Shigella Information

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According to press reports, two Maplewood Elementary School children have been infected with shigellosis, the illness caused by Shigella infection.  The Marion County Health Department contacted Maplewood officials on Wednesday, informing them that two students had contracted the illness; the school district launched an immediate review and response.

School district spokesman Kevin Christian said the bacteria were not found at the school. But since both cases involved Maplewood students, officials decided to clean the school for the safety of the students. It sent a team of custodians to scrub the school and cafeteria just in case the bacteria originated there.

Christian said the illness is more common in the day-care setting.

The school district also sent an Alert Now message and a letter to Maplewood parents.

Superintendent of Schools Jim Yancey said the district does not know who the children are since, by law, the Health Department could not disclose those names.

Yancey said the district response was phenomenal. He said he was worried because of the profoundly disabled young students at the school. He wanted to make sure the bacteria, if any, was eliminated quickly.

“It sounds like they did a good job,” said School Board Chairwoman Judi Zanetti.

Yancey said health officials say only 14,000 shigellosis cases are reported annually in the United States.

A new study published in the Centers for Disease Control and Prevention’s (CDC) journal, Emerging Infectious Diseases, found that the rate of outbreaks caused by unpasteurized milk (raw milk) and unpasteurized milk products was 150 times greater than outbreaks linked to pasteurized milk. In addition, the study revealed that states where raw milk sales are legal had more than twice the rate of outbreaks as states where it was illegal.

The 13-year study, involved a review of dairy product outbreaks from 1993 to 2006 in all 50 states. The authors compared the amount of milk produced in the United States during the study period (about 2.7 trillion pounds) to the amount that CDC estimates was likely consumed raw (1 percent or 27 billion pounds) to determine the 150 times higher rate for outbreaks caused by raw milk products. Raw milk products include cheese and yogurt.

The study included 121 dairy–related disease outbreaks, which caused 4,413 illnesses, 239 hospitalizations and three deaths. In 60 percent of the outbreaks (73 outbreaks) state health officials determined raw milk products were the cause. Nearly all of the hospitalizations (200 of 239) were in those sickened in the raw milk outbreaks. These dairy-related outbreaks occurred in 30 states, and 75 percent (55 outbreaks) of the raw milk outbreaks occurred in the 21 states where it was legal to sell raw milk products at the time. The study also reported that seven states changed their laws during the study period.

For a consumer, it is impossible to tell if raw milk is safe to drink by simply looking at, smelling, or tasting it. Even under ideal conditions of cleanliness, the process of collecting milk introduces some bacteria. Unless the milk is pasteurized, these bacteria can multiply and grow in the milk and cause illness in those who consume it. Pasteurization involves heating milk to kill disease-causing bacteria.

“This study shows an association between state laws and the number of outbreaks and illnesses from raw milk products,” said Robert Tauxe, M.D., M.P.H., deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases (DFWED). “Restricting the sale of raw milk products is likely to reduce the number of outbreaks and can help keep people healthier. The states that allow sale of raw milk will probably continue to see outbreaks in the future.”

The study also found that the raw milk product outbreaks led to much more severe illnesses, and disproportionately affected people under age 20. In the raw milk outbreaks with known age breakdowns, 60 percent of patients were younger than age 20, compared to 23 percent in outbreaks from pasteurized products. Because of their underdeveloped immune systems, children are more likely than adults to get seriously ill from the bacteria in raw milk.

“While some people think that raw milk has more health benefits than pasteurized milk, this study shows that raw milk has great risks, especially for children, who experience more severe illnesses if they get sick,” said study co-author Barbara Mahon, M.D., M.P.H., deputy chief of CDC’s DFWED Enteric Diseases Epidemiology Branch. “Parents who have lived through the experience of watching their child fight for their life after drinking raw milk now say that it’s just not worth the risk.”

Additional information on evidence-based scientific studies covering the benefits and risks of raw milk consumption can be found HERE (pdf).

Shigella bacteria cause human illness when they are ingested, and can lead to Shigella infection, or shigellosis, through various modes of transmission, including through food and water sources, animal-to-human contact, and person-to-person contact in daycares and other settings.

Improper sanitation and cross-contamination can be contributing factors to Shigella outbreaks associated with restaurant food.

The introduction of pasteurization greatly reduced the number of foodborne illness outbreaks associated with milk and other dairy sources, but the consumption of raw milk and unpasteurized cheeses remains a risk factor for Shigella infection. Shigella and other pathogens are shed in the feces of livestock such as cows and goats and can contaminate milk during the milking process.

Fresh fruits and vegetables can become contaminated before or after harvest. Water intended for recreation (e.g., pools, shallow lakes) and for human consumption can also become contaminated. When lakes become contaminated it may be several weeks or months before water quality conditions to improve or return to normal. Proper chlorination kills Shigella bacteria in pools and municipal water systems.

Person-to-person transmission of Shigella occurs through a fecal-oral route, and is particularly common among infants and young children due to their unrefined hygienic practices. Person-to-person transmission of Shigella has also been known to occur between infected individuals and their caregivers, and between infected food handlers and people who consume the food they prepare.

Shigellosis cases continue to rise in Louisville, with 18 laboratory-confirmed cases last week.

That’s the highest number in any week so far during the current outbreak, which has seen 84 confirmed cases in 13 weeks.

Shigellosis is a highly-contagious diarrhea illness caused by Shigella bacteria. Symptoms include watery or loose stools for several days, and in severe cases abrupt onset of fever, nausea, abdominal cramping and vomiting.

For the past five years, Louisville has had an average of 62 confirmed cases annually.

To prevent the illness, health officials are urging people to wash their hands carefully with soap and water, including under the fingernails. This is especially important after handling items such as diapers, after each bowel movement, after helping children use the toilet and before preparing or eating food, health officials said.

There has been a noticeable spike in Shigella infections throughout Florida and Georgia (the First Coast). In Florida, for example, there were 1,213 reported Shigella infections in 2010. This year, there has been 2,218 cases. The reason for the spike is not currently known, although the Duval County Health Department is busy investigating.

Shigella belongs to a family of bacteria that can cause sudden and severe diarrhea in humans. Shigellosis, the illness caused by the ingestion of Shigella bacteria, is also known as bacillary dysentery. Shigella thrives in the human intestine and is commonly spread both through food and person-to-person contact. Shigella is the third most common pathogen transmitted through food.

Jacksonville NBC affiliate First Coast News reports:

Duval County health leaders say kids are very vulnerable to the infection. Seventy-four percent of cases here have been people between the 0-and-19 age range.

“It’s harder to get kids to wash their hands properly and certainly the little kids like two to four year olds, you have to watch them wash their hands because they’re still learning to wash their hands and so you just really have to encourage that good behavior,” said Karen Elliott, surveillance epidemiologist with the Duval County Health Department.

Forty-five people in Brooklyn’s ultra-Orthodox communities in Williamsburg and Borough Park have been infected by shigella since August, according to city health officials.

Each year, New York City has between 300 and 400 cases of the disease, which frequently crops up in day care centers and other places where children congregate. The majority of those affected in this latest outbreak were also children.

No one has been hospitalized, city health department officials said.  The health department has asked doctors not to use antibiotics to treat shigella because drug-resistant strains of the bacteria may be starting to spread.

Shigella is a highly contagious and virulent bug that is commonly the culprit in outbreaks at schools and other institutional settings.  Shigella outbreaks are frequently caused by the fecal-oral route, whether the route of ultimate transmission be food or contact with surfaces contaminated by the bacteria.  This means that bacteria from the stool of an infected person is ingested by another person, leading to illness.

In any event, a large Shigella outbreak has occurred at Honea Path Elementary School in South Carolina.  Dozens of students have fallen ill in the past several weeks, causing the principal of Honea Path Elementary School to send a letter home to parents explaining what Shigella is and the importance of good handwashing. 

Officials with the State Department of Health and Environmental Control have assisted in the investigation of this outbreak, and have encouraged the school and staff, as well as parents, to recognize the ease by which Shigella can be transmitted person-to-person, and the resulting importance of good handwashing. 

There’s a bacterial infection making the rounds in the Hub City. Shigellosis is the result of a battle of bacteria. Due to an increasing number of gastrointestinal illnesses, the Lubbock Health Department is trying to spread the word about this nasty germ. It’s not uncommon for an outbreak this time of year, but the jump in numbers has the medical community concerned.

“There have been over a hundred cases since January in Lubbock and over a third of those have been since October 6th. So we’ve seen a distinct jump in the number of cases,” said registered nurse, Judy Davis.


About Shigella and its companion Shigella Blog were updated once again after extensive revisions by experts in the field and the staff and lawyers at Marler Clark, LLP PS, the only law firm in the United States that focuses its entire practice on foodborne illness litigation.

Shigella is a family of bacteria that can cause sudden and severe diarrhea (gastroenteritis) in humans. Shigellosis – the illness caused by the ingestion of Shigella bacteria – is also known as bacillary dysentery. It can occur after ingestion of fewer than 100 bacteria, making Shigella one of the most communicable and severe forms of the bacterial-induced diarrheas.

Shigella thrives in the human intestine and is commonly spread both through food and by person-to-person contact. Most Shigella infections are passed through the fecal-oral route. This happens when basic hygiene and handwashing habits are inadequate and can happen during certain types of sexual activity. Transmission is particularly likely to occur among toddlers who are not fully toilet-trained. Family members and playmates of such children are at high risk of becoming infected.

Food may become contaminated by infected food handlers who don’t wash their hands with soap after using the bathroom. Vegetables can become contaminated if they are harvested from a field with sewage in it. Flies can breed in infected feces and then contaminate food.

Water may become contaminated with Shigella bacteria if sewage goes into it or if someone with shigellosis swims in or plays with the water (especially in splash tables, untreated wading pools, or shallow play fountains used by daycare centers). Shigella infections can then be acquired by drinking, swimming in, or playing with the contaminated water.

The number of shigellosis cases reported annually to the Centers for Disease Control and Prevention (CDC) has varied over the past several years, from more than 17,000 during 1978–2003, to an all-time low of 14,000 in 2004, to almost 20,000 in 2007. Many cases go undiagnosed and/or unreported, however. The CDC estimates that 450,000 total cases of shigellosis occur in the U.S. every year.

Shigella is the third most common pathogen transmitted through food. During 2006, a total of 1,270 foodborne-related outbreaks from 48 states in the U.S. were reported. Although Shigella was responsible for only 10 (1%) of those outbreaks, 183 confirmed cases of shigellosis were reported. This contrasts with an average of 659 cases annually in the previous five years. Shigella has also responsible for a substantial portion of foodborne outbreaks on cruise ships.