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.

The County of San Diego Health and Human Services Agency is monitoring an outbreak of at least six cases of shigellosis in individuals experiencing homelessness since Sept. 30, 2021.

The cases were found after the individuals were hospitalized. They are expected to recover.

The County has notified the City of San Diego and will work with the city and potential exposure sites and homeless service providers to ensure good hygienic precautions, identify any additional cases and connect ill individuals to treatment and housing.

A health advisory to local providers also has also been issued.

“Shigellosis isn’t usually serious, but in the wrong circumstances it can spread, and we want to ensure this vulnerable population is kept safe,” said Seema Shah, M.D., medical director of HHSA’s Epidemiology and Immunization Services branch.

Shigellosis is a contagious infection typically spread by contaminated surfaces, food or water, or sometimes person-to-person such as men who have sex with men (MSMs). In 2020, the County identified 243 total cases; to date in 2021, the County has identified 220.

Although only a small number of organisms can make a person sick, casual contact is not the main way shigellosis bacteria are spread. Typical symptoms include diarrhea (sometimes bloody), fever and stomach cramps.

The infection is diagnosed with stool testing. Most people will recover fully without antibiotic treatment, though individuals with poor immune systems can develop life-threatening disease. If you have symptoms that resemble shigellosis, contact your primary care physician for assistance.

Recognized worldwide as the most common cause of dysentery, the Shiga bacillus—or Shigella—is a gram-negative rod belonging to the family Enterobacteriaceae, so named because many of its members live in the intestines of humans and warm-blooded animals. 

Shigellosis is the clinical syndrome caused by Shigella species and is most typically associated with diarrhea and other gastrointestinal symptoms. Shigella species are transmitted by the fecal-oral route, and most infections are transmitted from person to person, reflecting the low infectious dose. Because of its quite common person-to-person spread, shigellosis has long been associated with outbreaks in daycare centers, nursing homes, institutional settings (e.g., prisons), and cruise ships. Shigella infections also may be acquired from eating contaminated food; studies estimate that approximately one-third of U.S. shigellosis cases annually might be caused by the consumption of contaminated food. 

Most people who are infected with Shigella develop diarrhea, fever, and stomach cramps after being exposed to the bacteria. Symptoms may start 12 to 96 hours after exposure, usually within one to three days. Reactive arthritis can develop after a Salmonella infection. The other relatively rare complication that can occur with a Shigella infection is the development of hemolytic uremic syndrome (HUS). This rare complication is more commonly caused by E. coli O157:H7, and it can lead to a low red blood cell count (hemolytic anemia), low platelet count (thrombocytopenia), and acute kidney failure. It is more common to develop HUS after being infected with S. dysenteriae.

Seattle & King County is reporting an increase in shigellosis cases since mid-December in King County. Since the end of October, Public Health has received 40 total reports of Shigella infection, with 22 of those reported since December 14th. This compares to an average of 2-3 cases reported during a typical week this year. Public Health has had 173 reported cases of Shigella in 2019 and 129 cases in 2020 from preliminary data.

Shigella germs (bacteria) spread easily from one person to another because it takes as few as 10 germs to make you sick. Symptoms of shigellosis include diarrhea, fever and stomach cramps. Most people get better after about one week but can be sick longer or become dehydrated and need medical care. People can also be contagious even after feeling better. The germs can spread when someone with Shigella does not wash their hands well after using the toilet then contaminates objects, food or water. Shigella also spreads easily through sexual contact. Handwashing with soap and water is the best way to protect yourself and others against Shigella infections.

Among the recent infections, 28 cases occurred among people who reported experiencing homelessness or unstable housing or who accessed homeless services. These cases have occurred across multiple settings and no common source among the cases has been identified. Typically, in the U.S., those considered at highest risk for getting Shigella are travelers to developing countries, men who have sex with men, young children, and those with weakened immune systems. However, we know people experiencing homelessness are at increased risk for a wide range of health problems, including outbreaks caused by infectious diseases.

“Outbreaks of Shigella among people living homeless are often a reflection of the lack of access to medical care, basic hygiene and sanitation resources,” said Elysia Gonzales, Medical Epidemiologist, Public Health – Seattle & King County. “Shigella is highly contagious. It’s important that anyone with symptoms of Shigella contact a healthcare provider for potential testing and treatment to help decrease the spread of preventable illnesses among our most vulnerable residents.”

Public Health has identified at least 20 different homeless service sites that were visited by someone while infectious or just prior to illness. The public health team has been contacting homeless service providers at these sites, which include emergency shelters, day centers, supportive housing, food services, and encampments, to assess for any other known diarrheal illnesses and to provide infection control guidance.

Public Health has also been working with partners who conduct outreach to homeless service providers and homeless communities to assess for any possible cases of Shigella and to reinforce the importance of access to hand washing resources.

People who have Shigella usually get better with fluids and rest and do not typically require antibiotic treatment. Those with weakened immune systems can get a more serious illness. It is important to contact a healthcare provider if you have signs or symptoms such as diarrhea, fever, stomach cramps or dehydration, especially if these symptoms continue for more than a few days or become severe. Antibiotics can be an important part of controlling transmission in outbreak settings or among those living in crowded and unsanitary conditions and can shorten the duration of fever and diarrhea in individuals. However, there is also growing concern about antibiotic-resistant Shigella infections, so healthcare providers should do laboratory testing of stool samples to make sure they are prescribing the right antibiotic.

Homeless service sites who suspect any clusters of diarrheal illness should contact Public Health at 206-296-4774. The Sanitation and Hygiene Guide for Homeless Service Providers has information about special cleaning and disinfection practices for vomit, diarrhea, or blood.

More information about Shigella is available at King County’s shigellosis page and CDC’s shigellosis page.

The Multnomah County Health Department ordered the immediate closure of the Small Pharaoh #1 food cart in downtown Portland (SW 5th and Stark) late Tuesday, Aug. 11, 2020 after linking the business to an outbreak of shigellosis. This is the first food cart closure in Multnomah County in many years due to health concerns. Food carts are inspected, regulated and scored the same as brick and mortar restaurants.

Shigellosis is caused by a type of bacteria known as shigella that can cause severe gastrointestinal illness in people, including diarrhea, fever and cramps. It can also lead to more severe illnesses such as sepsis and kidney injury. Local data indicate that one out of three diagnosed infections typically require hospitalization.

Shigella is spread through food, through water, or person to person by swallowing fecal matter. Most people recover without treatment, and  this particular strain is highly resistant to the most common antibiotics used to treat shigellosis.

Health officials took the unusual step of ordering the closure of the food cart at 5th and SW Stark after several individuals from different households were confirmed to have shigellosis after eating food from the facility. Four cases have been confirmed with three additional presumptive cases with symptoms who have not been tested. Shigella is a very contagious bacteria and can spread after swallowing a very small amount of the bacteria.

Anyone with symptoms of shigellosis who ate at the downtown location of Small Pharaoh between July 27 and August 11 should contact their care provider or seek medical care as needed.

In general, anyone ill with diarrhea should stay home from work, especially if they prepare food or work in child care or a long-term care facility. Shigella can spread easily among people who live together. To prevent spread in a household: wash hands well before eating and after using the bathroom, and avoid sex until the diarrhea is completely gone.

Health care providers who believe someone is ill enough to need antibiotics should consult with an infectious disease specialist and Multnomah County Health Department about the details of drug resistance.

For consultation or to report possible illness associated with this outbreak, call 503-988-3406.

Shigella is a reportable illness, and 47 cases have been reported to the Health Department in 2020. Historically, the majority of shigella infections in the Portland area are acquired during international travel or through intimate contact among men who have sex with men. Since 2015, Multnomah County has identified cases among persons experiencing homelessness that were caused by shigella strains that had been previously circulating in the area among housed individuals. In other parts of the United States, shigella frequently causes outbreaks in childcare and long-term care facilities