Epidemiology, Testing, and Management of Extensively Drug-Resistant Shigellosis

Webinar

View slides - Slides updated as of 03/07/2023
View transcript

Overview

The Centers for Disease Control and Prevention (CDC) has detected an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems. XDR shigellosis is resistant to all generally recommended antibiotics in the United States, making it difficult to treat. XDR shigellosis is a serious public health threat: XDR Shigella bacteria have limited antimicrobial treatment options, are easily transmissible, and can spread antimicrobial resistance genes to other enteric bacteria. Clinicians should understand the nuances of testing and managing infections, especially when treating patients from populations at increased risk of drug-resistant shigellosis including: young children; gay, bisexual, and other men who have sex with men; people experiencing homelessness; international travelers; and people living with HIV.

During this COCA Call, subject matter experts from CDC, the Colorado Department of Public Health and Environment, and the UK Health Security Agency will provide updates on the current domestic and global epidemiology of XDR shigellosis, discuss its relevance for clinicians in the United States, describe infection presentation, explain the importance of having a detailed sexual and travel history, share approaches for clinical management, and review how clinicians should test and report shigellosis.

Presenters

Naeemah Logan, MD
LCDR, U.S. Public Health Service
Medical Officer
National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) Team
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Meseret Birhane, MPH, MAS
Surveillance Epidemiologist
National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) Team
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Louise Francois Watkins, MD, MPH
Medical Officer
National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) Team
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Laura Hinkle Bachmann, MD, MPH, FIDSA, FACP
Chief Medical Officer
Division of STD Prevention
National Center for HIV, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention

Rachel Jervis, MPH
Program Manager
Foodborne, Enteric, Waterborne, and Wastewater Diseases Program
Colorado Department of Public Health and Environment

Gauri Godbole, MD, FRCPath
Consultant Medical Microbiologist
UK Health Security Agency

Hannah Charles, MSc, DFPH
Senior Epidemiologist
UK Health Security Agency

Call Objectives

COCA Call Objectives

At the conclusion of the session, the participant will be able to accomplish the following:

1. Cite background information on the topic covered during the presentation.
2. Discuss CDC's role in the topic covered during the presentation.
3. Describe the topic's implications for clinicians.
4. Discuss concerns and/or issues related to preparedness for and/or response to urgent public health threats.
5. Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional team of healthcare providers.

Activity-Specific Objectives:

At the conclusion of the session, the participant will be able to accomplish the following:

1. Discuss the clinical characteristics, populations at greatest risk, and evolving epidemiological trends for XDR shigellosis.
2. Describe outbreak investigations of XDR shigellosis in the United States and the United Kingdom.
3. Outline strategies and resources to support the clinical management of XDR shigellosis and educate healthcare professionals about appropriate antibiotic use.
4. Review what CDC is doing to learn more about XDR Shigella in the United States and how clinicians and public health officials can help through testing and reporting.

Additional Resources

CDC's Shigella Health Alert Network Health Advisory: https://emergency.cdc.gov/han/2023/han00486.asp

CDC's Shigella website:
https://www.cdc.gov/shigella/

IDSA treatment guidance:
https://academic.oup.com/cid/article/65/12/e45/4557073

AAP treatment guidance: https://publications.aap.org/aapbooks/book/723/chapter/10679299/Shigella-Infections

WHO treatment guidance:
https://www.who.int/publications/i/item/9241592330

WHO report – XDR Shigella:
.who.int/emergencies/disease-outbreak-news/item/2022-DON364

UK report – XDR Shigella: https://www.sciencedirect.com/science/article/pii/S147330992200370X?via%3Dihub

CDC's NARMS Now: Human Data:
https://wwwn.cdc.gov/narmsnow/

Inclusive Sexual Health Services: Practical Guidelines for Providers & Clinics https://nationalcoalitionforsexualhealth.org/tools/for-healthcare-providers/inclusive-care-guide

CDC's Guide to Taking a Sexual History https://www.cdc.gov/std/treatment/sexualhistory.htm

CDC's STI Treatment Guidelines
STI Treatment Guidelines (cdc.gov)

Continuing Education

To receive continuing education (CE) for WD4520-022823 – Clinician Outreach and Communication Activity (COCA) Calls/Webinars – Epidemiology, Testing, and Management of Extensively Drug-Resistant Shigellosis, please visit CDC TRAIN and search for the course in the Course Catalog using WD4520-022823. Follow the steps below by April 4, 2025.

1. Register for and complete the course.
2. Pass the post-assessment at 75%.
3. Complete the evaluation.
4. Visit Your Learning to access your certificates and transcript.

In support of improving patient care, the Centers for Disease Control and Prevention is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CME: The Centers for Disease Control and Prevention designates this activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA CME: The Centers for Disease Control and Prevention has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1 AAPA Category 1 CME credits. Approval is valid until 12/13/2023. PAs should only claim credit commensurate with the extent of their participation.

CNE: The Centers for Disease Control and Prevention designates this activity for 1 nursing contact hours.

CPE: The Centers for Disease Control and Prevention designated this (Knowledge-based) event for pharmacists to receive 0.1 CEUs in pharmacy education. The Universal Activity Number is JA4008229-0000-23-013-L04-P and enduring is JA4008229-0000-23-014-H04-P.

Once credit is claimed, an unofficial statement of credit is immediately available on CDC TRAIN. Official credit will be uploaded within 60 days on the NABP/CPE Monitor.

CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 0.1 CEU's for this program.

CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES^®) and/or Master Certified Health Education Specialists (MCHES^®) to receive up to 1.0 total Category I continuing education contact hours. Maximum advanced level continuing education contact hours available are 1. Continuing Competency credits available are 1. CDC provider number 98614.

AAVSB/RACE: This program was reviewed and approved by the AAVSB RACE program for 1.0 hours of continuing education. Participants should be aware that some boards have limitations on the number of hours accepted in certain categories and/or restrictions on certain methods of delivery of continuing education. Please contact the AAVSB RACE program at race@aavsb.org if you have any comments/concerns regarding this program's validity or relevancy to the veterinary profession.

For Certified Public Health Professionals (CPH): The Centers for Disease Control and Prevention is a pre-approved provider of Certified in Public Health (CPH) recertification credits and is authorized to offer 1 CPH recertification credits for this program.

DISCLOSURE: In compliance with continuing education requirements, all planners and presenters must disclose all financial relationships, in any amount, with ineligible companies over the previous 24 months as well as any use of unlabeled product(s) or products under investigational use.

CDC, our planners, and presenters wish to disclose they have no financial relationship(s) with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Content will not include any discussion of the unlabeled use of a product or a product under investigational use with the exception of Dr. Louise Francois Watkins's discussion of treatment options for shigellosis, some of which are considered off-label use for infectious diarrhea.

CDC did not accept financial or in-kind support from ineligible companies for this continuing education activity.

Fees: No fees are charged for CDC's CE activities.

Target Audience

• Physicians
• Nurses
• Pharmacists
• Veterinarians
• Physician Assistants
• Health Educators
• Other Clinicians

Additional Information

• Contact Information: coca@cdc.gov
• Support/Funding: Centers for Disease Control and Prevention, Emergency Risk Communication Branch
• Method of Participation: You may participate in the educational activity by viewing the program information above.