High levels of domestic transmission and drug resistance -analysis of national surveillance data for shigellosis, the Netherlands, 2018 to 2024.

BACKGROUNDAntimicrobial resistance (AMR) among Shigella species is increasing, which is concerning. Strengthening surveillance is key to obtaining accurate, timely and actionable data on shigellosis.AIMWe aimed to describe Dutch national shigellosis surveillance data from 2018 to 2024, spanning the implementation of national genomic surveillance in 2022.METHODSWe described notified shigellosis cases and used logistic regression models to analyse associations between shigellosis and age, sex, year of infection, province, MSM (men who have sex with men) association, travel status, severity of disease and Shigella species.RESULTSIn 2018-2024, 3,020 shigellosis cases were notified. Incidence of shigellosis decreased during the COVID-19 pandemic years 2020-2021 but returned to pre-pandemic incidence in 2023 and 2024. Most cases were males (n = 1,887; 62.5%). Of the 1,731 cases with available data, 732 (42.3%) reported recent contact with MSM, representing 24.2% of all shigellosis cases. The proportion of extensive drug resistant (XDR) isolates increased from 2018 (1/58) to 2023 (24/109; 22.0%) (p < 0.001). Cases were more likely to be part of a cluster if they reported a recent MSM contact (p < 0.001) or harboured an XDR isolate (p < 0.001). Cases with recent MSM contact were more likely to harbour an XDR strain (p < 0.001).CONCLUSIONImplementation of genomic surveillance facilitated detection of clusters, provided more timely data on AMR and allowed for more detailed analyses of risk factors for Shigella transmission. Continued intervention efforts promoting hygiene and raising awareness on shigellosis and AMR are important to curb the increase of XDR shigellosis.