{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:36:15Z","timestamp":1772825775609,"version":"3.50.1"},"reference-count":16,"publisher":"American Public Health Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p> Objectives. To investigate a shigellosis outbreak in Genesee County, Michigan (including the City of Flint), and Saginaw County, Michigan, in 2016 and address community concerns about the role of the Flint water system. <\/jats:p><jats:p> Methods. We met frequently with community members to understand concerns and develop the investigation. We surveyed households affected by the outbreak, analyzed Shigella isolate data, examined the geospatial distribution of cases, and reviewed available water quality data. <\/jats:p><jats:p> Results. We surveyed 83 households containing 158 cases; median age was 10 years. Index case-patients from 55 of 83 households (66%) reported contact with a person outside their household who wore diapers or who had diarrhea in the week before becoming ill; results were similar regardless of household drinking water source. Genomic diversity was not consistent with a point source. In Flint, no space-time clustering was identified, and average free chlorine residual values remained above recommended levels throughout the outbreak period. <\/jats:p><jats:p> Conclusions. The outbreak was most likely caused by person-to-person contact and not by the Flint water system. Consistent community engagement was essential to the design and implementation of the investigation. <\/jats:p>","DOI":"10.2105\/ajph.2020.305577","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T20:00:56Z","timestamp":1587067256000},"page":"842-849","source":"Crossref","is-referenced-by-count":8,"title":["<i>Shigella sonnei<\/i> Outbreak Investigation During a Municipal Water Crisis\u2014Genesee and Saginaw Counties, Michigan, 2016"],"prefix":"10.2105","volume":"110","author":[{"given":"R. Paul","family":"McClung","sequence":"first","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mateusz","family":"Karwowski","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Castillo","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jevon","family":"McFadden","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Collier","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jim","family":"Collins","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marty","family":"Soehnlen","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Dietrich","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eija","family":"Trees","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grete","family":"Wilt","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Harrington","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Miller","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Adam","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Reses","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Cope","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Fullerton","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Mateusz Karwowski, Sarah Collier, Eija Trees, Elizabeth Adam, Hannah Reses, Jennifer Cope, Katie Fullerton, Vincent Hill, and Jonathan Yoder are with the Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta. Jevon..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Hill","sequence":"additional","affiliation":[{"name":"R. Paul McClung and Caroline Castillo are with the Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention (CDC), Atlanta, GA. 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