I went looking for a recent foodborne Shigella outbreak in the United States — anything from the last sixty days. I could not find one that any health department had publicly announced.

With norovirus, that silence has an easy explanation: norovirus is not individually reportable, most clinicians never test for it, and reporting an outbreak is encouraged rather than required. Shigella is different. Shigellosis is a nationally notifiable disease. The counting apparatus already exists, which means the silence has to mean something else.

What the federal record shows

CDC’s Current Outbreaks page, updated September 2, lists active multistate investigations for Campylobacter, E. coli, Listeria and Salmonella. Shigella is not on that table. It sits in a secondary list of additional foodborne germs, and that page carries no current outbreak notice. FDA’s foodborne investigation table has no Shigella entry either.

That is not because nothing is happening. On April 9, CDC published an analysis in Morbidity and Mortality Weekly Report that deserved far more attention in the food safety world than it got.

The epidemiology has moved

CDC and health departments across the country analyzed nearly 17,000 Shigella isolates covering 2011 through 2023. The share that were extensively drug resistant — XDR, meaning resistant to ampicillin, azithromycin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole all at once — rose from zero percent during 2011 through 2015 to 8.5% in 2023. There are no FDA-approved oral antimicrobial agents available to treat those infections. More than a third of XDR patients were hospitalized.

Who gets sick has shifted too. CDC found the vast majority of U.S. Shigella infections across that period were in adult men, 47% of whom had HIV; earlier outbreaks involved drug-susceptible strains and primarily affected children. Among patients with travel history available, more than 80% reported no recent international travel. This is domestic transmission. CDC estimates roughly 450,000 Americans get shigellosis every year, and concluded that strengthened surveillance, routine susceptibility testing and timely reporting are what is needed.

What that means for food

Here is the uncomfortable part for those of us who work on food. The Shigella clusters that surface now tend to be in shelters, in child care, and among people experiencing homelessness, or they move person to person and through sexual contact. Those are real patterns and CDC has documented them carefully. They are also patterns that rarely produce a press release, a named restaurant, or a recall.

None of that makes Shigella less of a food problem. Infection can occur with as few as ten organisms — one of the lowest infectious doses of any foodborne pathogen. A single infected food handler working one shift can seed an outbreak that fills a hospital.

We have watched it happen. In October 2024, the St. Clair County Health Department in Illinois investigated Shigella tied to a LongHorn Steakhouse in Fairview Heights. Twenty-four people tested positive and another forty-four reported symptoms after dining there between September 20 and 30. Nine were hospitalized. Patients ranged from twelve to eighty years old. Staff were required to produce two negative tests taken at least twenty-four hours apart before returning to work. Go back to 2015 and Santa Clara County traced a Shigella outbreak to a San Jose restaurant that involved 182 ill people across five counties, 72 of them lab-confirmed, with a dozen sent to intensive care.

Both are what a Shigella outbreak looks like when a health department finds it and says so out loud.

Nobody is publishing

The counties that would catch a restaurant cluster mostly do not tell you what they find. Public Health – Seattle & King County posts every foodborne outbreak it investigates, by name, and its 2026 list contains no Shigella — a real finding, because King County looked and wrote it down. Santa Clara County offers a complaint form and no outbreak list. Wake County has not named a foodborne outbreak since 2023. Oregon publishes guidelines and a twenty-year retrospective, nothing current. Virginia’s weekly gastrointestinal count does not include Shigella and never identifies an establishment.

We are left with a nationally notifiable pathogen, a documented national rise in an untreatable form of it, and local agencies that either are not finding foodborne clusters or are not saying when they do.

What I would want to know

If Shigella is genuinely not moving through restaurants this summer, that is good news and I will take it. But CDC just told us the circulating strains are harder to treat than they have ever been, and that the people getting them have not been traveling. A pathogen that infectious does not politely confine itself to one transmission route. If a food handler working while ill carries an XDR strain into a busy kitchen, the people who get sick will have fewer treatment options than at any point in my career.

That is an argument for looking harder, not for relief. Shigellosis is reportable for a reason, and a health department that publishes what it finds is the only kind that can credibly tell the public it has not found anything.

Frequently asked questions about Shigella

Is shigellosis a reportable disease?

Yes. Shigellosis is a nationally notifiable disease in the United States. Reporting timeframes are set by each state — West Virginia, for example, requires sporadic cases to be reported within 72 hours of diagnosis and outbreaks immediately. That is a sharp contrast with norovirus, which is not individually reportable anywhere.

What is XDR Shigella?

Extensively drug-resistant Shigella is defined by CDC as an isolate resistant to ampicillin, azithromycin, ceftriaxone, ciprofloxacin and trimethoprim-sulfamethoxazole. No FDA-approved oral antimicrobial agents are available to treat those infections. CDC reported in April 2026 that XDR strains rose from zero percent of isolates during 2011 through 2015 to 8.5% in 2023, and that more than a third of XDR patients were hospitalized.

How many people get Shigella infections each year in the United States?

CDC estimates roughly 450,000 cases of shigellosis annually.

How little Shigella does it take to make someone sick?

Infection can occur with as few as ten organisms, one of the lowest infectious doses of any foodborne pathogen. That is why a single infected food handler can sicken dozens of customers, and why handwashing failures matter more with this organism than with most others.

What are the symptoms of shigellosis?

Diarrhea that is often bloody, fever and stomach cramps, usually starting one to two days after exposure and lasting about a week. The bloody, painful form is known as dysentery.

How does Shigella get into restaurant food?

Through the fecal-oral route, most often an infected food worker who handles ready-to-eat food such as salads and sandwiches. Shigella is shed in stool and can persist for a week or two after a person stops feeling ill, so a worker who returns too soon is still a risk. Contaminated produce and water are also documented sources.

When can a food worker with Shigella go back to work?

Not on their own judgment. Food workers, health care personnel, child care staff and children in child care must obtain approval from the local or state health department before returning. During the 2024 Illinois restaurant outbreak, staff were required to produce two negative tests taken at least twenty-four hours apart.

Have there been recent Shigella outbreaks at U.S. restaurants?

None has been publicly announced in the last sixty days. The most recent well-documented restaurant cluster was the October 2024 LongHorn Steakhouse outbreak in Fairview Heights, Illinois — 24 confirmed cases, 44 more reporting symptoms, nine hospitalizations. Before that, the 2015 San Jose outbreak that sickened 182 people across five California counties.

About Marler Clark

Shigella takes remarkably little to make a person sick — a mere handful of organisms — which is why it spreads so easily through food touched by an infected worker. It causes dysentery, a painful and sometimes bloody diarrhea, and it passes so readily from person to person that a single sick food handler can spread illness well beyond the original meal. Marler Clark, The Food Safety Law Firm, is the nation’s leading firm representing victims of Shigella outbreaks. Our Shigella lawyers have represented thousands of victims in the only U.S. law practice devoted exclusively to foodborne illness, which has recovered more than $850 million for victims and families nationwide. We have traced Shigella outbreaks to tomatoes, airline meals, and restaurant food.

If you or a family member became ill with a Shigella infection after eating contaminated food, contact the Marler Clark Shigella attorneys for a free case evaluation.

Working with Marler Clark

How much does it cost to hire a food poisoning lawyer?

Marler Clark handles food poisoning cases on a contingency-fee basis. There is no charge for the initial consultation, and no attorney’s fees unless we obtain a recovery for you through a settlement or verdict. When your case concludes, you receive a full written accounting of all fees and expenses for your approval before any money is disbursed.

Do I have a Shigella case?

The strongest cases share three things: a laboratory-confirmed infection, usually from a stool sample; a documented link between your illness and a specific food, restaurant or product, often through a public health investigation; and real damages such as hospitalization, lasting injury, or lost income. Because shigellosis is reportable, prompt testing and a report to the health department help establish the source.

How long do I have to file a claim?

Statutes of limitation vary by state and by the type of injury, sometimes running as little as one year. Because receipts, leftover product and medical samples disappear quickly, it is best to speak with a lawyer as soon as possible.

Does Marler Clark handle cases nationwide?

Yes. We represent clients across the country and have litigated food poisoning cases in more than 35 states, working with local counsel where needed.

Additional resource: About Shigella — in-depth information about Shigella bacteria and infection.

Shigellosis, also known as bacillary dysentery, is the infectious disease caused by the Shigella bacteria. Most who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after exposure. The diarrhea is often bloody. Shigellosis usually resolves in 5 to 7 days. In some persons, especially young children and the elderly, the diarrhea can be so severe that the patient needs to be hospitalized. A severe infection with high fever may also be associated with seizures in children less than 2 years old. Some persons who are infected may have no symptoms at all, but may be carriers, and still pass the Shigella bacteria to others.

There are several different kinds of Shigella bacteria: Shigella sonnei, also known as “Group D”, accounts for much of the infection in the United States and is the strain most often linked to infection from food (shigellosis accounts for less than 10% of the reported outbreaks of foodborne illness in the United States.) A second type, Shigella flexneri, or “group B”, accounts for almost all of the rest of the infections in the U.S., and recent studies have determined a high percentage of infection by this strain is transmitted sexually. Other types of Shigella, such as Shigella dysenteriae type 1, are most often found in water contaminated with human feces. Such strains are rare in the U.S., although they continue to be important causes of death and disease in the developing world.

Shigellosis is more common in summer than winter. Children, especially toddlers aged 2 to 4, are the most likely to get shigellosis. Many cases are related to the spread of illness in child-care settings, and many more are the result of the spread of the illness in families with small children.

Increasingly, multidrug-resistant shigellosis cases are appearing in the US, often linked to travelers from outside the US.[1] These include Shigella sonnei that is resistant to ciprofloxacin, a main line antibiotic used to treat infections in adults. Shigella is already resistant to ampicillin. Since 2015, the CDC has tracked a sharp rise in extensively drug-resistant (XDR) Shigella—strains resistant to all five commonly recommended antibiotics (azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole, and ampicillin), for which no FDA-approved oral treatment currently exists. The proportion of reported U.S. infections caused by XDR strains rose from 0% in 2011–2015 to roughly 8.5% in 2023, prompting a national CDC Health Advisory in 2023. Whereas shigellosis has historically most affected young children, XDR infections have occurred mainly in adult men—many of them men who have sex with men or people living with HIV—and largely without recent international travel, indicating domestic transmission (CDC, 2023). 

Where does Shigella come from?

    The organism is frequently found in water polluted with human feces. Salads (potato, tuna, shrimp, macaroni, and chicken), raw vegetables, dairy products, and poultry are foods commonly listed as sources of Shigella. Contamination of these foods is usually through the fecal-oral route. Therefore, water polluted with human feces and unsanitary handling by food handlers is the most common causes of contamination.

    An estimated 450,000 cases of shigellosis occur annually in the U.S. and Shigella infections cause an estimated 600,000 deaths per year worldwide.[2] The number of infections attributable to contaminated food is unknown, but as it takes very little Shigella to cause infection, it’s probably substantial. Most of these deaths occur in developing countries with poor hygiene and unsafe water supplies. 

    How is Shigella detected?

    Determining that Shigella is the cause of the illness depends on laboratory tests that identify the bacteria in the stools of an infected person. These tests are sometimes not routinely performed unless the laboratory is instructed specifically to look for the organism. The laboratory can also do special tests to tell which type of Shigella the person has and which antibiotics, if any, would be best to treat it. Organisms like Shigella are difficult to isolate in foods because standard methods are insensitive to such toxins. Recently, a method to identify foodborne pathogens, like Shigella, by specifying segments of their DNA has been developed by FDA and is currently under field test. However, the isolation procedures are still inadequate.

    What are the typical symptoms of Shigella?

    Symptoms include abdominal pain, cramps, diarrhea, fever, vomiting, blood, pus, or mucus in stools, and painful rectal spasms. These symptoms normally manifest one to two days after ingestion. The disease is caused when virulent Shigella organisms attach to, and penetrate, the wall of the intestinal tract. After invasion, they multiply, and spread to other smooth surface cells within the body, resulting in tissue destruction. Some strains produce enterotoxin and Shiga toxin, very much like the verotoxin of E. coli O157:H7. 

    Once someone has had shigellosis, they are not likely to get infected with that specific type again for at least several years. However, they can still get infected with other types of Shigella. Infants, the elderly, and those with weakened immune systems are susceptible to the severest symptoms of disease, but all humans are susceptible to some degree. Shigellosis is a very common illness suffered by those with acquired immune deficiency syndrome (AIDS) and other immuno-compromised individuals.

    What are the long-term and serious complications of Shigella?

    Although most people with shigellosis recover completely within five to seven days, the infection can produce serious complications and lasting health problems. The most common post-infectious complication is reactive arthritis, historically referred to as Reiter’s syndrome. About 2 percent of people infected with certain types of Shigella—most often Shigella flexneri—later develop reactive arthritis, which can cause joint pain, eye irritation (conjunctivitis or uveitis), and painful urination. This reaction occurs mainly in people who are genetically predisposed, particularly those carrying the HLA-B27 gene, and typically appears one to several weeks after the infection. Reactive arthritis usually lasts three to five months, but in some cases it persists for years and progresses to chronic, difficult-to-treat arthritis.[3]

    The most severe complication is hemolytic uremic syndrome (HUS), a form of kidney failure marked by the destruction of red blood cells (hemolytic anemia), a low platelet count (thrombocytopenia), and acute renal failure. HUS is associated with Shiga toxin–producing Shigella—most often Shigella dysenteriae type 1—and is the leading cause of death in S. dysenteriae outbreaks. Much like the same complication seen with E. coli O157:H7, HUS can result in permanent kidney damage, neurological injury, and death.[4]

    Other complications, though less common, can be life-threatening, especially in young children, older adults, and people with weakened immune systems. These include bloodstream infections (bacteremia and sepsis), which occur when Shigella or other intestinal bacteria enter the bloodstream through the damaged lining of the intestine; generalized seizures in young children; and, more rarely, toxic megacolon, intestinal perforation, rectal prolapse, and encephalopathy. In some patients—particularly children in the developing world—repeated or severe infection interferes with the absorption of nutrients and contributes to malnutrition and impaired growth. Post-infectious irritable bowel syndrome and prolonged disturbances in bowel habits have also been reported following Shigella infection.[5]

    How can Shigella infection be prevented?

    Because it takes only a very small number of organisms—fewer than 100 bacteria—to cause illness, Shigellaspreads easily from person to person and through contaminated food and water. There is currently no vaccine to prevent shigellosis, so prevention depends on interrupting the fecal-oral route of transmission. The single most important measure is careful and frequent handwashing with soap and water, especially after using the bathroom, after changing a diaper or cleaning up after someone who is sick, before preparing or eating food, and before any sexual activity. Handwashing by young children should be supervised, particularly in child-care settings and in homes with children who are not yet toilet-trained.[6]

    Additional precautions further reduce the risk of infection. Soiled diapers should be disposed of promptly in a covered, lined container, and diaper-changing areas should be cleaned and disinfected after each use. People should avoid swallowing water from ponds, lakes, and swimming pools, and anyone with diarrhea should not swim, share baths, or prepare food for others. A safe, chlorinated water supply and an effective sewage-disposal system are the most important protections in areas with substandard sanitation. When traveling to developing countries, travelers should drink only boiled or treated water and eat only foods that are cooked and served hot or fruits they peel themselves—the same precautions that help prevent other forms of traveler’s diarrhea.[7]

    Because foodborne outbreaks are frequently caused by an infected food worker who contaminates food through poor hand hygiene, people who are ill should not prepare or serve food for others. The CDC advises food workers with a Shigella infection to stay home from the time they first feel sick until at least two days after their diarrhea has ended, and infected individuals should not return to food handling until stool testing confirms they are no longer shedding the bacteria. Shigellosis is a reportable disease in every state, and cases should be reported to state or local health authorities to help identify and control outbreaks.[8]

    [1]           See CDC “Multidrug-resistant Shigellosis Spreading in the United States.” April 2, 2015. Web April 23, 2015. http://www.cdc.gov/media/releases/2015/p0402-multidrug-resistant-shigellosis.html.

    [2]           Id.: “Shigella causes an estimated 500,000 cases of diarrhea in the United States every year. It spreads easily and rapidly from person to person and through contaminated food and recreational water. It can cause watery or bloody diarrhea, abdominal pain, fever, and malaise.”

    [3]           See CDC, “Signs and Symptoms of Shigella Infection,” at https://www.cdc.gov/shigella/signs-symptoms/index.html.

    [5]           See CDC, “Clinical Overview of Shigellosis,” at https://www.cdc.gov/shigella/hcp/clinical-overview/index.html.

    [6]           See CDC, “Preventing Shigella Infection,” at https://www.cdc.gov/shigella/prevention/index.html.

    [8]           See CDC, “Preventing Shigella Infection Among Food Service Workers and Managers,” at https://www.cdc.gov/shigella/prevention/preventing-shigella-infection-among-food-service-workers-and-managers.html.

    Longhorn Shigella

    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.

    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.

    NNPH has created flyers to help educate people in the community.

    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.