ArticleThe Lancet. Infectious diseases2023
Genomic reconstruction and directed interventions in a multidrug-resistant Shigellosis outbreak in Seattle, WA, USA: a genomic surveillance study.
Article in The Lancet. Infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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26 citing papers in PubMed, 31 citations in OpenAlex.
- Review
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- Protective and pathogenic antibody responses from a primate Shigella outbreak inform vaccine design.bioRxiv : the preprint server for biology · 2025Article
- Sexually transmitted enteric infections in men who have sex with men.Clinical microbiology reviews · 2025Review
- Shigellosis.Lancet (London, England) · 2025Review
- Multiplex Polymerase Chain Reaction Panels for Gastrointestinal Infections: Current Evidence, Regulatory Hurdles, and the Way Forward.Open forum infectious diseases · 2025Article
- A multifunctional anti-O-Antigen human monoclonal antibody protects againstProceedings of the National Academy of Sciences of the United States of America · 2025Article
- Multidrug-resistant Shigella flexneri outbreak affecting humans and non-human primates in New Mexico, USA.Nature communications · 2025Article
- Shigella sonnei: epidemiology, evolution, pathogenesis, resistance and host interactions.Nature reviews. Microbiology · 2025Review
- An Outbreak of Multidrug-ResistantTropical medicine and infectious disease · 2025Review
- Increased Severity of Multidrug-Resistant Shigella sonnei Infections in People Experiencing Homelessness.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Immunogenicity evaluation of altSonflex1-2-3Frontiers in immunology · 2025Article
- Antibodies elicited by altSonflex1-2-3 GMMA vaccine are bactericidal against a panel of drug-resistantFrontiers in immunology · 2025Article
- Article
- Risk factors and provider awareness of sexually transmitted enteric pathogens among men who have sex with men.Microbiology spectrum · 2024Article
- Epithelial Cell Infection Analyses with Shigella.Journal of visualized experiments : JoVE · 2024Article
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14 authors at 3 institutions in 1 country.
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Abstract
backgroundShigella spp have been associated with community-wide outbreaks in urban settings. We analysed a sustained shigellosis outbreak in Seattle, WA, USA, to understand its origins and mechanisms of antimicrobial resistance, define ongoing transmission patterns, and optimise strategies for treatment and infection control.
methodsWe did a retrospective study of all Shigella isolates identified from stool samples at the clinical laboratories at Harborview Medical Center and University of Washington Medical Center (Seattle, WA, USA) from May 1, 2017, to Feb 28, 2022. We characterised isolates by species identification, phenotypic susceptibility testing, and whole-genome sequencing. Demographic characteristics and clinical outcomes of the patients were retrospectively examined.
findings171 cases of shigellosis were included. 78 (46%) patients were men who have sex with men (MSM), and 88 (52%) were people experiencing homelessness (PEH). Although 84 (51%) isolates were multidrug resistant, 100 (70%) of 143 patients with data on antimicrobial therapy received appropriate empirical therapy. Phylogenomic analysis identified sequential outbreaks of multiple distinct lineages of Shigella flexneri and Shigella sonnei. Discrete clonal lineages (ten in S flexneri and nine in S sonnei) and resistance traits were responsible for infection in different at-risk populations (ie, MSM, PEH), enabling development of effective guidelines for empirical treatment. The most prevalent lineage in Seattle was probably introduced to Washington State via international travel, with subsequent domestic transmission between at-risk groups.
interpretationAn outbreak in Seattle was driven by parallel emergence of multidrug-resistant strains involving international transmission networks and domestic transmission between at-risk populations. Genomic analysis elucidated not only outbreak origin, but directed optimal approaches to testing, treatment, and public health response. Rapid diagnostics combined with detailed knowledge of local epidemiology can enable high rates of appropriate empirical therapy even in multidrug-resistant infection.
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