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Surveillance
CDC currently has six surveillance systems for obtaining information
about Shigella. They serve different purposes and provide
information on various features of the organism's epidemiology,
such as number of outbreaks, antimicrobial-resistant infections,
or subtypes.
- Public Health Laboratory Information System (PHLIS)
PHLIS is a passive, laboratory-based surveillance system that
collects data about many infections, including Shigella.
Reporting is limited to illnesses that are confirmed by culture
and verified at the state public health laboratory. After verification,
information about the infection is reported electronically to
CDC by the state http://www.cdc.gov/ncidod/dbmd/phlisdata.
Annual summaries of the PHLIS Shigella surveillance data can
be found at http://www.cdc.gov/ncidod/dbmd/phlisdata/shigella.htm.
- National Electronic Telecommunications System for Surveillance
(NETSS)
NETSS is a passive, physician-based surveillance system that
captures both laboratory-confirmed and clinically suspected
cases of all nationally notifiable diseases, including Shigella.
The number of illnesses reported through NETSS tends to be higher
than the number reported through PHLIS because NETSS does not
require confirmation by the state public health laboratory.
More information on NETSS can be found at http://www.cdc.gov/epo/dphsi/netss.htm.
Shigella infections and other surveillance data collected
by NETSS is published weekly in the CDC Morbidity and Mortality
Report (MMWR) and can be found at http://www2.cdc.gov/mmwr.
The MMWR also publishes an annual summary of the NETSS Shigella
surveillance data; this information can be found at http://www2.cdc.gov/mmwr/summary.html.
- FoodNet
The Foodborne Diseases Active Surveillance Network (FoodNet)
is an active surveillance system for identifying and characterizing
culture-confirmed infections that may be foodborne, including
Shigella. FoodNet workers regularly contact more than
300 laboratories for confirmed cases of foodborne infections
in several states encompassing a population of more than 25
million persons. In addition to monitoring the number of Shigella
infections, investigators monitor laboratory techniques for
isolation of bacteria, perform case-control studies of ill persons
to determine foods associated with illness, and administer questionnaires
to people living in FoodNet sites to better understand trends
in the eating habits of Americans. Annual FoodNet reports that
include data about Shigella can be found at http://www.cdc.gov/foodnet/annuals.htm.
More information on FoodNet can be found at http://www.cdc.gov/foodnet/.
- National Molecular Subtyping Network for Foodborne Diseases
Surveillance (PulseNet )
PulseNet is a national network of public health laboratories
that perform pulsed-field gel electrophoresis (PFGE), a type
of DNA "fingerprinting", on certain foodborne bacteria, including
Shigella. PFGE "fingerprint" patterns are submitted electronically
to CDC and can be compared rapidly with others in a large database.
This system can help determine if individual infections are
related or if an outbreak is occurring. PulseNet is not a surveillance
system itself but a laboratory subtyping method used in surveillance.
More information on PulseNet can be found at http://www.cdc.gov/pulsenet.
- National Antimicrobial Resistance Monitoring System (NARMS)
NARMS is a passive surveillance system that monitors antimicrobial
resistance of Shigella and selected other bacteria that
cause human illness. NARMS is a collaboration between CDC, 16
state and local health departments, the Food and Drug Administration
(FDA), and the United States Agricultural Department (USDA).
More information on NARMS can be found at http://www.cdc.gov/narms.
- Foodborne Outbreak Detection Unit
CDC monitors outbreaks of foodborne disease, including outbreaks
caused by Shigella. Each year, state and territorial
epidemiologists voluntarily (passively) report the results of
outbreak investigations to CDC. While outbreaks account for
a small percentage of the total number of illnesses that occur
each year, these investigations provide valuable information
about sources of foodborne infection and often highlight important
prevention opportunities. The latest summaries of foodborne
outbreaks can be found at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/ss4901a1.htm.
MMWR Articles
Outbreak of Gastroenteritis Associated with an Interactive Water
Fountain at a Beachside Park - Florida, 1999. MMWR
June 30, 2000 / 49(25);565-8
Outbreaks of Shigella sonnei infection associated with
eating fresh parsley - United States and Canada, July - August
1998. MMWR
April 16, 1999 / 48(14);285-9
Shigella sonnei Outbreak Associated with Contaminated
Drinking Water - Island Park, Idaho, August 1995
MMWR
March 22, 1996 / Vol. 45 / No. 11
Links
CDC
Safe Water System
FoodNet
Laboratory
Methods for the Diagnosis of Epidemic Dysentery and Cholera
PHLIS Data
References
Shane A, Crump J, Tucker N, Painter J, Mintz E. Sharing Shigella:
risk factors and costs of a multi-community outbreak of shigellosis.
Archives Pediatrics and Adolescent Med 2003; 157 601-603.
Sobel J, Cameron DN, Ismail J, et al. A prolonged outbreak of
Shigella sonnei infections in traditionally observant Jewish
communities in North America caused by a molecularly distinct
bacterial subtype. J Infect Dis 1998; 177: 1405-1408.
Ries AA, Wells JG, Olivola D, et al. Epidemic Shigella dysenteriae
type 1 in Burundi: panresistance and implications for prevention.
J Infect Dis 1994; 169: 1035-1041.
Lee LA, Shapiro CN, Hargrett-Bean N, Tauxe RV. Hyperendemic
shigellosis in the United States: a review of surveillance data
for 1967-1988. J Infect Dis 1991; 164: 894-900.
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