On March 18, 2014, the Taiwan Centers for Disease Control (Taiwan CDC) announced four imported cases of shigellosis confirmed this year. Three cases became infected while visiting Cambodia for a charity event and one case became infected while visiting Myanmar. Taiwan CDC reminds travelers that as several shigellosis cases have been imported from Southeast Asia over the recent years, people planning to visit these areas are advised to pay attention to food safety and hand hygiene to ensure their health and wellbeing.

According to Taiwan CDC, three imported shigellosis cases participated in a charity event held in Phnom Penh, Cambodia during February 22 and March 1, 2014. Among them, a 22-year-old female traveler developed abdominal pain and watery diarrhea prior to boarding her plane to Taiwan on March 1. After she returned to Taiwan, when her symptoms persisted, she sought medical attention at a hospital. Infection with shigellosis was confirmed in the case on March 11. To monitor the health of the other members in the same tour group with the case, the health authority has implemented a number of measures, including conducting health education and contact tracing. Of them, specimens were collected from 15 people who experienced suspected symptoms. Infection with shigellosis was confirmed in additional two cases that respectively are a 23-year-old female and a 24-year-old female. Based on the time of disease onset and the incubation period of shigellosis, it is determined that all these cases are imported. In addition, Taiwan CDC detected a suspected shigellosis case in a 37-year-old male who returned from attending a religious activity in Myanmar and experienced fever and diarrhea. Infection with shigellosis was confirmed in the case on March 14. Thus far, the health authority has compiled a list of 21 members who traveled in the same tour group with the case to monitor their health and administer follow up activities such specimen collection and health education.

The incubation period of shigellosis is 12 to 96 hours (1-3 days), but sometimes it may last as long as 1 week. Symptoms include mild to severe diarrhea, fever, nausea, vomiting, cramps, rectal tenesmus (difficulty to empty the bowel for defecation) and bloody or watery stools. It is possible to develop no symptoms in some cases. Contracting shigellosis during traveling can be tremendously disruptive to the itinerary and emotions, not to mention the possibility of carrying the disease back home and spreading it to family members and friends. To prevent possible infections and further transmission of the disease, Taiwan CDC urge people visiting tropical and subtropical countries where shigellosis is endemic to avoid raw produce or food purchased from dirty stalls, always wash hands before meals and pay attention to dietary and personal hygiene.

Taiwan CDC urges travelers experiencing discomfort during the trip or upon arrival in Taiwan to inform the tour guide for seeking immediate medical attention and contact quarantine services at the airport for facilitating implementation of subsequent measures that prevent further spread of the disease. Informing doctors of personal travel history is important not only for the diagnosis, but also for the implementation of the health authority’s measures to prevent epidemic diseases. Further, tour guides are advised to pay attention to the health status of tour group members. When a tour group member develops suspicious symptoms, tour guides are advised to voluntarily report such a case and provide the contact information of all tour group members and the itinerary of the tour group to the quarantine officer at the airport in order to facilitate diagnosis, follow-up and implementation of necessary measures. For any questions or further information, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-001922 if calling from a cell phone.