ECDC epidemiological updates have flagged over 1,000 cases of shigellosis among European travelers returning from Cabo Verde, the island nation off the coast of West Africa. Multiple EU/EEA countries have reported laboratory-confirmed Shigella infections linked to travel to the archipelago, which is a popular holiday destination for visitors from Portugal, the Netherlands, France, and the UK.

The outbreak is notable for its scale and for the drug-resistant profiles of some isolates, which limit available treatment options.

What is Shigella?

Shigella is a highly contagious bacterial pathogen that causes bacillary dysentery - severe diarrhea that is often bloody, accompanied by fever, stomach cramps, and tenesmus (painful straining). The infectious dose is remarkably low: as few as 10-100 organisms can cause illness, compared to millions needed for Salmonella. This makes Shigella extremely easy to transmit through contaminated food, water, or person-to-person contact.

Four species exist. Shigella sonnei and Shigella flexneri cause the majority of cases globally. WHO estimates 165 million Shigella infections occur worldwide each year, causing roughly 600,000 deaths, mostly in children under 5 in low-income countries. In travelers, shigellosis is one of the most common causes of traveler's diarrhea, particularly in destinations with limited water and sanitation infrastructure.

What's happening in Cabo Verde?

Cabo Verde (also known as Cape Verde) is a volcanic archipelago of 10 islands with a population of about 600,000. Tourism is the primary economic driver, with the islands receiving over 900,000 visitors annually, most from Europe. The combination of high tourist volume and water scarcity on several islands creates conditions where waterborne and foodborne pathogens can spread efficiently.

The current shigellosis outbreak appears linked to contaminated food and water sources on the islands. European surveillance networks began detecting elevated Shigella cases among returning travelers in early 2026. Case counts crossed the 1,000 mark across reporting countries, with Portugal and the Netherlands reporting the highest numbers. The true case count is likely considerably higher, as many travelers with diarrheal illness never seek laboratory testing.

The drug resistance problem

Several Shigella isolates from this outbreak have shown resistance to first-line antibiotics, including azithromycin and ciprofloxacin. Some isolates are resistant to both. This pattern is consistent with a broader, global trend of rising antimicrobial resistance in Shigella species, which WHO has flagged as a priority pathogen for resistance surveillance.

When first-line drugs fail, treatment options narrow to carbapenems or ceftriaxone, both of which require injection and are typically only available in hospital settings. For a disease that affects millions of travelers annually, having to hospitalize patients for IV antibiotics represents a major escalation in burden.

Drug-resistant shigellosis is not unique to Cabo Verde. The UK Health Security Agency has been tracking a multidrug-resistant Shigella sonnei strain circulating in England since 2021, with resistance to azithromycin, ciprofloxacin, and trimethoprim. The Cabo Verde outbreak adds another geographic node to what is becoming a global resistance problem.

What travelers should know

If you are traveling to Cabo Verde, basic food and water precautions reduce your risk significantly.

Water. Drink only bottled or treated water. Avoid ice unless you know it was made from purified water. Use bottled water for brushing teeth. Water scarcity on some islands means that stored water may have been inadequately treated.

Food. Eat only thoroughly cooked food served hot. Avoid raw salads, unpeeled fruit, and buffet food that has been sitting at room temperature. Street food that is cooked to order in front of you is generally safer than pre-prepared restaurant food.

Hygiene. Wash hands frequently with soap and water, particularly before eating and after using the bathroom. Carry alcohol-based hand sanitizer as a backup. Shigella's low infectious dose means that even small lapses in hand hygiene can result in infection.

If you get sick. Bloody diarrhea, high fever, or diarrhea lasting more than 3 days warrants medical attention. Tell your doctor you traveled to Cabo Verde and request stool culture with antibiotic susceptibility testing. Oral rehydration is the most important first-line intervention - dehydration from dysentery can become dangerous quickly, especially in children and elderly adults.

Current status

The outbreak in Cabo Verde has prompted ECDC to issue a risk assessment and travel health advisory. Cabo Verdean health authorities are working with WHO to improve water treatment and sanitation monitoring on the most affected islands. Whether the outbreak is contained or continuing to grow depends on infrastructure improvements that take time to implement.

For updated disease risks by region, including real-time alerts for Cabo Verde and other travel destinations, monitor the PandemicAlarm map.