A multi-country Shigella outbreak in Europe has been linked to stays at some hotels in Cape Verde.

Confirmed Shigella sonnei cases have been reported in the Netherlands, Denmark, France, Germany, Portugal, and the United Kingdom.

The European Centre for Disease Prevention and Control (ECDC) said there is no information about the source of infection but given the increase in travel during the coming holiday season, new cases are likely.

However, Holiday Claims Bureau and Hudgell Solicitors in the UK have noted complaints of illness and poor hygiene standards from holidaymakers, suggesting the source could be contaminated food or water. Holiday Claims Bureau said it had been informed of sick people testing positive for Shigella.

Travelers have described symptoms such as diarrhea, vomiting, stomach cramps, and pains, which in some cases lasted until they returned home.

Anne Thomson, Hudgell Solicitors’ travel litigation executive, said people can suffer as a result of a change in diet and climate.

“However, when we are alerted to situations wher a number of holiday guests are affected by similar symptoms, particularly when they are not part of the same traveling group, we feel an investigation is needed to contain any wider outbreak and prevent future problems,” she said.

“Holidaymakers becoming ill having only ever eaten at the specific hotel they are staying at, and concerns raised by guests over standards of hygiene and cleanliness throughout premises, and not just in dining areas, are often red flags to potential underlying problems.”

Patient numbers by country
The Netherlands has a cluster of nine confirmed Shigella sonnei cases with a travel history to Cape Verde since August 2022. A total of 22 cases have been reported, with 18 after Sept. 19. Sick people have a median age of 46 but range from 24 to 77 years old while 14 are women and four are men. A dozen patients stayed in different hotels of the same chain on the same island of Cape Verde, which is in West Africa.

The UK has 48 confirmed cases with specimen collection dates between November 2021 and October 2022, with the majority occurring since September this year.

In total, 23 patients reported travel to Cape Verde and nine others had been to Africa. Ten of 11 cases who went to Cape Verde stayed at the same hotel chain. Most cases are female and the median age is 51 with a range of 2 to 77 years old. Five cases are also co-infected with other gastrointestinal pathogens.

Denmark reported two cases that match the Dutch strain in a large EIEC/Shigella outbreak from December 2021 to February 2022. They had traveled to Cape Verde.

France has nine cases from February to September 2022. Three reported a trip to Cape Verde and another person mentioned a trip to Africa.

Germany reported two cases that cluster with the Dutch strain and have a travel history to Cape Verde. Two women aged 51 and 62 had disease onset in September and October.

Portugal reported one case in October linked to recent travel to Cape Verde. The patient is a 31-year-old female, hospitalized with a gastrointestinal infection and possible hemolytic uremic syndrome (HUS), a condition that can cause kidney failure.

Shigella bacteria cause an infection called shigellosis. Most infected people have diarrhea, fever, and stomach cramps. Symptoms usually begin a couple of days after infection and last a week. Travelers may be exposed to the bacteria through contaminated food, water, or surfaces. Those with a Shigella infection can spread it to others for several weeks. People should wash their hands with soap and water before preparing and eating food.