Posted Nov. 22, 2023. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.
Situation
Spokane County is currently experiencing a community-wide increase in shigellosis, with case counts higher than what is typically observed. Additionally, since 10/30/2023, five hospitalized cases of shigellosis among persons experiencing homelessness (PEH) have been reported in Spokane County. Spokane Regional Health District is currently working to identify specific settings or scenarios where transmission is occurring. Due to the distribution of cases, we believe there are likely others within the community of PEH with shigellosis who have not been identified.
Shigella bacteria causes a gastrointestinal infection called shigellosis. Shigella can spread easily from one person to another via fecal-oral transmission. It can spread 2 weeks after diarrhea has subsided due to bacterial shedding in feces.
Shigella is highly contagious; a very small inoculum (10 to 200 organisms) is sufficient to cause infection.
Requested Actions
- Be aware of symptoms and diagnosis and treatment of Shigella and other gastrointestinal-related illnesses.
- Order a gastrointestinal (GI) bacterial pathogen panel, by testing a stool sample from patients who present with diarrhea, especially in PEH.
- Report positive cases of shigellosis to the Spokane Regional Health District within 24 hours:
- Call reports to 509-324-1449 (24/7 recorded report line)
- Or fax to 509.324.3623
- Prior to treatment with antibiotics (which is not indicated for all cases), order antimicrobial susceptibility testing (AST), in addition to the stool culture.
- Food workers, healthcare workers, childcare workers, and people who attend childcare that test positive for Shigella must receive 2 negative PCR or culture stool specimens (24 hours apart, at least 48 hours after completion of antibiotics) before returning to work/childcare.
Clinical Considerations
Most people with Shigella infection (shigellosis) experience:
- Diarrhea that can be bloody or prolonged (lasting more than 3 days)
- Fever
- Stomach pain
- Feeling the need to pass stool (poop) even when the bowels are empty.
Symptoms usually start 1-2 days after infection and last 7 days. In some cases, bowel habits (frequency and consistency of stool) do not return to normal for several months.
Groups at higher risk for infection or severe illness:
Testing and Treatment
- Request a stool specimen for testing by culture or by a culture-independent diagnostic test (CIDT).
- Fluoroquinolones (such as ciprofloxacin), azithromycin, and third-generation cephalosporins (such as ceftriaxone) are recommended antibiotics. Trimethoprim-sulfamethoxazole and ampicillin are options if susceptibility is documented.
- If a patient has prolonged diarrhea (diarrhea lasting more than 3 days), follow-up stool cultures may be needed.
Patient Education
To prevent the spread of Shigella bacteria, please share these prevention messages with your patients with shigellosis:
- Wash hands with soap and water for at least 20 seconds:
- After using the toilet
- After changing a diaper or assisting anyone with toileting
- Wash child’s hands in addition to your own
- Do not share cigarettes or drug paraphernalia for two weeks after diarrhea has resolved.
- Avoid preparing food for friends, neighbors, colleagues, and (if possible) your family while you are sick, and up to two weeks after diarrhea has resolved.
- Stay home while you are sick.
- Food workers, healthcare workers, childcare workers, and people who attend childcare that test positive for shigella must receive 2 negative stool specimens (PCR or culture negative) before returning to work/childcare. Specimens must be collected at least 24 hours apart and at least 48 hours after completion of antibiotics.
- Wait to have sex (vaginal, anal, and oral) for two weeks after you no longer have diarrhea. Because Shigella
germs may be in stool for several weeks, follow safe sex practices, or ideally avoid having sex, for several weeks after you or your partner have recovered.
- When you start having sex again, wash your body and hands before and after sex, including in and around the anus and genitals.
- During oral sex (fellatio or cunnilingus) or oral-anal sex (anilingus or mouth to anus), use barriers, such as condoms, natural rubber latex sheets, dental dams, or cut-open non-lubricated condoms between your rectum and your partner’s mouth.
- Use condoms the right way, every time during anal or vaginal sex. Wash hands after handling used condoms or other barriers.
- Urge others you know with similar symptoms to seek health care.
- Avoid swimming until you have fully recovered.
Please contact the Spokane Regional Health District Communicable Disease at 509.324.1442 or cdepi@srhd.org
with any questions or concerns.
