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Shigellosis

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Very easy to spread from one person to another ... Shigella is shed in the stool of infected people and is most often spread: ... – PowerPoint PPT presentation

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Title: Shigellosis


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

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12
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

13
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

14
Shigellosis Outbreak Fill-and-Drain Wading Pool-
Iowa 2001
  • Symptoms
  • 100 diarrhea
  • 51 nausea
  • 47 vomiting
  • 39 bloody diarrhea
  • 29 headache
  • 16 hospitalized

15
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

16
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 0157H7

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18
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

19
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

20
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

21
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 (OR52.5)

22
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

23
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

24
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

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26
Day Care-Related Outbreaks of Rhamnose-Negative
Shigella sonnei Six states June 2001-March 2003
MMWR 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

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28
Multi-state Day Care Outbreak MMWR 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

29
Multi-state Day Care Outbreak MMWR 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

30
Multi-state Day Care Outbreak MMWR 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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