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SHIGELLOSIS

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Report test results, including antibiotic susceptibility results. ... Bacterial susceptibility unknown or Ampicillin and TMP-SMX-resistant ... – PowerPoint PPT presentation

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Title: SHIGELLOSIS


1
SHIGELLOSIS
  • Maria del Rosario, MD, MPH
  • WVDHHR/BPH/IDEP
  • IDEP Training - February 2008

2
Objectives
  • To orient the audience about Shigellosis
    protocol.
  • To discuss important aspects of Shigellosis
    (found on the protocol).
  • To discuss key steps in the management of
    outbreaks.

3
The Protocolhttp//www.wvdhhr.org/idep/pdfs/idep
/Shigellosis/Shigella_Protocol_07.pdf
  • Health Care Provider Responsibilities
  • Laboratory Responsibilities
  • Public Health Action includes outbreak
    management
  • Surveillance, Disease Prevention and Control
    Objectives
  • Epidemiology
  • Clinical Aspects
  • Disease Prevention and Control including
    treatment
  • References

4
Epidemiology (1)
  • Agent genus Shigella (bacteria)
  • 4 species
  • S. sonnei,
  • S. boydii,
  • S. flexneri,
  • S. dysenteriae
  • Reservoir Humans

5
Epidemiology (2)
  • Mode of Transmission
  • Person-to-person fecal-oral, oral-genital, MSM
  • Ingestion of contaminated food and/or drink
  • Contact with contaminated inanimate objects
  • Incubation Period
  • Average 1-3 (up to 4) days
  • Range 12 to 96 hours, up to a week

6
Epidemiology (3)
  • Infectivity
  • Easily transmitted from person-to-person
  • Low infective dose 10 to 100 organisms
  • Asymptomatic individuals or those with mild
    illness can transmit the disease
  • Antibiotic Treatment
  • No treatment required
  • Most infections are self-limited (48-72 hrs.)
  • Reasons for treatment
  • Decrease duration of diarrhea and eradicate
    bacteria from feces
  • Prevent spread of disease

7
Epidemiology (4)
  • Public health implications
  • Outbreak occurrence
  • In crowded living conditions
  • Reasons see Infectivity
  • Increasing and rapid development of antibiotic
    resistance
  • No vaccine

8
Clinical Description
  • Disease presentation, severity, and case fatality
    - dependent upon
  • Host
  • Bacterial serotype
  • Disease Presentation
  • Asymptomatic
  • Fever, nausea, abdominal pain, vomiting,
    dysentery (blood, mucus)
  • Convulsions, intestinal perforation, HUS

9
Case Ascertainment (1)
  • Clinical description
  • An illness of variable severity characterized by
    diarrhea, fever, nausea, abdominal pain, and
    tenesmus. Headache and convulsions have been
    reported in some cases. Asymptomatic infections
    may occur.
  • Laboratory criteria for diagnosis
  • Isolation of shigella sp. from a clinical
    specimen.

10
Case Ascertainment (2)
  • Case classification
  • Probable a clinically compatible case that is
    epidemiologically linked to a confirmed case.
  • Confirmed a case that meets the laboratory
    criteria for diagnosis.

11
  • Public Health Action

12
Is it reportable? (1)
  • YES !
  • WHAT and WHEN
  • Sporadic cases - report within 72 hours of
    diagnosis
  • Outbreak situation report IMMEDIATELY

13
Is it reportable? (2)
  • WHO
  • Healthcare providers and facilities should report
    a (confirmed, probable) case/s, including
    susceptibility test results.
  • Laboratories
  • Report test results, including antibiotic
    susceptibility results.
  • Send isolate to OLS for testing.
  • For details see
  • http//www.wvdhhr.org/idep/PDFs/IDEP/Reportable20
    Diseases_20Conditions_20Events_07.pdf

14
Investigation
  • Ascertain case/s
  • Investigate all cases of shigellosis
  • Initiate general control measures
  • Good hand hygiene
  • Assure safe water supply/source
  • Proper storage and cooking of food
  • Exclude infected (symptomatic or asymptomatic)
    individuals from handling and/or preparing food
  • Advise individuals with diarrhea not to use
    recreational water venues for 2 weeks after
    resolution of symptoms
  • Determine occurrence
  • Outbreak report immediately to IDEP
  • Sporadic cases report within 72 hours
  • Report in WVEDSS

15
WVEDSS Form
Complete the form.
16
OUTBREAK
  • Definition
  • Increase in the number of cases of disease over
    and above the expected number of cases
  • Food-borne outbreak 2 or more cases
    experiencing similar illness after ingestion of a
    common food
  • Water-borne outbreak 2 or more cases
    experiencing similar illness after consumption or
    use of water intended for drinking (also includes
    unintentional ingestion of water in association
    with exposure recreational water)

17
Outbreak Response (1)
  • Ascertain cases.
  • Immediately notify IDEP of the outbreak.
  • Initiate control and preventive measures.
  • Report in WVEDSS.
  • Create a linelist of cases (probable and
    confirmed) and close contacts.

18
Sample Line List
  • Update line list form as often as possible
  • Send/fax the line list form to IDEP as soon as
    created or updated

19
Outbreak Response (2)
  • Create an epi-curve (graphical presentation of
    data obtained from the linelist) Purpose
  • To assess the pattern of disease transmission
  • To guide the investigation
  • To establish appropriate preventive and control
    measures

20
Outbreak Response (3)
  • Focus the interview /investigation on specific
    risk factors based on the pattern of disease
    transmission depicted by the epi-curve

Epi-curve Point Source disease transmission
  • Ask about
  • Food history
  • Restaurant exposure
  • Swimming
  • Visit to waterparks
  • Other activity history

21
Outbreak Response (4)
Epi-curve Person-to-person disease transmission
  • Ask about
  • Daycare
  • School
  • Occupational exposure
  • Activity history

22
Outbreak Response (5)
  • Evaluate preventive and control measures.
  • Assure that cases are appropriately treated
  • Susceptible bacteria Ampicillin, TMP-SMX
  • Bacterial susceptibility unknown or Ampicillin
    and TMP-SMX-resistant Ceftriaxone or
    Azithromycin
  • Exclusion or restriction of foodhandlers/preparers
  • 2005 Food Code
  • Until 2 negative stool cultures taken 24 hours
    apart, collect specimen after 48 hours of
    completion of antibiotic treatment
  • See protocol for details

23
Outbreak Response (6)
  • Preventive and Control Measures
  • Child care centers
  • Exclude all infected
  • Emphasize hand hygiene
  • Supervise handwashing of young children
  • Access to handwashing sinks for young children
  • Eliminate access to shared water play areas
  • Sanitary diaper changing techniques and cleaning
    of diapering areas

24
Outbreak Response (7)
  • Preventive and Control Measures
  • Child care centers cont.
  • Sanitary food handling
  • Culture all symptomatic persons. If positive,
    treat.
  • Infected foodhandlers follow Food Code
  • Exclude non-foodhandlers from childcare till
    diarrhea stops and culture taken 24 hours after
    antibiotic completion is negative
  • Cohorting when resources allow

25
Outbreak Response (7)
  • Preventive and Control Measures cont.
  • Preschool, Kindergarten, Grade school
  • Exclude all infected
  • Emphasize hand hygiene
  • Supervise handwashing of young children
  • Eliminate access to shared water play areas
  • Sanitary food handling
  • Culture all symptomatic persons. If positive,
    treat.
  • Infected foodhandlers follow Food Code
  • Infected non-foodhandlers treat, exclude until
    diarrhea stops and negative culture

26
Outbreak Response (8)
  • Preventive and Control Measures cont.
  • Institutional setting (HCF, LTCF, etc.)
  • Strict attention to hand hygiene
  • Sanitary food handling
  • Culture all symptomatic persons. If positive,
    treat.
  • Infected foodhandlers follow Food Code
  • Infected non-foodhandlers treat, exclude until
    diarrhea stops and negative culture taken 24
    hours after completing treatment
  • Cohort if resources allow

27
Outbreak Response (9)
  • Forward outbreak paper report to IDEP.
  • Several entities may need to be involved in the
    write-up

28
References
  • IDEP Shigellosis
  • http//www.wvdhhr.org/idep/a-z/a-z-shigellosis.asp
    Protocol
  • Food and Waterborne Outbreak Manual
  • Coming soon!
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