{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:15:08Z","timestamp":1792124108214,"version":"4.4.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T00:00:00Z","timestamp":1739491200000},"content-version":"unspecified","delay-in-days":44,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>In February 2023, 52 cases of gastrointestinal illness were reported in customers of Takeaway A, South Wales. <jats:italic>Shigella flexneri<\/jats:italic> serotype 2a was the causative organism. An outbreak investigation was conducted to determine the extent and vehicle of the outbreak.<\/jats:p>\n\t  <jats:p>Following descriptive summary and environmental investigations, a case\u2013control study was completed. Participants completed a telephone questionnaire on food, travel, and environmental exposures. A multivariable logistic regression model was built, including exposures with <jats:italic>p<\/jats:italic>-values &lt; 0.2 and interactions identified on stratified analysis. Staff faecal samples were screened for <jats:italic>Shigella<\/jats:italic> sp.<\/jats:p>\n\t  <jats:p>Thirty-one cases and 29 controls were included in the study. Eighty-seven per cent of cases and 76% of controls ate from Takeaway A on 10 February 2023. Coleslaw was the main factor associated with illness (aOR: 200, 95% CI: 12\u20133220) and an interaction with cabbage was identified (aOR: 886, 95% CI: 26\u201330034). <jats:italic>Shigella<\/jats:italic> sp. were not detected in any staff samples.<\/jats:p>\n\t  <jats:p>Coleslaw was the most likely vehicle. Though the contamination route is unknown, a food handler is the most likely source. This large outbreak differs from recent European outbreaks, which primarily have been associated with sexual transmission. Although uncommon in the UK, <jats:italic>S. flexneri<\/jats:italic> should be considered as a cause of foodborne outbreaks.<\/jats:p>","DOI":"10.1017\/s0950268824000943","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T09:57:41Z","timestamp":1739527061000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Large <i>Shigella flexneri<\/i> outbreak linked to a takeaway, South Wales: a case\u2013control study"],"prefix":"10.1017","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2298-6768","authenticated-orcid":false,"given":"Amy","family":"Plimmer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laia","family":"Fina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oghogho","family":"Orife","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley","family":"Griggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7846-7135","authenticated-orcid":false,"given":"Maria","family":"Saavedra-Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donall","family":"Forde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cerys","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Driscoll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananda Giri","family":"Shankar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2426-5893","authenticated-orcid":false,"given":"Daniel","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"S0950268824000943_r19","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2015-052323"},{"key":"S0950268824000943_r2","doi-asserted-by":"publisher","DOI":"10.1002\/9781119328070"},{"key":"S0950268824000943_r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijhm.2022.103240"},{"key":"S0950268824000943_r1","volume-title":"Medical Microbiology","author":"Hale","year":"1996"},{"key":"S0950268824000943_r15","doi-asserted-by":"publisher","DOI":"10.1016\/B0-12-227055-X\/01085-3"},{"key":"S0950268824000943_r5","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054589"},{"key":"S0950268824000943_r3","unstructured":"[3] Centers for Disease Control and Prevention (2023) Information for Healthcare Professionals | Shigella \u2013 Shigellosis. https:\/\/www.cdc.gov\/shigella\/audience-medical-professionals.html (accessed 22 May 2023)."},{"key":"S0950268824000943_r13","doi-asserted-by":"publisher","DOI":"10.1007\/s12560-019-09410-3"},{"key":"S0950268824000943_r6","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2015-052014"},{"key":"S0950268824000943_r10","unstructured":"[10] Food Standards Agency (2018) Safe Method: Chilled Storage and Displaying Chilled Food. https:\/\/www.food.gov.uk\/sites\/default\/files\/media\/document\/chilled-food.pdf (accessed 19 February 2024)."},{"key":"S0950268824000943_r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2022.01.036"},{"key":"S0950268824000943_r16","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-6-130"},{"key":"S0950268824000943_r4","unstructured":"[4] Thorley, K , et al. (2022). Sexually Transmitted Shigella spp. in England \u2013 Data up to quarter 2, 2022. September 2022. https:\/\/www.gov.uk\/government\/publications\/non-travel-associated-shigella-infections\/sexually-transmitted-shigella-spp-in-england-data-up-to-quarter-2-2022 (accessed 19 May 2023)."},{"key":"S0950268824000943_r9","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000311"},{"key":"S0950268824000943_r22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003320"},{"key":"S0950268824000943_r17","first-page":"81","article-title":"Shigella: A highly virulent and elusive pathogen","volume":"1","author":"Zaidi","year":"2014","journal-title":"Current Tropical Medicine Reports"},{"key":"S0950268824000943_r12","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.64.10.3882-3886.1998"},{"key":"S0950268824000943_r14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198301273080407"},{"key":"S0950268824000943_r8","unstructured":"[8] R Core Team (2023) R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing. https:\/\/www.r-project.org\/ (accessed 4 December 2023)."},{"key":"S0950268824000943_r21","doi-asserted-by":"publisher","DOI":"10.4315\/0362-028X-66.4.535"},{"key":"S0950268824000943_r7","volume-title":"Stata Statistical Software: Release 14.2","year":"2015"},{"key":"S0950268824000943_r18","doi-asserted-by":"publisher","DOI":"10.1086\/498900"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268824000943","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T09:57:46Z","timestamp":1739527066000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268824000943\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":22,"alternative-id":["S0950268824000943"],"URL":"https:\/\/doi.org\/10.1017\/s0950268824000943","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e25"}}