Shigella

Last content update: 7/18/24

Public Health has identified an outbreak of Shigella among individuals experiencing homelessness in Santa Clara County. As of July 18, there are 15 people who have tested positive for Shigella associated with this outbreak investigation and 22 more suspected cases in the county have been identified.

Service providers conducting outreach or service delivery with people experiencing homelessness or in encampments should follow the recommendations below.

Several encampments affected by the ongoing Shigella outbreak are located along the Guadalupe River. Shigella can spread through water, and only a small number of individual bacteria are needed to cause illness. Because some individuals sick with Shigella have reported using the river for bathing and toileting, Public Health advises that people avoid contact with Guadalupe River water downstream of Highway 85 (the intersection of Highway 85 and Almaden Expressway). People who do come in contact should avoid swallowing the water and should wash with soap and water before eating or touching their face. Partner organization workers who may come into contact with river water in the vicinity of the encampments have been advised to wear personal protective equipment.

What is Shigella?

Shigella are bacteria (germs) that cause diarrhea. Shigella bacteria cause an infection called shigellosis.

How is Shigella spread?

Shigella germs are in poop, so anything that gets contaminated by poop can potentially spread the germs.

You can get exposed to Shigella germs from:

  • Having direct contact with someone infected with Shigella (for example, having sex with them).
  • Eating food or drinking liquids that are contaminated with Shigella.
  • Touching objects that are contaminated with Shigella and then putting your unwashed hands in your mouth.

Shigella spreads easily – swallowing just a small amount of Shigella germs can make you sick.

What are the symptoms of Shigella infection?

Symptoms of Shigella infection (shigellosis) are diarrhea that can be bloody or prolonged (lasting more than 3 days), fever, stomach pain, and feeling the need to poop even when the bowels are empty. Symptoms usually last about 7 days.

How soon after exposure to Shigella will symptoms appear?

Symptoms usually begin 1 to 7 days after exposure to Shigella germs.

What is the treatment for Shigella infection?

A person with Shigella infection (shigellosis) should drink plenty of fluids to replace fluids lost from diarrhea and prevent dehydration. This is especially important for people who are very young, very old, or immunocompromised. A healthcare provider may also prescribe antibiotic medicine to treat shigellosis.

If you think you or someone you are caring for is becoming severely dehydrated, contact a healthcare provider or go to the nearest emergency room.

Need a doctor or health insurance? Call the County's Patient Access Department at 1 (866) 967-4677 or drop in at 770 S. Bascom Ave. San Jose, CA 95128.

How can you help prevent the spread of Shigella?

If you think you have Shigella infection, clean your hands and surfaces you touch often while you have diarrhea and for several weeks after.

  • Hand washing with soap and water is the most important way to prevent the spread of Shigella. While washing hands with soap and water is preferred, if these are not available, use hand sanitizer.
  • Clean and disinfect surfaces or linens that are touched often or have been near diarrhea.
  • Throw out any food items that have been near diarrhea. Follow food safety practices and wash fresh fruits and vegetables thoroughly.
  • Do not have sex until diarrhea has been gone for 2 weeks. Shigella germs can be found in poop for several weeks after the diarrhea has gone away. When you start having sex again, wash your hands, body, and sex toys before and after and use barriers such as condoms or dental dams. For more information, see our Shigella and safer sex flyer (English | Spanish).
  • Stay home from work or school if you have diarrhea and are a food, healthcare, or childcare worker.

Guidance for Providers Serving People Experiencing Homelessness

Service providers conducting outreach or service delivery with people experiencing homelessness or in encampments should follow the recommendations below.

1. Report Suspected Shigella Cases

  • Notify the Public Health Department at (408) 885-4214, ext. 3  if individuals with symptoms of vomiting or diarrhea in the last four weeks are identified in or around encampments or shelter settings.

2. Support Access to Clean Water and Hygiene Supplies

  • Ensure adequate supply of clean water for drinking and handwashing.
  • Ensure adequate supply of hygiene items such as hand sanitizer, soap, paper towels, and safer sex supplies.
  • Encourage handwashing by increasing availability of handwashing stations and toileting facilities.
  • Distribute diapers, wipes, and gloves to individuals caring for children with diarrhea.
  • If providing food, follow food safety practices and CDC recommendations to prevent Shigella infection among food service workers.

3. Prevent the Spread of Infection Within Public Restrooms and Workplaces

  • Promote thorough hand washing.
    • Hands should be washed with soap and water for at least 20 seconds before eating/drinking or preparing food and after using the restroom, changing diapers, cleaning and/or touching soiled items.
    • Dry hands using disposable paper towels, not shared cloth towels.
    • Use hand sanitizer (at least 60% alcohol) when you can’t use soap and water.
  • Consider posting handwashing signs in and around bathrooms.
  • Clean surfaces of visible soil, dirt, or debris before attempting to disinfect surfaces.
  • Disinfect surfaces using a bleach solution OR a cleaning agent that is EPA-approved to be effective enough to kill norovirus. Leave the cleaning agent on the surface for the amount of time recommended by the EPA.
    • To make a bleach solution, mix 1 gallon of water with 3/4 cup of concentrated bleach or 1 cup of regular strength (5.25%) bleach. Leave all surfaces wet for at least 5 minutes. Rinse all surfaces intended for food or mouth contact with water before use.
  • Clean and disinfect handwashing stations, toileting facilities, and high-contact surfaces (door knobs, light switches, hand rails, etc.) at least daily.
    • In the setting of more vomiting and diarrhea than usual or visible soiling, consider increasing frequency of cleaning and disinfection to multiple times per day.
  • Clean up spills of human waste (diarrhea, feces or vomit) using appropriate protective equipment and absorbent materials, and discard appropriately. See full instructions below.

To request protective supplies such as masks, gowns, and gloves, email [email protected].

Guidance for Shelter Providers

For any residents or staff identified with vomiting or diarrhea:

  1. Notify the Public Health Department at (408) 885-4214, ext. 3 of any individuals with symptoms of vomiting or diarrhea.
  2. Facilitate testing by providing a stool collection kit to the ill resident or staff. Kits can be dropped off and picked up by the Public Health Department upon request by calling (408) 885-4214, ext. 3.
  1. Isolate the ill resident and/or ensure use of a separate/dedicated bathroom, if possible.
  2. Ill staff should remain home while actively symptomatic and should not be allowed to prepare or handle food until testing results return.
  3. Promote thorough handwashing and consider posting handwashing signs in and around bathrooms.
  4. Follow workplace cleaning guidance (above).

To request protective supplies such as masks, gowns, and gloves, email [email protected].

Specific Cleaning Methods for Human Waste

When cleaning spills of diarrhea, vomit, or feces:

  1. Use personal protective equipment (PPE), such as gloves, masks, and gowns to protect yourself and your clothes from contamination.
  2. If possible, block-off the area immediately.
  3. Clean up visible debris using disposable absorbent material (paper towels or other disposable cloths)
  4. Discard soiled items carefully in a sealed plastic bag.
  5. Liberally clean and disinfect area and objects surrounding the contamination with a bleach solution OR an EPA-approved cleaning agent that is effective enough to kill norovirus. Leave the cleaning agent on the surface for the amount of time recommended by the EPA. 
    1. To make a bleach solution, mix 1 gallon of water with 3/4 cup of concentrated bleach or 1 cup of regular strength (5.25%) bleach. Leave all surfaces wet for at least 5 minutes. Rinse all surfaces intended for food or mouth contact with water before use.
  6. Take off gloves, gown, and mask, in that order, and discard before exiting contaminated clean-up area.
  7. Place discarded PPE in a sealed plastic bag.
  8. Re-glove and dispose of bag in a secure trash container; do not allow the bag to touch your clothing.
  9. Always wash your hands after handling any contaminated material, trash, or waste.

Additional Resources

If you are a healthcare provider, sign up for health alerts, advisories, and updates from the Santa Clara County Health Officer.

 

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