In a health advisory by the County of San Diego Health ad Human Services Agency (HHSA) Public Health Services (PHS) Division, health officials reported six hospitalized cases of Shigella sonnei among persons experiencing homelessness (PEH) since September 30. They added that no death has been associated with any of these cases reported.

The disease outbreak was confirmed after individuals were hospitalized. Health officials are currently monitoring them and investigating the possible cause of the infection.

 Shigella Outbreak: Homeless People in San Diego Hospitalized After Being Infected With the Contagious Disease
(Photo : Wikimedia Commons)
A gram stain of gram negative (-), rod-shaped Shigella flexneri bacteria on microscope slide. The pink coloration is due to safranin staining of the cell.

Shigella Outbreak in San Diego

Fox 5 San Diego reported that county health officials have already notified San Diego and will be working with the city to identify potential exposure sites. They have also connected with homeless service providers to make sure good hygienic precautions are followed and to know if there are any more cases of Shigella to immediately provide treatment and housing.

HHSA's Epidemiology and Immunization Services branch medical director Dr. Seema Shah said in an interview that shigellosis is usually not serious but it can spread easily in some circumstances, which is something that they are trying to avoid by keeping the vulnerable population safe.

This type of infection is contagious and usually transmitted via contaminated food, water, and surfaces. But it can also be transferred sometimes from one person to another. There were a total of 243 cases of Shigellosis last year, while the county has identified 220 cases so far this year.

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Actions Requested in Response to the Shigella Outbreak in San Diego

According to the health advisory, patients presenting symptoms of diarrhea or bloody diarrhea should be considered for testing of shigellosis, especially those PEH, men who have sex with men (MSMs), and those who are immunocompromised.

Secondly, PEH diagnosed with shigellosis should not be released from the hospital without shelter and access to an unshared restroom, which can be arranged through the Epidemiology Program.

Moreover, a stool culture must be acquired through antimicrobial susceptibility testing and ciprofloxacin AST with dilutions of 0.12 μg/mL or lower should be requested. The health advisory also listed a PCR test, culture test, and AST to obtain bacterial culture and isolate them for submission to the San Diego Public Health Laboratory.

While waiting for AST results, antimicrobial treatment is warranted based on the severity of cases, hospitalization, and underlying factors. AST results will be used to guide clinicians on which proper therapy should they administer and when to consider a consultation with an infectious disease specialist.

Lastly, report immediately any Shigella species result on PCR tests and blood cultures.

What is Shigellosis Infection?

According to the Centers for Disease Control and Prevention (CDC), Shigellosis is a type of infection caused by Shigella bacteria. Most people who contracted it could experience a set of symptoms, such as diarrhea, bloody diarrhea, fever, and stomach cramps.

These symptoms typically start a day or two after getting infected and mostly lasts for up to seven days. Most patients recover without receiving antibiotics medication, although some with severe types like those with underlying conditions and weakened immune systems should be given proper medication.

Antibiotics can help patients get better faster and will reduce the possibility of transmitting Shigella bacteria to other people. The most effective way to prevent transmission is by washing hands as often as possible using soap and running water, and by practicing hygienic habits.

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