California Restaurant Source of Shigella - Number of Cases Continues to Climb

UPDATE (10/23/15)- Within a few days, the number of Shigella cases linked to a California restaurant continues to climb.  Reports now have the number at 110 cases in 4 different California Counties.

10/20/15
A California restaurant is being held responsible for up to 80 people becoming infected with Shigella with about a dozen becoming hospitalized.  Because this is a highly contagious bacterial infection, a number of secondary infections are beginning to arise. (People who are contracting the disease from someone who ate at the restaurant).

Shigella causes severe diarrhea, sometimes bloody, as well as fever and abdominal pain. Symptoms will occur within a day or two after infection and will last 5 to 7 days.  It is highly infectious, only requiring less than 20 cells to cause infection.  It spreads through contact with food or person to person which can be problematic when someone has profuse diarrhea and does not wash their hands or washes their hand insufficiently. 

 

Glove usage handling ready-to-eat foods would help...but that is not a law in CA.  In 2014, California repealed the law requiring glove usage to prevent bare hand contact with ready-to-eat food.

Getting sick workers to stay home is another issue.  Many people will still go to work even if they are ill.

 

 

Increased Number of Shigella Cases Occurring in US

CDC is reporting that there has been an increase in the number of Shigella infection cases in the US.  Of the 243 cases,  45 cases were reported in Massachusetts. California had 25 cases and there were 18 cases in Pennsylvania.   The strain is resistant to the antibiotic Ciprofloxacin, a second generation antibiotic, which does cause the medical community a little concern.

Shigella causes diarrhea, sometimes bloody, that can last for 5 to 7 days.  It is highly infectious and is spread from a person who is sick to another person via the fecal oral route.  So hand washing is important.  It is considered a foodborne pathogen, so food that has been handled by someone with Shigella can serve as a vector.

 

Keys to prevention - Exclusion of people who have the symptoms or who have been diagnosed, and proper hand washing.

 

 

US News and World Report

http://www.usnews.com/news/articles/2015/04/02/drug-resistant-stomach-bug-spreading-across-the-us

Drug-Resistant Stomach Bug Spreading Across the U.S.

By Kimberly Leonard April 2, 2015 | 5:26 p.m. EDT

Travelers are infecting Americans when they return home.

A recent, rapid spread of a diarrhea-causing bug that is immune to medicine has caused government health officials to issue a warning to travelers about their hygiene.

Shigella Outbreak in American Samoa, 2014 - CDC MMWR

Shigella is one of the reportable illnesses according to the US Food Code.  In this CDC MMWR Report, it can be seen why when you consider so many children became infected in such a short period of time.

In this outbreak, some 280 cases of severe diarrhea (and in some cases bloody diarrhea), primarily among young children, were seen on this US Territorial Island.  Investigators felt that most of the cases were due to person-to-person contact [although it can be transferred via ready-to-eat foods when the foods are handled by an infected handler.]

 

    

CDC - Morbidity and Mortality Weekly Report (MMWR)

 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a8.htm?s_cid=mm6401a8_e

Notes from the Field: Outbreak of Diarrheal Illness Caused by Shigella flexneri — American Samoa, May–June 2014

  

Weekly

 

January 16, 2015 / 64(01);30-30

  

Julia E. Painter, PhD1,2, Allison Taylor Walker, PhD1,2, Jarratt Pytell2, Motusa Tuileama Nua3, Siitia Soliai-Lemusu3, Eric Mintz, MD2, Ibne Ali, PhD2, Michele Parsons, MS2, Haley Martin2, Michael Beach, PhD2, Anna Bowen, MD2, Jennifer Cope, MD2 (Author affiliations at end of text)

 

On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea. Based on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15–June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. Cases were widely distributed across the island. The highest number of cases occurred in children aged 0–9 years. Across age groups, cases were similarly distributed among males and females. These patterns are not consistent with the epidemiology of disease caused by E. histolytica, which tends to cause more cases in males of all ages.