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. 2005 Aug;98(8):774-8.
doi: 10.1097/01.smj.0000172764.14147.e5.

Shigellosis among swimmers in a freshwater lake

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Shigellosis among swimmers in a freshwater lake

Martha Iwamoto et al. South Med J. 2005 Aug.

Abstract

Objective: Shigella infection is highly communicable; however, outbreaks associated with swimming in recreational fresh water are rarely identified.

Materials and methods: A cohort study of lake visitors was performed.

Results: Seventeen (24.6%) case patients among 69 persons who visited the lake over the holiday weekend were identified. Attack rates increased with increasing exposure to lake water; the risk of illness was greatest among swimmers who reported getting lake water in their mouths (relative risk = 5.37, 95% confidence interval = 2.2, 13.3). Shigella sonnei was isolated from stool samples of four of eight swimmers tested.

Conclusions: The outbreak likely was caused by fecal contamination of lake water by an infected swimmer; there was no evidence of sewage contamination into the lake. Fresh water is a potential source of infection in patients with acute gastroenteritis and recent exposure. Since testing and chlorination of lake water is impractical, prevention relies on avoidance of fecal contamination and/or minimizing ingestion of the water.

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