Northern Nevada Public Health (NNPH) has identified a Shigellosis outbreak after an influx of new cases and hospitalizations were reported.

Since late October, at least 14 cases and nine hospitalizations were reported, although the actual number of cases is expected to be much higher. Based on Nevada State Public Health Laboratory analysis and epidemiologic investigation, greater than 50 percent of the Shigellosis cases were among individuals experiencing homelessness. There is currently a low risk of transmission to the public at large.

As a result of this increase, NNPH is working to educate people about the risks of infection and prevention measures. NNPH staff are working with several agencies who serve or work with affected populations to mitigate the outbreak.

Shigellosis (pronounced “shih-guh-low-suhs”) is an intestinal (bowel) infection that causes diarrhea (sometimes bloody), fever, stomach pain, and the feeling of the need to pass a stool (poop) even when the bowels are empty. If you think you might have Shigellosis, contact your doctor or other healthcare provider.

Shigellosis can be spread by coming into contact with the poop of an infected person, eating or drinking contaminated food or water, or through sexual contact (oral, hand, anus).

According to the Centers for Disease Control and Prevention (CDC), Shigellosis can be difficult to treat. Prevention is critical to reducing the spread of the infection, which includes:

  • Hand Hygiene: Wash hands frequently with soap and water for at least 20 seconds after using the toilet, before preparing food, and after caring for a sick person.
  • Avoid Food Preparation and Recreational Water: If you think you have Shigellosis or come into contact with it, do not prepare or share food with others, and avoid swimming in pools, lakes, or other recreational water sources while symptomatic and for at least two weeks after recovery.
  • Safe Sex Practices: Refrain from sexual activity (vaginal, anal, oral) during illness and for two weeks following recovery. Safe sexual practices include using barriers like condoms or dental dams and washing hands after touching used barriers. Sex toys should be washed before and after use with soap and water.
  • Stay Home from Work or School: Avoid work (especially in food service, healthcare, or childcare), school, or daycare until cleared by public health authorities.

Individuals experiencing symptoms are encouraged to seek medical care.

The St. Clair County Health Department (SCCHD) and Illinois Department of Public Health (IDPH) continue to investigate the outbreak of Shigellosis caused by Shigella bacteria, a disease that affects your digestive system. As of October 11, 2024, the SCCHD has identified 24 individuals with positive Shigella lab reports and an additional 44 individuals reporting illness consistent with Shigellosis after dining at the LongHorn Steakhouse located at 6115 North Illinois Street, in Fairview Heights, Illinois between the dates of September 20th and September 30th, 2024. Age range of those affected are from age 12 to 80 years of age. A total of nine (9) people have been hospitalized.

LongHorn Steakhouse officials voluntarily closed the Fairview Heights establishment on October 2, 2024 and have fully cooperated with SCCHD and IDPH on the investigation to determine the source of the infections. SCCHD has performed environmental assessments of the restaurant and provided corrective actions and guidance in consultation with IDPH on safe food handling practices, proper handwashing protocols and professional environmental cleaning services to prevent further spread of disease.

SCCHD continues to receive test results from patrons and staff that have been tested. Restaurant staff are required to have two (2) negative results for Shigella infection at least 24 hours apart prior to being released to return to work at the establishment. SCCHD has also issued an alert to area physicians about the outbreak, providing guidance for patients that exhibited symptoms similar to those of Shigellosis. SCCHD is no longer asking patrons to complete our online survey; however, we continue to monitor for additional reports of illness. If you or someone you know consumed food from the LongHorn Steakhouse in Fairview Heights between the dates of September 20th and September 30th, 2024, became ill and are still experiencing symptoms, please see your healthcare provider and complete the testing for Shigella infection.

Shigella infection or Shigellosis symptoms usually start one to two days after infection and last seven (7) days. Shigella spreads easily; swallowing just a small amount of Shigella germs can make you sick. Shigella germs are in feces, so anything that gets contaminated by feces (hands not properly or thoroughly cleaned) can potentially spread the germs. Shigella can spread from one person to another or through contaminated water, food, surfaces, or objects. Routinely cleaning and sanitizing kitchen utensils, counters and surfaces before preparing food can reduce the risk of all germs. Good hygiene practices are equally important whether or not food is being prepared.

The Alameda County Public Health Department, Los Angeles Department of Public Health, and California Department of Public Health (CDPH) investigated an outbreak of shigellosis associated with a Kaiser Permanente union delegate conference held at the Westin Bonaventure Hotel in downtown Los Angeles from August 21 to August 24, 2023. The event included 269 attendees from across California. This outbreak was assigned the code “OB20233135.”

A total of 32 cases were identified linked to this outbreak. Ages ranged from 41 to 71 years (median 49.5). Seventy-two percent of cases with known information were female. Known illness onset dates ranged from August 24 to August 26, 2023. Four cases were hospitalized, and no deaths were reported.

All but seven of the known cases were at least PCR positive for Shigella. At least 13 of the known cases were positive for Shigella flexneri, type 3. Whole genome sequencing determined that five of these cases were infected with near identical Shigella strains (within 0-1 alleles).

The Los Angeles Department of Public Health distributed a REDCap survey to all conference attendees to collect exposure information. A total of 85 survey responses were recorded as of September 8. The boxed lunch served on August 24, 2023 was the primary exposure of interest.The main kitchen at the Westin Bonaventure was investigated by Los Angeles County Environmental Health. The main kitchen was closed on September 1, 2023. At least one ill worker was identified with an onset of August 25, 2023. One other employee had left work early on an undetermined day. Thirteen out of 14 employees were tested: one asymptomatic employee was positive for Shigella/EIEC, EPEC who had also prepared the chicken curry and tuna salad wrap. One other asymptomatic employee was positive for STEC and did not participate in making the wrap. 

As of December 12, 2023, Spokane Regional Health District (SRHD) has confirmed 57 cases of shigellosis, a diarrheal illness, primarily among members of the community experiencing homelessness. Panhandle Health District (PHD) has confirmed four cases of shigellosis among residents of Kootenai County. It is not yet known if the cases in Spokane County are linked to the cases in Kootenai County.

Shigellosis is a gastrointestinal infection caused by the bacteria shigella. It can spread easily from one person to another via fecal-oral transmission with symptoms of diarrhea, fever, and stomach pain. Symptoms usually start one to four days after infection and last about seven days. However, the bacteria can continue to be shed in feces up to two weeks after diarrhea has subsided.

Although anyone can get shigellosis, groups at higher risk for infection or severe illness include:

  • People who are experiencing homelessness
  • Gay, bisexual, and other men who have sex with men
  • People who have recently traveled internationally
  • Children younger than 5 years old
  • People who have weakened immune systems

“We are seeing community-wide transmission among those experiencing homelessness,” said Health Officer Dr. Francisco Velazquez. “At the end of the day, if we’re mindful of hygiene and sanitization, then we can prevent the spread of communicable diseases.”

Velazquez recommends washing hands well and often (especially after using the bathroom, changing diapers and before preparing or eating food), cleaning high-touch surfaces throughout the day, and encouraging those around you to practice good handwashing and use hand sanitizer. 

“We will continue to monitor the situation in our area and are thankful for our partnerships with SRHD and the state,” said Jeff Weigel, epidemiologist program manager at PHD. “We have alerted local healthcare providers to be diligent with any patients presenting with shigellosis symptoms and to contact us immediately.” 

In addition, it is important for food services, restaurants, and meal sites to emphasize the importance of hand washing and sanitization as part of their processes and procedures. 

To support organizations who are most affected by the current outbreak, SRHD has taken the following actions:

  • Provided guidance and in-person training to homeless shelters, service providers and meal sites on how to improve handwashing and sanitization to prevent further spread
  • Communicated with health care partners and emergency responders, providing awareness via regular updates, a county-wide Provider Alert, and a provider-focused web page
  • Provided homeless shelters with additional supplies of hand sanitizer, body wipes and personal undergarments
  • Educated food establishments (including grocery stores) and the Food Coalition on safe food handling, hand hygiene and sanitation practices

The following resources from the Centers for Disease Control & Prevention (CDC) can provide more information:

The Pennsylvania Department of Health (PADOH) released a health advisory on Wednesday, November 15, 2023. Below is a summary.

  • The Pennsylvania Department of Health (DOH) identified an increase in the number of shigellosis cases reported during October 2023. This increase was almost twice as large as the 5-year statewide average number of cases during the month of October from 2018-2022 and is particularly prominent in the southeastern region of the state.
  • Although it is not clear whether this recent increase includes drug resistant strains, laboratories are encouraged to perform cultures of suspected cases to obtain isolates for antimicrobial susceptibility testing.
  • All positive laboratory results for Shigella are required to be reported to the DOH and all positive isolates or specimens are required to be submitted to the DOH Bureau of Laboratories within five workdays of the positive test result.
  • If you have additional questions about this guidance, please contact DOH at 1-877- PA- HEALTH (1-877-724-3258) or your local health department.

The patient count in an outbreak of infections from Shigella continues to increase in Yakima County, WA.

As of Oct. 18 public health officials had confirmed 72 people with infections since the first of this year. That’s compared to 10 cases at this time in 2022.

The source of the bacteria has not yet been found. Health officials are asking that anyone who has symptoms of Shigella infection seek medical attention and ask for specific testing because the symptoms can mimic other illnesses.

According to the U.S. Centers for Disease Control and Prevention symptoms include diarrhea that can be bloody or lasts longer than three days. Some patients also experience fever, stomach pains, or feeling the need to pass stool even when the bowels are empty. Symptoms may start one to two days after infection and can last seven days.

Shigella spreads from person to person and from contaminated surfaces or foods and beverages. A small amount of the microscopic bacteria is enough to cause severe illness. People can become infected by swallowing the bacteria through touching contaminated surfaces then touching the mouth, or by eating food prepared by someone with an infection.

“Shigella spreads easily from person to person and with 72 cases in Yakima County so far this year it is an important reminder to be vigilant and utilize preventative measures,” Yakima CountyDirector of Disease Control Melissa Sixberry said.

“As upcoming holidays and gatherings take place, remember to always wash your hands, and stay home if you are sick when holiday gatherings take place, remember to always wash your hands, and stay home.”

Good hygiene practices can help limit the spread of Shigella infections. Such  practices include washing hands often and thoroughly, especially before eating and after using the restroom or changing diapers, and before preparing or serving food. People should clean and sanitize work areas frequently and avoiding preparing or sharing food when they have symptoms of infection.

Alameda County Public Health Department, in coordination with the California Department of Public Health (CDPH), is investigating an outbreak of shigellosis likely associated with a union delegate conference held at a hotel venue in downtown Los Angeles from August 21-24, 2023. 

The event included an estimated 300+ attendees from across California. As of August 31, 2023, CDPH is reporting six shigellosis cases from four California local health jurisdictions among event attendees, including Alameda County residents. 

At least three/six cases were PCR+ for Shigella; culture and additional subtyping are pending. Known illness onset dates were on 8/25/23; at least two patients have been hospitalized. As of September 1, 2023, Alameda County is reporting three shigellosis cases to CDPH, all of whom attended this event.

Shigella: Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Shigella outbreaks. The Shigella lawyers of Marler Clark have represented thousands of victims of Shigella and other foodborne illness outbreaks and have recovered over $850 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Shigella lawyers have litigated Shigella cases stemming from outbreaks traced to a variety of sources, such as tomatoes, airplane and restaurant food. 

If you or a family member became ill with a Shigella infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Shigella attorneys for a free case evaluation.

As the Texas Department of Health has reported, there is a Shigella Outbreak in Lavaca County that has sickened nearly 100. It appears to be linked to a local food establishment, Los Cabos San Lucas Mexican Grill, in Hallettsville, Texas.

Background

The Texas Department of State Health Services Public Health Region 8 (DSHS PHR 8) is currently investigating an outbreak of shigellosis in Lavaca County. DSHS PHR 8 is working to identify the source of the outbreak by interviewing individuals who have become sick and collecting food samples from a location where multiple individuals have eaten prior to becoming sick. 

Shigellosis is an infection caused by ingesting Shigella bacteria. The bacteria spread easily, and people can become infected by eating food prepared by someone with shigellosis, swallowing water while swimming in a lake or improperly treated swimming pool, or touching surfaces or items contaminated with the bacteria from someone with an infection.

Symptoms of Shigella 

Common symptoms of shigellosis are:

  • Vomiting
  • Diarrhea, which may contain blood and/or mucus
  • Stomach Pain
  • Fever
  • Urge to pass stool (poop) but bowels are empty

Symptoms usually start 1-2 days after infection and last 7 days. In some cases, frequency and consistency of stool (poop) do not return to normal for several months.

Recommendations for Healthcare Providers

  • Healthcare providers are encouraged to test patients for shigella if they report symptoms compatible with shigella infection. 
  • Obtain a detailed food history for all patients reporting symptoms of foodborne illnesses.
  • Report cases of shigellosis to DSHS PHR 8 (contact information below).  

Recommendations for the Public

If you are currently experiencing symptoms of shigella infection, visit your doctor to get tested. Your doctor may prescribe you antibiotics for this infection, but some people may get better without medication.

People can become sick with shigellosis by eating or drinking the shigella bacteria, by touching something contaminated with the bacteria and then touching the mouth, or through contact with bacteria during sex. It only takes a small amount of shigella bacteria to make a person sick. If you are sick with symptoms of shigella infection, you can help keep it from spreading:

  • Wash your hands often using warm, soapy water for at least 20 seconds.
  • Use a separate bathroom from other household members. If a separate bathroom is not available, clean and disinfect surfaces in the bathroom after each use.
  • Do not prepare food for others while you are sick.
  • Do not go swimming.
  • Do not have sex for at least two weeks after diarrhea ends.
  • Stay home from school, daycare, or jobs in healthcare or food service until your symptoms have resolved for at least 24 hours (without taking medicine that would mask symptoms).

Diarrheal disease is a significant cause of morbidity and mortality worldwide; it is the second leading cause of death in children under the age of 5, with approximately 800,000 deaths annually. Both Shigella and ETEC are common causes of traveler’s diarrhea and global children’s diarrhea.

This research is a phase 1, double-blind, placebo-controlled, dose-escalating, single-center study, involving three vaccine dosage escalation cohorts (108, 109, and 1010 cfu vaccine organisms) evaluating a combined Shigella and ETEC vaccine.

Each of the three dose-escalation cohorts will consist of 8 study participants who will be randomly allocated to receive either vaccine or placebo, as a single, oral dose.

A fourth cohort will be an adaptive design cohort consisting of 30 study participants to be randomly allocated to receive either two doses of vaccine, one dose of vaccine, or two doses of placebo. Participants in the first three cohorts will receive the oral dose while in an inpatient setting. During the following subsequent 96 hours (4 days), participants will remain on the inpatient research isolation ward to be closely monitored, and each stool will be collected by study staff.

The research involves approximately a six-day inpatient stay with four follow-up visits over the course of six to eight months.

QUALIFIED PARTICIPANTS MUST

  • Participants in this study must be 18-49 years old and healthy.
  • Be able to remain in an inpatient facility for approximately six days
  • Appear for follow-up outpatient clinic visits 

QUALIFIED PARTICIPANTS WILL RECEIVE

  • Compensation up to $3,775 is provided.

To qualify, email clintrials@som.umaryland.edu, call 410-706-8800, or complete our contact form.

The Indian Express reports: Devananda (16), who fell sick and died after having shawarma, was killed by shigella infection caused by a bacteria of the same name, said Kasaragod district medical officer Dr A V Ramdas.

More than 52 persons fell sick after eating shawarma from Ideal snacks bar in Cheruvathur on April 29 and 30. Devananda had shawarma from the snacks bar on both days, said police.

Of the 52 persons under treatment, seven patients are in intensive care units in three hospitals but their conditions have stabilised, said Dr Ramdas.

The presence of shigella was established after samples of blood and stools of the food-poisoning victims were tested at Kozhikode Medical College Hospital, he said.

Unhygienic, undercooked or contaminated food and water can be a source of shigella, which can cause an intestinal infection that is very contagious, said the district medical officer (DMO).

The sliced meat stacked on a spit for shawarma is slow-roasted for hours in front of a flame that can penetrate just one centimetre, said Dr Ramdas. During rush hours, if the eatery chooses to serve fast, many customers would get undercooked meat, he said.

The mayonnaise, which is made of eggs, and vegetable salad served with the shawarma can also be a source of the bacteria because the present weather is ideal for their multiplication, said Deputy DMO Dr A T Manoj.

“The bacteria can also spread if the food was handled by an infected person,” he said.

The public should maintain proper eating and food hygiene to prevent the spread of shigella, he said.
Most of the patients under treatment after eating shawarma from Ideal are between the age of 10 and 20 years. The youngest patient is a two-and-a-half-year-old girl, and the oldest is a 39-year-old man.

Shigella infection or shigellosis is an intestinal infection caused by the shigella family of bacteria, Dr Ramdas said. Diarrhoea is the main symptom of the infection. “This is more serious than the usual loose motion,” he said.

It can spread by consuming unclean water, spoiled food, unwashed fruits and vegetables, or closely interacting with shigella-infected persons, he said.