Shigella Outbreak in Santa Cruz County

• Shigellosis is a highly infectious intestinal disease caused by a family of bacteria called Shigella.

• The incubation period is 12 hours to 4 days, meaning that illness usually starts between 12 hours and 4 days after shigella bacteria enter the body.
• The main sign of shigella infection is diarrhea, which can be watery, bloody, or both. Many people with shigella also get fever, stomach aches, and nausea. Vomiting can occur but is not common.
• Symptoms typically last 4-7 days. People with mild illness usually get better without specific treatment.
• With more severe shigella infection, patients can get diarrhea so severe they become dehydrated. Occasionally, shigellosis causes seizures, bloodstream infection, or arthritis, and can rarely result in death.

• Shigella is highly infectious and spreads very easily. Anyone can be infected with Shigella.
• When people become infected, Shigella organisms are present in their stool or diarrhea.
• • Spread of infection can occur when tiny particles of infected stool enter another person’s mouth.
  • In the United States, Shigella infection is usually passed from person-to-person by interpersonal contact.
    • For example, Shigella can be passed among young children in childcare who are all handling the same toys or among adults who are unable to properly their wash hands.
• Shigella has also been known to spread through: sexual contact, eating raw foods contaminated by an infected food handler, or by drinking contaminated liquids.
• People who have been ill can continue to carry shigella bacteria for weeks after feeling better, so good handwashing after going to the bathroom is important to prevent illness from spreading.

• Handwashing! Thoroughly clean your hands using soap and water for at least 20 seconds, or use hand sanitizer followed by hand washing at earliest opportunity. Do this frequently, and before eating, drinking, or touching your face. Make sure to clean under your nails.
• Creeks, rivers, lagoons, and ocean water may be contaminated with bacteria that can result in gastrointestinal illness. Protect yourself and your pets by not swimming or bathing in creeks, rivers, lagoons, and ocean water known or suspected of being contaminated. Some waterways have signage posted, if testing has shown they contain elevated levels of bacteria.
• Avoid all waterways for at least 2-3 days after rain. If you come in contact with contaminated water, bathe yourself and/ or your pet as soon as possible. Avoid eating, drinking or smoking before you've washed your hands.
• Children should be supervised when washing their hands in day care centers and at home.
• When possible, young children with a Shigella infection who are still in diapers should not come into contact with uninfected children.
• In traveling to the developing world where Shigella infection is more common: drink only treated or boiled water, and eat only cooked hot foods or fruits/vegetables you peel yourself after thorough washing.
• During sexual contact, avoid unprotected direct oral-anal contact and be sure to wash hands, other body parts, and any objects thoroughly after sex.

Prevention Tips and Resources for Employers

• Read the Shigella Prevention and Control Guidelines Factsheet to implement healthy practices that can help prevent the spread of Shigella in the workplace.
• Consider posting notices about Handwashing and other Shigella prevention tips in break areas, janitorial areas and restrooms.  Scroll down to the main Resources section at the bottom of this page to view/print flyers in multiple languages).
• Per CDC returning to work guidance, cases in sensitive occupations or situations, such as Food Service and Childcare, should be excluded from these settings while symptomatic and until Public Health restrictions are lifted. By State law, California Retail Food Code requires that food service workers be excluded until cleared.
   
• Please follow CDC guidance for the following occupations:

Food Service Workers

• Information for Food Service Workers and Managers | Shigella – Shigellosis | CDC
• CDC Factsheet: Information for Food Service Workers and Managers
• CDPH Illness Reporting Requirements for Food Service Workers and Persons-In-Charge

Childcare Providers

• Preventing and Controlling Shigellosis Outbreaks in Early Care and Education Facilities | Shigella – Shigellosis | CDC
• Diaper Changing Steps for Childcare Settings | CDC

             Direct Caregivers for Adults

• Although there is no specific CDC guidance for Adult Care Centers, some CDC guidance for Childcare settings may be considered (i.e. Safe Diapering).

              Shelter and Street Outreach Workers

• CDC Guidance for Shigellosis Among People Experiencing Homelessness
• CDC Shigella Toolkit
• HUD Toolkit for Preventing and Managing the Spread of Infectious Disease within Shelters
• HUD Toolkit for Preventing and Managing the Spread of Infectious Disease within Encampments

• People who have shigellosis usually get better without antibiotic treatment in 5 to 7 days. People with mild shigellosis may need only fluids and rest. Bismuth subsalicylate (for example, Pepto-Bismol) may be helpful, but people sick with shigellosis should not use medications that cause the gut to slow down and interfere with the way the body digests food, such as loperamide (for example, Imodium) or diphenoxylate with atropine (for example, Lomotil).
• Healthcare providers may prescribe antibiotics for people with severe cases of shigellosis to help them get better faster. However, some antibiotics are not effective against certain types of Shigella. Healthcare providers can order laboratory tests to determine which antibiotics are likely to work. Tell your healthcare provider if you do not get better within a couple of days after starting antibiotics. They can do more tests to learn whether your type of Shigella bacteria can be treated effectively with the antibiotic you are taking. If not, your doctor may prescribe another type of antibiotic.
• CDC recommends the following precautions be taken by adult patients and those who take care of children who are recovering from Shigella. 

Adults:

• Wash your hands carefully and frequently with soap and water, especially after using the bathroom.
• Do not prepare food for others while you are sick. After you get better, wash your hands carefully with soap and water before preparing food for others.
• Stay home from childcare, school and food service facilities while sick.
• Avoid swimming until you have fully recovered.
• Wait to have sex (vaginal, anal, and oral) for 2 weeks after you no longer have diarrhea. Because Shigella bacteria (germs) may be in stool for several weeks, follow safe sexual practices, or ideally avoid having sex, for several weeks after you have recovered.

Caregivers/Parents:

• Supervise handwashing of toddlers and small children after they use the bathroom. Wash your hands and your infant’s hands with soap and water after diaper changes.
• Throw away soiled diapers in a covered, lined garbage can. Clean diaper changing areas after using them. (Safe & Healthy Diapering in the Home)  
• Keep your child out of childcare and group play settings while sick with diarrhea.