Effects of El Nino/La Nina on the Number of Imported Shigellosis Cases in the Republic of Korea, 2004-2017

Shigellosis is a major diarrheal disease in low- and middle-income countries. Although the incidence of such diseases in South and Southeast Asia has been associated with climate fluctuations linked to the El Nino-Southern Oscillation (ENSO), the impact of ENSO on shigellosis infections remains unknown. Data reported to being infected with shigellosis while traveling abroad from 2004 to 2017 were obtained from the Korea Centers for Disease Control and Prevention. We investigated the relationship between the Oceanic Nino Index (ONI) and Indian Ocean Dipole Mode Index and the relative risk of shigellosis in outbound travelers using distributed lag linear and non-linear models. From 2004 to 2017, 87.1% of imported shigellosis was infected in South and Southeast Asian countries. The relative risk of imported shigellosis infection in outbound travelers increased as the ONI decreased. In the association with the five-month cumulative ONI, the relative risk of infection continuously increased as the La Nina index gained strength. Climate fluctuations associated with the La Nina phenomenon in South and Southeast Asian countries can lead to issues in sanitation and water safety. Our findings suggest that the decreasing trend in the ONI is associated with an increased incidence of shigellosis in these countries.