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Shigellosis among Tourists -- Union of Soviet Socialist Republics, 1983

CDC has received several reports of a severe diarrheal illness affecting tour groups to the southern Union of Soviet Socialist Republics (U.S.S.R.)in 1983:

Tour #1. A 60-year-old woman developed vomiting, chills, and diarrhea in July 1983 in Tashkent, Uzbek Soviet Socialist Republic. She had been in Bukhara, Uzbek, for the 2 days before her onset of illness. The diarrhea persisted for 2 weeks, despite medication prescribed by physicians in the U.S.S.R., and on her return to the United States, she consulted her private physician. She was treated with trimethoprim/sulfamethoxazole, and after 3 days, the diarrhea resolved. Stool culture yielded Shigella flexneri 1b.

Tour #2. A 52-year-old man became ill with diarrhea and chills in September 1983, while on a tour in Yerevan, Armenian Soviet Socialist Republic. His symptoms persisted after his return to the United States, and a stool culture grew S. flexneri 1b.

Tour #3. A physician-member of a tour group to the Caucasus in August 1983 reported that more than 60% of tour-group members experienced an illness characterized by high fever, nausea, and nonbloody diarrhea that lasted 2 days to 2 weeks. The illness first occurred after the group had been in Tbilisi, Georgian Soviet Socialist Republic, for several days. The illness was treated empirically with trimethoprim/sulfamethoxazole or doxycycline; antidiarrheal medications were avoided.

Following these reports, CDC contacted tour leaders who had led 39 tours through the U.S.S.R. between April and October 1983. In 12 of the 39 tours, more than one-third of tour members had a diarrheal illness compatible with shigellosis.

All 12 affected tour groups were among the 18 groups that traveled through either Uzbek Soviet Socialist Republic or the Caucasus Mountain Republics of Georgia, Armenia, or Azerbaidzhan during July through October 1983. In contrast, none of 17 tour groups to the U.S.S.R. that did not visit these areas in the southern U.S.S.R. and none of four tours to the Caucasus in May and June 1983 experienced similar outbreaks of diarrheal disease. The Shigella isolates from tours 1 and 2 were confirmed as S. flexneri type 1b, resistant to ampicillin and chloramphenicol and sensitive to trimethoprim/sulfamethoxazole. S. sonnei was isolated from a member of a tour to the Caucasus returning to the United States in late August; this isolate was not characterized further. No other pathogens were reported to have been isolated among the surveyed groups. Reported by CW Bird, MD, R Locey, MD, Oakland County Health Div, Oakland County, KR Wilcox, Jr, MD, Michigan State Dept of Public Health; DB Prescott, MD, Storrs, Connecticut; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Persons who traveled to the Soviet Republics of Uzbek, Georgia, Armenia, and Azerbaidzhan in summer and fall of 1983 appear to have been at high risk for acquiring a febrile diarrheal illness, some of which was shigellosis. Shigella is usually transmitted person-to-person or via contaminated food or water. The source of the illness in these tour groups is not known. It is not known whether a similar risk was present before 1983 or will be present in 1984. Antimicrobial-resistant Shigella should be considered in the differential diagnosis of diarrheal illness occurring in tourists to these areas.

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