Epidemiological update: Shigellosis and other gastrointestinal infections in travellers returning from Cabo Verde

The source of infection has not been identified, but current information points to food- or waterborne transmission. The likelihood of new infections in travellers visiting the Santa Maria region in Cabo Verde remains moderate. Additional cases of shigellosis and other gastrointestinal infections are expected until the source of infection is identified, and effective control measures are put in place. Laboratory testing of samples from returning travellers has most often identified Shigella and Salmonella; which suggests a persistent source or ongoing exposure. This is being investigated further.

Previous outbreaks in 2022-2023 and 2025 were reported in a Rapid Risk Assessment published in 2023 [1] and in a Communicable Disease Threats Report published in 2025 [2]. 

Epidemiological situation

Between September 2022 and March 2026, a total of 766 confirmed and possible shigellosis cases were reported by 13 EU/EEA countries, the UK, and the US among travellers returning from Cabo Verde: Belgium (46), Czechia (14), Denmark (45), Finland (9), France (67), Germany (92), Ireland (2), Luxembourg (19), Norway (5), Poland (1), Portugal (12), Sweden (120), the Netherlands (64), the UK (263), and the US (7).

In addition, during the same period, over 300 confirmed and possible cases of other gastrointestinal infections, such as salmonellosis, campylobacteriosis, giardiasis, cryptosporidiosis, yersiniosis, amoebiasis, and shiga toxin producing and enteroinvasive Escherichia coli (STEC and EIEC) infections, were also reported in travellers returning from Cabo Verde.

Based on the available epidemiological information, most individuals with shigellosis and other gastrointestinal infections, including salmonellosis, stayed at the same hotel chain in the Santa Maria region on the island of Sal.

The source of infection has not yet been identified. Current information strongly suggests a food- or waterborne transmission, although some instances of direct person-to-person transmission (faecal–oral route) is also plausible.  

Laboratory testing has detected a predominant Shigella outbreak strain in travellers returning from Cabo Verde since September 2022. This suggests a persistent source of infection or ongoing transmission. To support this, a persistent Salmonella strain has also been detected since 2024.

Assessment

The likelihood of travellers contracting Shigella or other gastrointestinal pathogen infections when visiting the Santa Maria region in Cabo Verde is moderate, given that cases continue to be reported and the source of infection has not yet been identified. Additional cases are expected until the source is identified and effective control measures are implemented.

Onward pathogen transmission in EU/EEA countries cannot be excluded, particularly for Shigella, which has a low infectious dose. Shigella and other gastrointestinal infections spread easily via the faecal–oral route through close personal contact, contaminated surfaces, and food handling. Sexual transmission is also possible. Secondary cases may occur in households, childcare settings, healthcare facilities, and other close-contact settings.

Actions

ECDC is monitoring the event via the European Surveillance Portal for Infectious Disease (EpiPulse) for epidemiological and microbiological updates and is liaising with affected countries, the World Health Organization (WHO), and Cabo Verde authorities.

ECDC published a Rapid Risk Assessment (RRA), ‘Outbreak of Shigella sonnei in the EU/EEA, the United Kingdom, and the United States among travellers returning from Cabo Verde’, on 17 February 2023. ECDC also published a Communicable Disease Threats Report (CDTR), ‘Communicable disease threats report, 29 November - 5 December 2025, week 49’ on 5 December 2025. The recommendations previously published in the RRA and CDTR are still valid. 

Recommendations

For travellers

• Practice strict hand hygiene, especially before cooking, eating and after using the toilet.
• Consume well-cooked foods served hot. Avoid ready-to-eat foods, including unwashed fruits and vegetables, salads, and ice-containing products.
• Drink bottled or boiled water.
• If symptoms such as diarrhoea (including bloody diarrhoea), fever or stomach cramps occur during or after travel, seek prompt medical attention.

For healthcare professionals and travel medicine providers

• Be alert to gastrointestinal infections in travellers returning from Cabo Verde.
• Ensure appropriate diagnostic sampling and testing. 
• Report cases to national public health authorities in accordance with surveillance requirements.
• Provide pre-travel advice on safe foods, water, and hygiene practices.

For public health authorities

• Increase awareness among travel clinics, laboratories, and clinicians about the ongoing outbreak.
• Countries identifying isolates clustering with representative outbreak sequences of Salmonella or Shigella, should consider a possible association with travel to Cabo Verde. Representative publicly available outbreak sequences for comparison are: SRR22099609, SRR18143656, and SRR22085217 for Shigella sonnei and ERR15088213 and ERR15975047 for Salmonella Enteritidis.

References

1. European Centre for Disease Prevention and Control (ECDC). Outbreak of Shigella sonnei in the EU/EEA, the United Kingdom, and the United States among travellers returning from Cape Verde – 17 February 2023. ECDC: Stockholm; 2023. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/shigella-sonnei-risk-assessment-february-2023.pdf 

2. European Centre for Disease Prevention and Control (ECDC), Communicable Disease Threats Report (CDTR) Week 49, 29 November − 5 December 2025: Recurrent multi-country outbreak of shigellosis in travellers returning from Cape Verde. Available here: https://www.ecdc.europa.eu/sites/default/files/documents/Communicable-disease-threats-report-week-49-2025.pdf