Four decades of shigellosis in Israel: Epidemiology of a growing public health problem

Despite the improved standard of living in Israel, shigellosis remains a common disease. Examination of trends in the incidence of shigellosis in Israel between 1951 and 1987 showed a period of declining rates followed by an increase in the reported incidence beginning around 1969. This increase was mainly due to Shigella sonnei; rates of infection with Shigella flexneri remained relatively constant. Trends showed marked differences between age group and between ethnic groups. In comparison, the rates in the United States - much lower than those in Israel - began to decline in the early 1950s and have remained low. The incidence in Israel is now about 20 times higher than that in the United States. Thus shigellosis remains a major and growing public health problem in Israel, a country that has enjoyed a dramatic improvement in basic sanitary services and infrastructure over the past few decades. This disturbing finding lends urgency to efforts to control the disease.