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.

Background: Humboldt County Public Health has become aware of several confirmed and suspected cases of Shigella gastroenteritis with links to the Eureka 101 corridor on the north and west sides of town throughout the past 4 weeks.

Based on current and ongoing investigations we suspect the spread may be greater than our current understanding. Therefore, we are alerting medical providers in the area to consider testing for and treating Shigella to help both understand the extent of the problem and to help stop the spread of this highly contagious bacterial illness.

Infection with Shigella is generally self-limited; the average duration of symptoms associated with untreated Shigella gastroenteritis is seven days. In the absence of specific antibiotic treatment, patients with Shigella gastroenteritis may shed the organism for up to six weeks after the resolution of symptoms; risk factors for asymptomatic shedding are not known. Treatment of Shigella in symptomatic individuals can shorten the duration of symptoms in an individual patient as well as serve public health function to slow the spread of disease in the community.

Symptoms: Shigella infection typically presents within one to three days from exposure with constitutional symptoms such as fever, anorexia, and malaise. Initially diarrhea is watery but may subsequently contain blood and mucus. Stool is frequent with abdominal cramping, bloating, gas. Those with more severe cases and risk factors may require hospitalization.

Public and Environmental Health officials are working to contain local cases of the gastrointestinal illness Shigella bacteria, after three lab-confirmed cases and two more suspected cases infected Eureka residents during the past month.

The cases span multiple households, infecting school-age children and adults, including a person experiencing homelessness. Officials believe the virus may have been spread through one or more Eureka laundromats, after an infected person washed contaminated clothing at the facility. Environmental Health officials are working closely with the operators of the two laundromats, the Self-Serve Laundromat on Summer Street and Eureka Laundromat on Little Fairfield Street, to make sure their facilities are cleaned and disinfected properly.

Shigella germs are found in stool, and infection is spread by eating food or drinking liquids contaminated by an infected person, or when a person touches a contaminated surface or object and then touches their mouth or puts the object into their mouth. People infected with shigellosis typically experience a fever, abdominal cramps and diarrhea which may be bloody. Onset of shigellosis symptoms usually occurs one to two days after exposure—but may take longer—and lasts around a week. Infected people can remain contagious up to six weeks after symptoms resolve. Most people with shigellosis recover completely without severe complications. In rare cases Shigella may cause bloodstream infections, seizures, kidney failure or arthritis.

The best way to prevent the spread of shigellosis is to wash hands:

  • Before, during and after preparing food
  • Before eating
  • Before and after caring for someone who is sick
  • After using the toilet
  • After blowing your nose, coughing or sneezing
  • After touching garbage
  • After changing diapers or cleaning up a child who has used the toilet
  • After touching an animal, animal feed or animal waste
  • After handling pet food or pet treats.

People with shigellosis should: Stay home from school or from health care, food service or childcare jobs while sick Abstain from sharing food Abstain from swimming and hot tubs Abstain from having sex for at least two weeks after symptoms resolve.

With no new cases in more than a month, the shigella outbreak declared in October 2021 among people experiencing homelessness is over, the County Health and Human Services Agency announced today.

The last shigella case connected to the outbreak was identified Dec. 11, 2021, and for over a month, cases have remained at the historical  baseline, which is no more than one case per week in people experiencing homelessness.

On Jan. 14, the County sent a letter to City of San Diego officials informing them that the current outbreak of shigellosis no longer exists. The California Department of Public Health has also deemed this outbreak to be over. The County will continue to closely monitor case counts.

The shigella outbreak was first identified in early October when six people experiencing homelessness were hospitalized due to shigellosis.

On Oct. 11, 2021, the County issued a health advisory to the local medical community to be on the lookout for potential shigella cases.

At the same time, the County began working with the City of San Diego, potential exposure sites, and homeless service providers to mitigate the spread of shigellosis by ensuring good sanitation precautions, expanding public restroom availability, distributing personal hygiene kits, working with food service providers, identifying additional cases, and connecting ill people to treatment and housing.

For three months, the County held regular meetings with the City and other stakeholders to control the shigellosis outbreak, maintained a website to report cases, and issued news updates informing the public about new cases and containment measures being implemented.

In total, 53 shigella cases were connected to the outbreak — 47 confirmed and six probable infections. All cases were identified in people experiencing homelessness. There were no deaths.

Channel 7 San Diego reports:

Nearly 50 people have now gotten sick from a Shigella outbreak in San Diego County, calling attention to the city’s lack of public restrooms and showers.

The bacterial infection causes fever and digestive issues, and, if left untreated, can be deadly. So far each known patient in San Diego is homeless.

“We are failing, miserably,” said Amie Zamudio, homeless outreach director for Housing for the Homeless.

Zamudio helps get San Diegans who need medical treatment off the streets.

“There are thousands of people out here who are medically fragile and immuno-compromised, and are desperately in need of restrooms and hygiene,” Zamudio said.

The lack of sanitation resources impacts more than just personal hygiene, according to experts.

“We’re all susceptible to infectious diseases,” said Jennifer Felner, who is an assistant professor of public health at San Diego State.

Felner spent years studying San Diego’s hepatitis A outbreak that started in 2016. Her team was able to make a direct link between a lack of public restrooms and the outbreak, which infected nearly 600 San Diegans. The outbreak was blamed for 20 deaths.

“We all are affected by this lack of access to bathrooms, showers and other critical resources in San Diego,” Felner said.

In response to the current shigella outbreak, the county has rolled out 16 new handwashing stations, and eight new portable toilets

But, Felner said, until we provide more permanent solutions, we will continue getting sick.

“We keep having this conversation when emergencies happen,” Felner said. “And these emergencies are going to keep happening if we don’t come up with concrete solutions.”

One possible solution is based out of Portland. The Hygiene Hub is run by a nonprofit on city-donated land. Four days a week, it offers one shower, two toilets, a clean bedding exchange, foot- and leg-injury treatment and storage services.

“There’s a failure of public infrastructure,” said Sandra Comstock, the executive director of Hygiene 4 All, the nonprofit heading the hub. “That’s the real problem. We don’t have the housing for people, but we also don’t have the bathrooms, the trash services or the other things that people in houses take for granted.”

Back in San Diego, the city has what’s called the Day Center in East Village, a site where people can use the restroom, shower and do laundry. The center has 10 toilets/urinals and 5 sinks. And Father Joe’s Village’s main campus dedicates 9 toilets/urinals, 10 sinks and 12 showers to Day Center clients. An average of 326 people use the center’s services in a given month.

But here’s what makes the Hygiene Hub in Portland different: The restrooms and showers are sanitized and stocked by attendants, not security guards.

“It’s a giant difference,” Comstock said.

The attendants, all of whom were homeless themselves, receive training on de-escalating violence, and intervening in mental health or substance abuse situations.

Over the past year, Comstock said, most of their 20 attendants have found stable housing.

“The sense of happiness when people come into this space,” Comstock said, “particularly when they come out of the shower, there aren’t words to describe how beautiful that is.”

The hub serves about 80-100 people a week.

“I think there are a lot of things that are really interesting and exciting about that kind of a model,” Felner said.

Zamudio said she, too, would welcome a program like the Hygiene Hub in San Diego. At the very least, she said, it’s paramount that elected officials include hygiene options in their plan to tackle the homeless crisis.

“It’s just really sad that we’re not able to see how sick people already are and the need for restrooms and ongoing hygiene and ongoing care,” Zamudio said. “It’s not an unrealistic demand.”