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Background  Shigellosis is rare in Taiwan, with an average annual incidence rate of 1.68 cases per 100,000 persons in 2000–2007. However, the incidence rate for a mountainous township in eastern Taiwan, Zhuoxi, is 60.2 times the average rate for the entire country. Traveling between Zhuoxi’s 6 villages (V1–V6) is inconvenient. Disease transmission among the villages/tribes with endemic shigellosis was investigated in this study.    Methods  Demographic data were collected in 2000–2010 for epidemiological investigation. Thirty-eight  Shigella flexneri  2a isolates were subjected to pulsed-field gel electrophoresis (PFGE) genotyping and antimicrobial susceptibility testing (AST).    Results  Fifty-five shigellosis cases were identified in 2000–2007, of which 38 were caused by  S .  flexneri  2a from 2000–2007, 16 cases were caused by  S .  sonnei  from 2000–2003, and 1 case was caused by  S .  flexneri  3b in 2006.  S .  flexneri  2a caused infections in 4 of the 6 villages of Zhuoxi Township, showing the highest prevalence in villages V2 and V5. PFGE genotyping categorized the 38  S .  flexneri  2a isolates into 2 distinct clusters (clones), 1 and 2. AST results indicated that most isolates in cluster 1 were resistant to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole and trimethoprim-sulfamethoxazole (ACSSuX); all isolates in cluster 2 were resistant to ACSSuX and tetracycline. Genotypes were primarily unique to different villages or tribes. Tribe V2-1 showed the highest endemic rates. Eighteen isolates recovered from V2-1 tribe members fell into 6 genotypes, where 5 were the same clone (cluster 1). An outbreak (OB2) in 2004 in village V2 was caused by different clonal strains; cases in tribe V2-1 were caused by 2 strains of clone 1, and those in tribe V2-2 were infected by a strain of clone 2.    Conclusions  From 2000–2007, 2  S .  flexneri  2a clones circulated among 4 villages/tribes in the eastern mountainous township of Zhuoxi. Genotyping data showed restricted disease transmission between the villages and tribes, which may be associated with difficulties in traveling between villages and limited contact between different ethnic aborigines. Transmission of shigellosis in this township likely occurred via person-to-person contact. The endemic disease was controlled by successful public health intervention.

Infrequent cross-transmission of Shigella flexneri 2a strains among villages of a mountainous township in Taiwan with endemic shigellosis