Incubation period days

Period of communicability 4 weeks, but may persist for longer in the carrier.

Occurrence and distribution Any outbreak of an acute diarrhoeal disease with blood should be considered to be bacillary dysentery until proved otherwise. Distribution is worldwide with sporadic outbreaks occurring in both the developed and the developing world. Infection is often carried from one area to another or across international boundaries by carriers.

Control and prevention Bacillary dysentery is likely to present as an outbreak; so control will need to be implemented in the manner described in Section 4.1. Generally, it is better to bring treatment to the site of the outbreak, setting up temporary treatment centres, unless the outbreak is a small one and the hospital has sufficient facilities to isolate cases. A seasonal outbreak will suggest that water supplies need to be improved. Search for carriers is generally unsatisfactory and investigation should be restricted to food handlers.

Breast-feeding is protective for babies and infants and should be continued even by the sick mother. Washing hands with soap and water is the most effective method of interrupting transmission.

With widespread antibiotic resistance, Shigella infections could be controlled by vaccinating susceptible groups, especially if there is an outbreak in the vicinity. A live oral vaccine of S. flexneri (SC602) is currently under trial, while others are in the developmental stage.

Treatment Management is the same as with other diarrhoeas - to replace fluid and electrolytes lost. ORS is adequate and effective in all cases, but the severely dehydrated will require intravenous rehydration. There is a place for antibiotics in the treatment of bacillary dysentery although sensitivity must be determined, as resistance is common. Ampicillin, nalidixic acid, TMPX-SMX, ciprofloxacin or ofloxocin can be given as a 5-day course. Antibiotic treatment should not be relied upon as resistance makes control more difficult and the disease can relentlessly spread though a country.

Surveillance is similar to cholera (Section 8.3) with notification of any outbreaks and monitoring of the weather for seasonal occurrences.

There are many similarities between cholera and bacillary dysentery, especially in the management and control so further help can be found in Section 8.3.

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