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Shigella Blog

Surveillance & Analysis on Shigella News & Outbreaks

Shigella hits Iowa

According to press reports, cases of shigellosis continue to grow in Woodbury County nearly a month after health officials reported an outbreak of the contagious bacterial infection that causes diarrhea.

Ninety-five cases had been reported to Siouxland District Health Department as of Friday afternoon. About 20 had been diagnosed in early November.

District Health Deputy Director Tyler Brock said the majority of the sick are children, but a number of adults have contracted shigellosis too.

Shigella in Stanly, Cabarrus, Rowan, Union, and Mecklenburg Counties

There is a regional outbreak of shigella related illnesses throughout Stanly, Cabarrus, Rowan, Union, and Mecklenburg counties.  Cabarrus County has over 40 lab confirmed cases reported which is the highest number of reported cases in all these counties,” said Cindy Russell, Stanly County Health Department communicable disease nurse.

“We want to call your attention to this outbreak as many Stanly County residents participate in activities that cross county lines. As of this week, Stanly County has had two reported cases of shigella and one probable case.”

Shigella is a highly infectious disease. Most of those that are infected with shigella develop watery stools, fever and stomach cramps starting a day or two after they are exposed to the bacteria, according to the health department. The watery stools are often bloody. Shigellosis usually resolves in five to seven days.

Most shigella infections result when basic hygiene and handwashing practices are inadequate. The bacterium passes from stools or soiled fingers of one person to another person, according to the health department. It is particularly likely to occur with toddlers who are not fully toilet-trained. Family members and playmates of toddlers are at high risk of becoming infected.

Shigella infections may be acquired from eating contaminated food. Contaminated food usually looks and smells normal. Food may become contaminated by infected food handlers who forget to or improperly wash their hands with soap after using the bathroom.

Stanly County Health Department staff is consulting with staff from the surrounding county health departments as well as the State Division of Public Health.   Health department staff has alerted the schools, day care centers and health care providers as to the incidence of this infectious disease.  Staff members are also informing them how to prevent the spread of this as it is highly infectious.

Grayson County Texas Public Health Information Bulletin Shigella Infections (Shigellosis) Fall 2013

Shigellosis is an infectious disease of the digestive system caused by a group of bacteria called Shigella. Most people who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they swallow the bacteria. The diarrhea is often bloody. Shigellosis usually goes away in 4 to 7 days. Persons with shigellosis in the United States rarely require hospitalization. A severe infection with high fever may be associated with seizures in children less than 2 years old. Some persons who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others.

Many different kinds of germs can cause diarrhea. Bacteria like Salmonella, E. coli, and Shigella are common causes of intestinal infections, but several kinds of viruses also can be responsible. If you or your child develops diarrhea which does not clear up quickly, see your doctor or other health care provider. A stool test ordered by your doctor will reveal which type of germ is responsible, and whether an antibiotic will help. The following symptoms may indicate a Shigella infection:

• Diarrhea that may contain mucus and blood

• Fever

• Stomach cramps

• Nausea

Tips for preventing the spread of shigellosis include:

• Wash hands with soap carefully and frequently, especially after going to the bathroom, after changing diapers, and before preparing foods or beverages

• Dispose of soiled diapers properly

• Disinfect diaper changing areas after using them

• Keep children with diarrhea out of child care settings

• Supervise handwashing of toddlers and small children after they use the toilet

• Do not prepare food for others while ill with diarrhea

• Avoid swallowing water from ponds, lakes, or untreated pools

Shigella in Texas

A health warning was issued for Grayson county residents Friday after health officials and Sherman schools report an outbreak of a highly contagious disease.

Friday, Sherman ISD sent letters out to parents notifying them of a Shigella outbreak in three of their schools.

“We do have three different campuses that were impacted. We have Sory Elementary that had multiple cases on that campus, five specific cases that I’m aware of. And we have two other campuses that only had one case, one student case in those particular campuses. They are Dillingham and Fairview Intermediate,” said Assistant Superintendent Dr. Tyson Bennett.

Grayson County Health Director, John Teel, said there are 14 reported cases of Shigellosis–an infection caused by the Shigella bacteria–that causes high fever, vomiting and diarrhea.

“We either catch it from someone we have close contact with, and it’s usually children, it’s usually young children who don’t know how to wash their hands very well,” he said.

That’s why Bennett said they are disinfecting campuses.

Shigella in Iowa

Woodbury County Health officials are urging those sick with diarrhea to stay home from work and school to prevent the spread of shigellosis, an extremely contagious bacterial infection of the lining of the intestines.

Siouxland District Health Deputy Director Tyler Brock said 42 cases of the non-life-threatening illness transmitted through human contact have been reported recently in the county, and he only expects those numbers to grow. Last year Woodbury County recorded a single case of shigellosis.

Brock said only about 20 of the cases were diagnosed; the others, he said, were identified during phone interviews with family members suffering similar symptoms. Patients include school and daycare-age children, as well as adults. None of the patients have been hospitalized as a result of the illness.

North Carolina Seeing Shigella Uptick

The Cabarrus Health Alliance is continuing to investigate Shigella-related illnesses and officials are urging everyone to be aware of the symptoms and use precautionary measures.

As of Friday, October 25: 47 people have reported symptoms and 14 of those are confirmed Shigellosis. The non-confirmed cases have symptoms but lack a lab test with a positive or negative diagnosis.

The onset of Shigella began at Bethel Elementary and has spread to CC Griffin Middle School. While all 47 people are not students or staff at those schools, they do link back to the schools in some way.

Florida Health Officials Warn of Shigella Increase

Health officials at the Florida Department of Health in Broward County are advising parents, schools and daycare centers to take precautionary action to prevent the spread of Shigellosis. Shigellosis is a highly contagious form of diarrhea caused by Shigella bacteria. Shigella can spread through person to person contact and may cause severe diarrhea, fever and stomach cramps. Parents of children, or anyone with symptoms of Shigellosis should contact their healthcare provider for diagnosis and treatment. Careful attention to handwashing is the single most important measure to decrease transmission of Shigella bacteria. Symptoms may last from 48 to 72 hours, and frequently include diarrhea (may be watery or bloody), fever, and stomach cramps. School aged children and children in daycare should be excluded from school until symptoms have ceased and laboratory cultures test negative for Shigella.

Yellowstone sees increase in Shigella

Yellowstone County health officials warned Wednesday that the county has recently seen a noticeable increase in shigella infections.

Shigella is a bacteria found in the stool of infected people and is passed on via a fecal-oral route or by eating or drinking contaminated food or beverages, a news release from RiverStone Health, the county’s public health agency, said.

As of Wednesday, five cases had been confirmed and two more were pending. Typically, Yellowstone County sees only one or two cases annually.

“Five reported cases of shigella infection may not seem large, but we estimate that for every reported case, the actual number of cases could be 20 times greater,” said John Felton, RiverStone’s president and CEO and Yellowstone County’s health officer.

Eight more cases have been confirmed around the state by the Montana Department of Public Health and Human Services. Montana usually sees about 11 cases a year.

Symptoms can include bloody diarrhea, fever and stomach cramps and can appear 12 to 96 hours after infection, RiverStone said.

Shigella Bacteria Linked to Spring Lake Beach

A bacteria spread through contact with contaminated water is to blame for an illness that sickened 92 people at a July 4 event, state health officials said Tuesday.

Lab tests determined the culprit to be the shigella bacteria, which can cause gastrointestinal distress. Sixteen of those sickened at Spring Lake Beach in Burrillville were hospitalized and four remained in the hospital on Tuesday, but none of the illnesses was believed to be severe.

State Health Director Michael Fine said anyone who swam in the lake Thursday should seek medical attention if they develop gastrointestinal symptoms but that the illness often resolves on its own.

“We expect to see new cases over the next week — but not lots of new cases,” he said. “We know that no one is severely ill.”

The beach is expected to be reopened Wednesday. Tests of the water show no continuing shigella contamination.

Officials believe the illness was spread through contact with water contaminated with human feces. Most of those sickened are under 18, and Fine said the young are especially vulnerable. An estimated 2,000 people were in the lake on July 4.

CDC Reports California Shigella Outbreak is Antibiotic Resistant

The CDC in MMWR, reports that in May 2012, the Los Angeles County Department of Public Health’s Acute Communicable Disease Control Unit and Environmental Health, Food, and Milk Program investigated an outbreak of shigellosis associated with a private bridge club. This investigation documented the first known transmission of Shigella sonnei with decreased susceptibility to azithromycin in the United States.

Cases were defined as an illness clinically compatible with shigellosis in a patient or S. sonnei isolated from stool of a person with an epidemiologic link to the bridge club during May 22–26, 2012. Investigators attempted to interview all bridge club workers and members who had visited the bridge club during the week of May 22; they collected stool specimens from workers who handled food and from workers and members with diarrhea who had not already submitted a stool specimen for culture at a health facility. Thirty-nine cases were identified among club members with diarrhea and four among club workers; of the four workers, two, including one who handled food, reported no symptoms. The average age of affected persons was 75.3 years (range: 54–98 years); 55% were female. Among those with symptoms, the duration of illness averaged 5.9 days (range: 1–14 days). Common symptoms included diarrhea in 95% of patients, abdominal cramps in 70%, and fever in 56%. Thirty-one (72%) persons sought medical care, and 10 (23%) were hospitalized. No specific exposures implicated a source for the outbreak.

Among the 43 cases, 14 were culture-confirmed; 10 isolates underwent pulsed-field gel electrophoresis (PFGE), yielding indistinguishable patterns. Four isolates submitted to CDC’s National Antimicrobial Resistance Monitoring System (NARMS) displayed resistance to streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Unlike most Shigella isolates tested by NARMS, these isolates also showed elevated azithromycin minimum inhibitory concentrations (MICs) of >16 µg/mL and harbored a plasmid-encoded macrolide resistance gene, mphA.

CDC’s PulseNet identified two additional isolates indistinguishable from the outbreak PFGE pattern. One was from a man in Pennsylvania aged 23 years who had visited Los Angeles in April, and the other from a man in Hawaii aged 53 years who visited Los Angeles during April and May; both men were hospitalized with diarrhea. Neither case was epidemiologically linked to the bridge club or to each other.

Although sporadic cases of shigellosis caused by Shigella strains with increased azithromycin MICs have occurred, this is the first outbreak documented in the United States and might indicate increasing circulation of such strains. Illnesses in this outbreak tended to be severe; however, the affected population was much older than the general U.S. population. Clinical management of such illnesses is likely to be complex; although azithromycin currently is recommended for treatment of infections caused by multidrug-resistant Shigella, options for alternative treatment among children with such infections primarily include parenteral antimicrobial medications.