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.