Dysentery in general practice: a study of cases and their contacts in Enfield and an epidemiological comparison with salmonellosis

Abstract

SUMMARY: During a laboratory study of diarrhoea in a large urban area during the years 1953–68, 5319 Sonne dysentery infections in 2620 households and six cases of Flexner dysentery in five households were confirmed. The annual incidence per 10,000 population fluctuated between 2 and 31 with an average of 12.Shigella sonnei was found in 10% of new cases of diarrhoea investigated. Plural infections were found in 58% of the households studied and 30% of all contacts examined were shown to be infected. Among these contacts the infection rate was higher for children (42%) than adults (20%), and higher for adult females (24%) than males (16%). The duration of infection was under 2 weeks in nearly half the index cases followed up and longer than 2 months in only 3%, Intermittent excretion was observed in 15%. Repeated Sonne dysentery infection and illness was observed after intervals as short as 5 months. Antibiotic sensitivity was recorded after 1955 and colicine typing after 1960. Changes in antibiotic sensitivity were noted. Children of primary-school age were most susceptible to Sonne dysentery, but symptoms in ill cases were as severe in adults as in children. During years of high incidence cases were concentrated within a small number of primary schools.Sh. sonnei infections were compared with salmonella infections studied concurrently. Sonne dysentery was a winter disease and most cases were under 11 years old, and case-to-case infection was the usual means of spread. Salmonellosis was prevalent in summer and affected nearly as many adults as children, often persons sharing an article of food. It was more prolonged and severe than Sonne dysentery, but less infectious. In all these respects S. typhimurium occupied an intermediate place between Sonne dysentery and ‘other salmonellas’.