Key Objectives:
To explore how CDC can support state and local health departments to meet two major challenges in the prevention and control of shigellosis: 1) identifying and containing outbreaks of antibiotic-resistant Shigella among men who have sex with men, and 2) assessing the role of exclusion policies in managing childcare-associated outbreaks.
Brief Summary:
CDC is poised to expand and strengthen molecular-based Shigella surveillance and outbreak detection nationwide, which will inform new prevention and control strategies. By leveraging this enhanced laboratory and epidemiologic capability, CDC will support health departments to address both emerging and longstanding public health challenges in shigellosis, including the development and spread of antibiotic-resistant infections, the rising incidence of shigellosis among men who have sex with men (MSM), and the difficulty of containing outbreaks, particularly those in childcare settings. According to WHO and CDC, the prevention and control of antibiotic-resistant shigellosis is a public health priority. Outbreaks of shigellosis among MSM are increasingly reported in the United States and are often due to strains that are resistant to clinically important antibiotics. Antibiotic-resistant shigellosis is not limited to MSM, however. The potential for outbreaks of antibiotic-resistant Shigella in childcare settings is especially worrisome because a rising proportion of strains are resistant to azithromycin, the first-line treatment for children. Exclusion policies are commonly used to mitigate childcare-associated shigellosis outbreaks, but data gaps preclude an evaluation of their effectiveness in relation to social and economic impacts. The heterogeneity of at least five different childcare exclusion policies across states further reflects the challenge of evaluating and standardizing recommendations. This roundtable will provide a forum for state and local health departments to discuss how CDC can help them address major challenges to preventing and controlling shigellosis. Topics may include: developing questionnaires for MSM-associated outbreaks; identifying risk factors for transmission among MSM, for antibiotic-resistant infection, and for spread to vulnerable populations; creating targeted prevention messages; and building an evidence base to guide interventions such as childcare exclusion policies.