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Understanding Shigellosis: Shigella Bacteria Overview

Shigellosis is a serious gastrointestinal illness caused by Shigella bacteria, affecting babies, elderly, and unwell individuals. Learn about symptoms, spread, prevention, and outbreaks from a case study in Iowa.

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Understanding Shigellosis: Shigella Bacteria Overview

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  1. Shigellosis

  2. Shigellosis • Serious gastrointestinal illness caused by the Shigella bacteria • Very easy to spread from one person to another • It is very serious in babies, older adults, and people who are not well

  3. Background • Discovered over 100 years ago by a Japanese scientist named Shiga • Different serotypes • Shigella sonnei – Group D – 2/3 • Shigella flexneri – Group B – almost the rest • Shigella dysenteriae type 1 – deadly epidemics in developing world

  4. How is shigellosis spread? • Shigella is shed in the stool of infected people and is most often spread: • on hands that have not been washed after using the bathroom • from touching others or by touching food or drinks that others will eat • by sexual practices that involve fecal-oral contact • In countries with inadequate sewage disposal, flies can carry Shigella from feces to food

  5. Symptoms • The symptoms of Shigella infection are: • sudden stomach pain • stomach cramps • diarrhea • hospitalization • Young children – high fever & seizures • fever • vomiting • blood, pus, and mucus in the stool • Symptoms begin about one day to one week after a person becomes infected and can last up to one week. • Some people may have no symptoms but can still spread the infection to others.

  6. Incubation Period & Duration • Incubation Period - 1-4 days • Duration • 5-7 days

  7. Treatment • Antibiotics may be used to treat shigellosis, but there are some resistant strains.

  8. Prevention • Washing hands with soap and running water is the most important way to prevent the spread of Shigella • after using the bathroom • after changing diapers • after cleaning the toilet • after handling soiled towels or linens • before eating • before preparing food • People with diarrhea should not fix or serve food that will be eaten by others

  9. Prevention in Day Care Setting • Never send a child with Shigellosis to a day care center, especially if the child has diarrhea • Use day care centers that do the following: • staff wash their hands after changing each diaper • staff clean the changing area after each child • children must wash their hands often • children must wash their hands after using the toilet • ill children are cared for at home or in a separate room • facility is clean and sanitary

  10. MMWR: Shigellosis Outbreak Associated With an Unchlorinated Fill-and-Drain Wading Pool- Iowa 2001 • June 15, 2001 • Local physicians reported 11 cases of diarrhea to LHD • 2 lab confirmed as Shigella sonnei • 9 visited large water park with a wading pool • Questionnaire • Demographics • Illness history • Participation in group gatherings • Water activities • Use of the park or wading pool

  11. Shigellosis Outbreak Fill-and-Drain Wading Pool- Iowa 2001 • Primary case • Diarrhea within 72 hours of visiting the park during June 11-13 • Secondary case • Diarrhea within 72 hours of household contact with a primary case patient • 89 Interviewed • 45 primary cases • 16 lab confirmed Shigella sonnei • 24 secondary cases • 10 lab confirmed Shigella sonnei

  12. Shigellosis Outbreak Fill-and-Drain Wading Pool- Iowa 2001 • Symptoms • 100% diarrhea • 51% nausea • 47% vomiting • 39% bloody diarrhea • 29% headache • 16% hospitalized

  13. Shigellosis Outbreak Fill-and-Drain Wading Pool- Iowa 2001 • Pool exposure associated significantly with illness • Pool frequented by diaper and toddler aged children • 20-30 children at one time • “Fill & Drain” system • Filled each morning with potable city water • Drained & Left empty each evening • Backflow device- no recirculation or disinfection system (pump, filter, mechanical disinfection system) • Each morning before filling, pool is rinsed with a high pressure washer and is scrubbed with a chlorine cleanser twice weekly • Chlorine levels were not monitored and chlorine was not added to the pool water

  14. Shigellosis Outbreak Fill-and-Drain Wading Pool- Iowa 2001 • Inadequate disinfection of pool • Heavy use by diaper and toddler aged children • Transmission of shigellosis – result of residual contaminated water • Infectious dose is low • Small volume of ingested water can cause infection • Lack of chlorination- increased risk of spread of E.coli 0157:H7

  15. Shigellosis Outbreak Fill-and-Drain Wading Pool- Iowa 2001 • Prevention • Not swimming ill with diarrhea • Not swallowing recreational water • Practicing good hygiene when using the pool

  16. Shigellosis Outbreak Fill-and-Drain Wading Pool- Iowa 2001 • Single outbreaks can expand to community-wide outbreaks • Educate community about possible modes of transmission • Child care facilities • Food handlers • Swimming • Prevention recommendations • Thorough handwashing after using restrooms, changing diapers and before handling/preparing foods • Enforcement of exclusion criteria at child care facilities • Exclusion of persons from swimming while ill with diarrhea

  17. MMWR: Outbreak of Gastroenteritis Associated With an Interactive Water Fountain at a Beachside Park – Florida, 1999 • Florida Dept. of Health • 3 reports of Shigella sonnei linked to an interactive water fountain at a beachside park • A case • Abdominal cramps or diarrhea ( 3 or more loose stools within 24 hour period) in a person who visited the park on August 7-27 with illness onset <12 days after visit

  18. Water Fountain Outbreak • 86 park visitors were interviewed • 38 met case definition • Onsets of illness - August 15- September 2 • Median age - 8 years (Range 2-65 years) • Symptoms • 97% diarrhea • 90% abdominal cramps • 82% fever • 66% vomiting • 13% bloody diarrhea • 5 Lab confirmed cases of Shigella and 2 cases of Cryptosporidium • Water fountain ingestion (OR=52.5)

  19. Water Fountain Outbreak • Environmental assessment • Fountain used re-circulated water that drained from the wet deck/play area floor into an underground reservoir • Re-circulated water passed through a hypochlorite tablet chlorination system before being pumped back to the reservoir and then to several high-pressure fountain nozzles at ground level throughout the play area

  20. Water Fountain Outbreak • Several potential opportunities for water contamination • Fountain popular with diaper and toddler aged children who frequently stood directly over the nozzles • Chlorine levels were not monitored • Hypochlorite tablets were depleted after 7-10 days of use and had not been replaced after the park opened on August 7

  21. Water Fountain Outbreak • Park re-opened on December 12 • Cartridge filtration system installed • Chlorine monitor installed to halt fountain operation automatically when residual chlorine levels fall below 3ppm • Sign advising visitors to shower before entering the fountain and to avoid water consumption • Children with diapers were excluded from entering the fountain

  22. Day Care-Related Outbreaks of Rhamnose-Negative Shigella sonnei: Six states June 2001-March 2003MMWR 53 (3) 60-63, 2004 • June 2001- March 2003 • Shigella sonnei outbreaks • Delaware, Maryland, New Jersey, North Carolina, South Carolina, and Virginia • Five to forty-fold increases in statewide Shigella rates • Outbreaks in multiple day care centers that became prolonged and communitywide • Isolates genetically similar (PFGE) • 3,081 lab confirmed cases • A day care related case was defined as S.sonnei infection in a child attending day care or in a close contact of child attending day care

  23. Multi-state Day Care OutbreakMMWR 53 (3) 60-63, 2004 • Southeastern Virginia • 878 lab confirmed cases • Maryland • 1,222 lab confirmed cases • New Jersey • 453 lab confirmed cases • Delaware • 506 lab confirmed cases • North Carolina • 935 lab confirmed cases • New York City • 115 lab confirmed cases • Pennsylvania • 317 lab confirmed cases

  24. Multi-state Day Care OutbreakMMWR 53 (3) 60-63, 2004 • PFGE • 1,349 isolates submitted to PulseNet • 2 dominant patterns found • 505 (37%) • 382 (28%) • PFGE & Rhamnose fermentation • 386 isolates • 246 had the dominant pattern • 241 (98%) rhamnose negative

  25. Multi-state Day Care OutbreakMMWR 53 (3) 60-63, 2004 • Public Health Interventions • All Health departments excluded children with diarrhea from day care • Not allowed to return until diarrhea ceased • All but one health department did not allow children to return until two stool cultures testing negative for Shigella had been

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