends of infections with pathogens transmitted commonly through food and the effect of increasing use of culture-independent diagnostic tests on surveillance - Foodborne Diseases Active Surveillance Network, 10 US sites, 2013-2016. MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):397-403.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/28426643?tool=bestpractice.com
In 2016, Shigella sonnei accounted for 80.5% of cases, followed by S flexneri with 12.6% of cases, S boydii with 0.2%, and S dysenteriae with 0.1%.[3]Centers for Disease Control and Prevention (CDC). National Shigella surveillance: Shigella Annual Report, 2016. 21 May 2018 [internet publication].
http://www.cdc.gov/nationalsurveillance/shigella-surveillance.html
The majority of reported cases occurred in children between 1 and 4 years old.[3]Centers for Disease Control and Prevention (CDC). National Shigella surveillance: Shigella Annual Report, 2016. 21 May 2018 [internet publication].
http://www.cdc.gov/nationalsurveillance/shigella-surveillance.html
Overall mortality in the US is very low (0.1% in 2016).[10]Marder EP, Cieslak PR, Cronquist AB, et al. Incidence and trends of infections with pathogens transmitted commonly through food and the effect of increasing use of culture-independent diagnostic tests on surveillance - Foodborne Diseases Active Surveillance Network, 10 US sites, 2013-2016. MMWR Morb Mortal Wkly Rep. 2017 Apr 21;66(15):397-403.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/28426643?tool=bestpractice.com