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.”

The County of San Diego has announced three new shigella cases associated with an ongoing outbreak, bringing the total to 38 confirmed and three probable cases among people experiencing homelessness.

The continuing investigation shows onset of illness dates between Aug. 16 and Nov. 8, 2021, with the four new cases occurring between Oct. 23 and Nov. 8, 2021. The 41 cases in this outbreak represent 11% of the 349 total cases reported to date in San Diego County.

The cases are primarily among individuals experiencing homelessness, with the majority at multiple locations in central San Diego. A case with a known address outside the City of San Diego is being investigated to determine where that individual was residing when they contracted the disease. No source of the outbreak has currently been identified.

The County of San Diego has announced five new shigella cases associated with an ongoing outbreak, bringing the total to 31 confirmed and three probable cases among people experiencing homelessness.

The continuing investigation shows onset of illness dates between Aug. 16 and Oct. 30, 2021, with the three new cases occurring between Sept. 30 and Oct. 30, 2021. The 34 cases in this outbreak represent 10.6% of the 319 total cases reported to date in San Diego County.

The cases are all among individuals experiencing homelessness with the majority at multiple locations in central San Diego. No source of the outbreak has currently been identified.

The County is working closely with the City of San Diego to:

  • Prevent any future potential exposure sites.
  • Promote good hygienic precautions among homeless service providers and food providers.
  • Connect ill individuals to treatment and housing.

Other steps have included:

  • Relocation of 32 currently deployed handwashing stations to areas frequented by homeless individuals.
  • Placement of 16 new handwashing stations, with the most recent station placed near the Sports Arena site. Evaluation of additional need is ongoing.
  • Increased cleaning of portable and fixed public bathrooms.
  • Evaluating potential placements of new portable restrooms.
  • Increased sidewalk sanitization from twice weekly to seven days per week for the time being. Frequency will be continually assessed.
  • Notification by the County Department of Environmental Health and Quality about the outbreak – and precautions – to food facilities in the downtown, Mission Valley and Hillcrest areas, charitable feeding operators, the California Restaurant Association, Downtown San Diego Partnership, Regional Task Force on Homelessness and Gaslamp Quarter Association.
  • Public health nurses conducting outreach at shelters.
  • Homeless Outreach Teams offering shelter resources and distributing weekly 1,000 hygiene kits with shigella information to persons experiencing homelessness.
  • County Public Health shigella website with outbreak information.

Shigella is a contagious infection typically spread by contaminated surfaces, food or water, or person to person. Those at increased risk include young children (especially those in daycare), people who are experiencing homelessness, travelers to locations with poor sanitation and men who have sex with men. In 2020, a total of 240 shigellosis cases were reported in San Diego County residents while the 426 cases reported in 2019 was the highest since 1995.

Typical symptoms of shigellosis include diarrhea (sometimes bloody), fever and stomach cramps. While most people will recover fully without antibiotic treatment, some individuals with poor immune systems can develop life-threatening disease and may need further treatment.  People with symptoms that resemble shigella should contact their medical care provider. The provider may order stool testing to help with the diagnosis.

Strategies to avoid getting or spreading shigella include frequent hand washing and not preparing food while ill with diarrhea.

The County of San Diego has announced two new shigella cases associated with an ongoing outbreak, bringing the total to 26 confirmed and three probable cases among people experiencing homelessness.

The continuing investigation shows onset of illness dates between Aug. 16 and Oct. 21, with the three new cases occurring between Oct. 18 and Oct. 21. The 29 cases in this outbreak represent 9% of the 295 total cases reported to date in San Diego County.

The cases are all among individuals experiencing homelessness with the majority at multiple locations in central San Diego. Three cases outside the City of San Diego are now under investigation. No source of the outbreak has currently been identified.

The County is working closely with the City of San Diego to:

  • Identify potential exposure sites.
  • Promote good hygienic precautions among homeless service providers and food providers.
  • Identify additional cases.
  • Connect ill individuals to treatment and housing.

Other steps include:

  • Relocation of 32 currently deployed handwashing stations to areas frequented by homeless individuals.
  • Placement of 15 new handwashing stations. Evaluation of additional need is ongoing.
  • Increased cleaning of portable and fixed public bathrooms.
  • Evaluating potential placements of new portable restrooms.
  • Increased sidewalk sanitization from twice weekly to seven days per week for the time being. Frequency will be continually assessed.
  • Notification by the County Department of Environmental Health and Quality about the outbreak – and precautions – to food facilities in the downtown, Mission Valley and Hillcrest areas, charitable feeding operators, the California Restaurant Association, Downtown San Diego Partnership,  Regional Task Force on the Homeless and Gaslamp Quarter Association.
  • Public health nurses conducting outreach at shelters.
  • Homeless Outreach Teams offering shelter resources and distributing shigella information as part of hygiene kits given to persons experiencing homelessness, including an extra 600 the week of Oct. 18.
  • The County is assembling an additional 1,000 hygiene kits to distribute to people experiencing homelessness outside of central San Diego.

Shigella is a contagious infection typically spread by contaminated surfaces, food or water, or person to person. Those at increased risk include young children (especially those in daycare), people who are experiencing homelessness, travelers to locations with poor sanitation and men who have sex with men. In 2020, a total of 240 shigellosis cases were reported in San Diego County residents while the 426 cases reported in 2019 was the highest since 1995.

Typical symptoms of shigellosis include diarrhea (sometimes bloody), fever and stomach cramps. While most people will recover fully without antibiotic treatment, some individuals with poor immune systems can develop life-threatening disease and may need further treatment.  People with symptoms that resemble shigella should contact their medical care provider. The provider may order stool testing to help with the diagnosis.

Strategies to avoid getting or spreading shigella include frequent hand washing and not preparing food while ill with diarrhea.

The County of San Diego has announced three new shigella cases associated with an ongoing outbreak, bringing the total to 18 confirmed and three probable cases among individuals experiencing homelessness.

The continuing investigation shows onset of illness dates between Aug. 16 and Oct. 15, with the three new cases occurring between Sept. 20 and Oct. 15. The 21 cases in this outbreak represent 7.6% percent of the 275 total cases reported to date in San Diego County.

The County of San Diego has announced 11 new shigella cases associated with an ongoing outbreak, bringing the total to 15 confirmed and three probable among individuals experiencing homelessness.

The continuing investigation shows onset of illness dates between Aug. 16 and Oct. 14. The 18 cases in this outbreak represent 6.8 percent of the 266 total cases reported to date in San Diego County.

The cases are all among individuals experiencing homelessness who resided at multiple locations in central San Diego. No source of the outbreak has currently been identified.

The County is working closely with the City of San Diego to:

  • Identify potential exposure sites.
  • Promote good hygienic precautions among homeless service providers and food providers.
  • Identify additional cases.
  • Connect ill individuals to treatment and housing.

Other steps include:

  • Relocation of currently deployed handwashing stations to areas frequented by homeless individuals and evaluation of need for additional stations.
  • Increased cleaning of portable and fixed public bathrooms.
  • Increased sidewalk sanitization from twice weekly to seven days per week for the time being. Frequency will be continually assessed.
  • Notification by the County Department of Environmental Health and Quality about the outbreak – and precautions – to food facilities in the downtown area, charitable feeding operators, the California Restaurant Association, Downtown San Diego Partnership and Gaslamp Quarter Association.
  • Public health nurses conducting outreach at shelters.
  • Homeless Outreach Teams distributing Shigella information as part of hygiene kits given to persons experiencing homelessness, including an extra 600 the week of Oct. 18.

Shigella is a contagious infection typically spread by contaminated surfaces, food or water, or person-to-person. Those at increased risk include young children (especially those in daycare), people who are experiencing homelessness, travelers to locations with poor sanitation, and men who have sex with men. In 2020, a total of 240 shigellosis cases were reported in San Diego County residents while the 426 cases reported in 2019 was the highest since 1995.

Typical symptoms include diarrhea (sometimes bloody), fever and stomach cramps. While most people will recover fully without antibiotic treatment, some individuals with poor immune systems can develop life-threatening disease and may need further treatment.  People with symptoms that resemble shigella should contact their medical care provider. The provider may order stool testing to help with the diagnosis.

Strategies to avoid getting or spreading shigella include frequent hand washing and not preparing food while ill with diarrhea.