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Shigellosis -- North Carolina

The North Carolina Division of Health Services has received reports of a large outbreak of diarrheal disease among persons attending the annual Rainbow Family gathering, held this year at the Nantahala National Forest. Most participants attended the gathering between July 1 and July 7. National Forest Service personnel estimate a peak attendance, on July 4, of approximately 12,000 persons. Attendees came from states throughout the country. Anecdotal reports from attendees suggest that the attack rate of acute diarrheal illness may have been greater than50%. Shigella sonnei has been isolated from 25 persons from nine states (California, Georgia, Illinois, Massachusetts, Michigan, Ohio, North Carolina, Tennessee, and West Virginia) following their attendance at the gathering. Of those isolates with known antimicrobial resistance, 18/18 are resistant to ampicillin, 8/9 to trimethoprim- sulfamethoxazole, and 5/5 to tetracycline. Poor hygiene, insufficient potable water, inadequate trench latrines, and frequent rainfall during the event may have contributed to the propagation and transmission of infection. The transmission of other enteric diseases has not been excluded. Physicians should be aware of the potential for diarrheal disease in participants at this gathering and should obtain appropriate diagnostic specimens. Culture-confirmed cases of enteric diseases should be reported to local and state health departments. Reported by: Communicable Disease Control Br, Div of Health Svcs, North Carolina Dept of Human Resources. Tennessee Dept of Health and Environment. Div of Field Svcs, Epidemiology Program Office; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

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