Shigella Blog

Shigella Outbreaks - Sporadic Shigellosis

Bill Marler — Sun, 31 Jan 2010 17:47:42 -0800

Risk Factors for Sporadic Shigellosis, FoodNet 2005

Clinton C. Haley, Kanyin L. Ong, Katrina Hedberg, Paul R. Cieslak, Elaine Scallan, Ruthanne Marcus, Sanghyuk Shin, Alicia Cronquist, Jennifer Gillespie, Timothy F. Jones, Beletshachew Shiferaw, Candace Fuller, Karen Edge, Shelley M. Zansky, Patricia A. Ryan, Robert M. Hoekstra, Eric Mintz.

Foodborne Pathogens and Disease Abstract

Background: An estimated 450,000 cases of shigellosis occur annually in the United States. Outbreaks have been associated with food, water, child daycare centers, and men who have sex with men. However, for sporadic infections, which account for the majority of cases, risk exposures are poorly characterized.

Methods: Foodborne Diseases Active Surveillance Network (FoodNet) conducts active, laboratory-based shigellosis surveillance in 10 US sites. We interviewed cases with illness onset during 2005 about exposures during the week before symptom onset using a standardized questionnaire. The proportion of patients who denied nonfood risks was used to estimate the burden attributable to foodborne transmission.

Results: Overall, 1494 cases were identified. The approximate incidence was 3.9/100,000, with the highest rates among children aged 1–4 years (16.4) and Hispanics (8.4). Of the 929 cases interviewed, 223 (24%) reported international travel in the week before symptom onset. Of the 626 nontraveling cases with complete risk factor information, 298 (48%) reported exposure to daycare or a household member with diarrhea; 99 (16%) reported drinking untreated water or recreational exposure to water; and 16 (3%) reported sexual contact with a person with diarrhea. Two hundred and fifty-nine (41%) denied all nonfood exposures examined.

Conclusions: Sporadic shigellosis is most common among young children and Hispanics. Common exposures include international travel and contact with ill persons or daycare. However, more than one-third of US shigellosis cases annually might be due to food consumed in the United States.

About Shigella and Shigella Blog Updated

Bill Marler — Sat, 30 Jan 2010 16:26:16 -0800

About Shigella and its companion Shigella Blog were updated once again after extensive revisions by experts in the field and the staff and lawyers at Marler Clark, LLP PS, the only law firm in the United States that focuses its entire practice on foodborne illness litigation.

Shigella is a family of bacteria that can cause sudden and severe diarrhea (gastroenteritis) in humans. Shigellosis – the illness caused by the ingestion of Shigella bacteria – is also known as bacillary dysentery. It can occur after ingestion of fewer than 100 bacteria, making Shigella one of the most communicable and severe forms of the bacterial-induced diarrheas.

Shigella thrives in the human intestine and is commonly spread both through food and by person-to-person contact. Most Shigella infections are passed through the fecal-oral route. This happens when basic hygiene and handwashing habits are inadequate and can happen during certain types of sexual activity. Transmission is particularly likely to occur among toddlers who are not fully toilet-trained. Family members and playmates of such children are at high risk of becoming infected.

Food may become contaminated by infected food handlers who don’t wash their hands with soap after using the bathroom. Vegetables can become contaminated if they are harvested from a field with sewage in it. Flies can breed in infected feces and then contaminate food.

Water may become contaminated with Shigella bacteria if sewage goes into it or if someone with shigellosis swims in or plays with the water (especially in splash tables, untreated wading pools, or shallow play fountains used by daycare centers). Shigella infections can then be acquired by drinking, swimming in, or playing with the contaminated water.

The number of shigellosis cases reported annually to the Centers for Disease Control and Prevention (CDC) has varied over the past several years, from more than 17,000 during 1978–2003, to an all-time low of 14,000 in 2004, to almost 20,000 in 2007. Many cases go undiagnosed and/or unreported, however. The CDC estimates that 450,000 total cases of shigellosis occur in the U.S. every year.

Shigella is the third most common pathogen transmitted through food. During 2006, a total of 1,270 foodborne-related outbreaks from 48 states in the U.S. were reported. Although Shigella was responsible for only 10 (1%) of those outbreaks, 183 confirmed cases of shigellosis were reported. This contrasts with an average of 659 cases annually in the previous five years. Shigella has also responsible for a substantial portion of foodborne outbreaks on cruise ships.

Shigella Still Spreading in St. Louis Day Care Centers

Shigella Lawyer — Mon, 07 Dec 2009 04:42:46 -0800

According to the Post-Dispatch, for the second time in two months, St. Louis city health officials have issued an alert about outbreaks of highly contagious intestinal bacteria that are usually spread by children.

There have been 148 cases of shigellosis in 2009, compared with 11 cases by this date last year, according to the St. Louis City Department of Health. Missouri reports 647 cases this year compared with the yearly average of 604. Illinois has not reported any shigellosis outbreaks this year.

Shigellosis infection is marked by fever, stomach cramps and diarrhea that can be bloody. Most infections resolve without treatment within a week, although antibiotics may be effective in treating severe cases.

Most of the illnesses are linked to day-care centers and schools, health officials reported. Children ages 4 and younger are most commonly infected.

Shigella can live in feces and is typically spread when people don't wash their hands properly after using the bathroom or changing diapers.

Health officials recommend washing hands frequently and thoroughly with warm water and soap. Children should be supervised when washing hands. Disinfecting toys, eating surfaces and toilets or diaper changing areas can also help prevent the spread of the bacteria.

Childcare-associated Shigellosis outbreak clues researchers into best treatment, management strategies

Bill Marler — Thu, 19 Nov 2009 23:31:29 -0800

Enforcing simple hygiene strategies in childcare centers can help limit Shigellosis transmission and may combat growing antimicrobial-resistance patterns among these organisms, according to CDC and Missouri State Department of Health and Senior Services officials who investigated a Shigella sonnei outbreak that affected 693 people and spanned 44 licensed daycare facilities in northwest Missouri from May to October 2005.

Surveillance data revealed that 300 of the 639 people who became ill reported childcare-center exposure, with 176 patients reporting either employment or attendance at a childcare center, and 112 reporting household contact with a childcare-center employee or attendee.

Childcare centers that lacked a hand-washing station in every room, and those that enrolled diapered children without providing a diapering station in every room were at greater risk for spreading the disease among attendees, according to a case-control comparison.

Current state regulations do not permit the use of alcohol-based hand sanitizers in Missouri childccare centers, according to the researchers, despite evidence that these products can decrease enteric illness and complement hand-washing policies.

Several additional Missouri health requirements also have officials concerned. School exclusion policies require two consecutive negative cultures for children to return to childcare, rather than a single negative culture or symptom resolution. The researchers believe this policy may “implicitly encourage antimicrobial treatment in children who attend daycare centers and may result in unnecessary adverse drug events in children and increase antimicrobial resistance among enteric and respiratory pathogens.”

Among the 31 outbreak isolates tested for antimicrobial susceptibility, 95% were resistant to ampicillin, 90% were resistant to trimethroprim-sulfamethoxazole (TMP/SMX) and 90% were resistant to both antibiotics — the two most commonly recommended for empiric treatment in children until recently.

During this outbreak azithromycin was used most often, administered to 44% (n=92) of the 210 children aged 18 or younger who were prescribed an antibiotic. Cephalosporin was the next most commonly prescribed (27%, n=57), followed by fluoroquinolones (5%, n=11), ampicillin (2%, n=3) and an unknown antimicrobial (7%, n=15).

“Given the current frequency of resistance to ampicillin and trimethroprim sulfamethoxazole among S. sonnei strains, the uncertain safety of administering fluoroquinolones to children, the difficulties in monitoring azithromycin resistance and the lack of an appropriate vaccine, public health measures should focus on prevention of shigellosis outbreaks through appropriate hygiene practices and, where possible and allowed by state regulations cohorting convalescing children in daycare centers,” the researchers wrote.

Arvelo W. Pediatr Infect Dis J. 2009;28:976-980.

Bacteriophages to be used by Army to kill Shigella

Shigella Attorney — Fri, 16 Oct 2009 18:01:56 -0800

An émigré scientist from the former Soviet Union is working to develop a new treatment for diarrhea based on a century-old remedy commonly used in his former homeland. Alexander Sulakvelidze, chief scientist for privately held Baltimore biotech Intralytix, says the bacteriophage-based probiotic preparation shows promise for managing shigella infections, a "significant worldwide cause of diarrheal disease" — and apparently the U.S. Army agrees. Bacteriophages — highly specific viruses that infect bacteria — may be used to target "problem" bacterial species in the human gastrointestinal tract, according to Sulakvelidze.

The company recently received a $100,000 phase 1 Small Business Technology Transfer grant from the Pentagon to develop the treatment, an alternative to antibiotics. Shigella are "major gastrointestinal tract pathogens of particular concern" to the Army because U.S. troops are often stationed in countries where the disease is widespread, said Sulakvelidze, the company's principal investigator for the contract, in a statement.

There are about 164.7 million cases of shigellosis worldwide, almost entirely in developing nations, according to the World Health Organization. About half a million visitors from industrialized nations to developing nations contract the infection annually, and about 1.1 million people die from it each year, 61 percent of whom are children younger than 5. There is no vaccine for shigellosis, and some strains of it have developed resistance to antibiotics, according to the federal Centers for Disease Control and Prevention.

Shigella Hits St. Louis

Shigella Lawyer — Thu, 08 Oct 2009 20:09:47 -0800

St. Louis city health officials on Wednesday reported a sharp increase in cases of a highly contagious intestinal bacteria that is typically spread by children. There have been 67 cases of shigellosis from July 1 through Monday, compared to nine cases for all of 2008, according to the St. Louis City Department of Health.

Health officials said four day care centers and one school clustered in south St. Louis city reported illnesses. Officials did not offer other specifics except to say that children ages 4 and younger are most commonly infected.

Shigellosis infection is marked by fever, stomach cramps and diarrhea that can be bloody. Most infections resolve without treatment within a week. Some antibiotics may be effective in treating more severe cases, although health officials warned that specimens from the St. Louis cases were shown in labs to be resistant to two antibiotics, trimethoprim-sulfamethoxazole and ampicillin.

NIH Grants $2.87M for Development of Treatment for C. difficile and Shigella Gastrointestinal Infections

Shigella Attorney — Fri, 02 Oct 2009 21:07:47 -0800

NIH has awarded a group of researchers $2.87 million for preclinical development of an oral drug to treat C. difficile and Shigella.

The consortium is led by Brigham Young University (BYU) and includes SRI International, Southwest Research Institute (SwRI), and McMaster University. CSA-13 is based on Ceragenin™ technology, which is a class of antimicrobial compounds that mimic functions of the body’s own innate immune system.

The technology was invented by Paul B. Savage, Ph.D., Reed Izatt professor at BYU, and was exclusively licensed to Ceragenix. The company is using the Ceragenin platform to formulate Cerashield™ antimicrobial coatings for medical devices. In March the firm reported that the NIH had granted the University of Utah $1.66 million to evaluate a Cerashield coating to reduce orthopedic implant infections.

“We are very pleased that the NIH sees potential in our technology as an oral drug to treat these dangerous infections,” says Steve Porter, chairman and CEO of Ceragenix. “We believe that the NIH funded research activities will be synergistic with our development efforts on antimicrobial medical device coatings.”

Shigella And Other Diseases Are Killing People In Papua New Guinea

Shigella Attorney — Fri, 11 Sep 2009 19:39:14 -0800

Thirty people have died in Papua New Guinea (PNG) from the severe form of dysentery called Shigella that has infected 700 others.

While PNG’s limited health system is dealing with Shigella, to the north in Wasu, 13 people have died amid the country's first outbreak of cholera and 200 others have contracted the water-borne disease.

PNG health officials are combating simultaneous outbreaks of the Flu, Shigella, and Cholera.

All totaled 120 people are dead and the diseases, mostly in the Morobe province on the country’s north coast, have infected thousands.

It is Papua New Guinea's first cholera outbreak and medics fear the situation will get much worse before it gets better.

Radio New Zealand is monitoring this medical emergency.

Americans Warned About Shigella, Salmonella, and Cholera As Ethiopia Fights Outbreak Of "Acute Watery Diarrhea"

Shigella Attorney — Tue, 01 Sep 2009 09:20:20 -0800

We cannot find a copy of it, but apparently there was a Voice of America report that the U.S. Embassy in Addis Ababa, Ethiopia warned Americans in the country of increased risks of diarrheal illnesses including Shigella, Salmonella, and Cholera.

Addis Ababa, one of the dirtiest cities in the world, is experiencing a severe outbreak of "Acute Watery Diarrhea" with one thousand cases being reported a day. Hospitals are said to be erecting tents to handle all the patients showing up for treatment.

According to the United Nations Humanitarian Affairs office:

AWD has spread to nine out of ten sub-cities in Addis Ababa and cases continue to increase in each region currently affected by the outbreak (Afar, Amhara, Oromiya, SNNPR and Somali). Humanitarian partners, including UNICEF and WHO, are particularly concerned by the increase in the number of woredas affected in a short period of time and are extremely worried that some people, particularly children, living in areas affected by the ongoing food crisis may be especially vulnerable to infection due to malnutrition.

As a result of the growing seriousness of the situation, the Federal Ministry of Health (FMoH) has reportedly revised the projected requirements included in the forthcoming Humanitarian Requirements Document, which projects needs per sector for the period August to December, for the prevention, management and treatment of AWD cases.

The government and aide groups have now set up a "command center' to manage the crisis. The UN Humanitarian Bulletin is available for updates.

Popular Boston Area Beach Closed After People Come Down With Shigella

Shigella Attorney — Sat, 22 Aug 2009 11:28:40 -0800

Swimmers at Shannon Beach, MA in Winchester are coming down with shigellosis, forcing the Department of Conservation and Recreation to close the popular area formerly known as Sandy Beach.

Renamed last year for Sen. Charles E. Shannon, the former policeman and state senator who represented the area until his death at age 61, was closed at 3 p.m. Friday, Aug. 21st. It will remain closed until further notice.

"In the interest of public health and safety, we closed the Shannon Beach facility immediately upon learning of the apparent bacterial contamination," DCR Commissioner Richard K. Sullivan, Jr. told WCVB-TV in Boston.

He said a number of people experiencing Shigella reported visiting Shannon Beach within the last three weeks.

"(The) Department of Public Health (DPH) encourages anyone who may have visited Shannon Beach and Playground facilities and who has any of these symptoms, particularly unresolved diarrheal illness, to contact their health care provider," said DPH Commissioner John Auerbach. "The best prevention is washing hands with soap, particularly after using the toilet or changing diapers. Soap kills bacteria."

In addition to diarrhea, symptoms include fever, nausea, stomach cramps and vomiting.

When Should Baby Drink The Water? Seems There Is Less To Fear Than Some Think

Shigella Attorney — Wed, 19 Aug 2009 13:34:29 -0800

Shigella, along with Salmonella and Cholera, were each responsible for one of the 30 drinking water outbreaks back in the 1993-94 period studied by the Centers for Disease Control and Prevention (CDC). It found those outbreaks, including 20 from private water wells, were responsible for 2,366 illnesses and one death.

Nothing in the CDC report has anything to do with whether or not babies should drink water. Nevertheless, the report was thrown against the wall this morning in the New York Times as part of a discussion about whether it is safe for babies to drink water.

Dr. Alan Greene, a Danville, CA pediatrician and author, cautions parents against letting baby drink water. Greene, who has his own Web site, says wait until the baby is eating solid food and even then limit water intake to 2 to 4 ounces between feedings.

As for encephalitis, babies will not get it from drinking water from a public supply in the United States. He advises using “absolute pore size” filters to remove Crypto and other parasites. If you have a baby or want one, check out the NYT for the rest.

Shigella Gives Zanesville City Schools A Warning About Cleaning & Student Sanitation

Shigella Attorney — Mon, 03 Aug 2009 10:59:54 -0800

Schools are going to be hypersensitive this year about “deep cleaning” and student sanitation because of Swine Flu. Maybe that will help with the old standby threats from the likes of .

In Ohio, the Zanesville City Schools are “scrambling to make sure everything is clean as possible for the upcoming school year.” That’s because two of 79 children in a daycare program operated out of the Rufus Putnam School have tested positive for Shigella.

Both victims are girls, the ages 2 and 3. According to Vicki Whitacre, the Zanesville-Muskingum Health Department’s medical director, food handlers at the daycare are also being tested. Fifteen people who had some contact with the girls have reported experiencing diarrhea symptoms.

Food is brought into the daycare from another site and no other programs served have experienced any problems. The school district is having everything cleaned and wiped down.

Shigella Strikes Swimmers At New Hampshire's Silver Lake

Shigella Attorney — Thu, 30 Jul 2009 19:09:32 -0800

Five swimmers at Silver Lake in Hollis, N.H. got sick during July. Now, four of the five have been confirmed as victims of Shigella. All the swimmers have recovered.

Health officials Monday were out on the lake taking water samples and test results have found the Shigella bacteria are present. More testing is underway, but in meantime swimmers are being warned about the potential for contamination.

Shigella symptoms include diarrhea, fever and stomach cramps starting a day or two after being exposed. Anyone who swam in the lake recently and who are experiencing those symptoms are urged to seek immediate medical care.

Grand Lake St. Mary's Wedding Sends Guests Off With Shigella

Shigella Attorney — Fri, 17 Jul 2009 12:40:21 -0800

Two eastern Ohio counties are reporting an outbreak of Shigella that may be traced back to a wedding held on the beautiful shores of Grand Lake St. Mary's in Celina.

According to the Wapakoneta Daily News:

Seven Auglaize County residents are among those affected by a bacterial infection from a source in Celina, confirmed the Auglaize County health commissioner.

Health Commissioner Charlotte Parsons, who confirmed the outbreak of shigella this week, said the source of the food- and water-born disease can be traced back to a wedding in Celina.

Most of the seven Auglaize County cases were within one family, Parsons said. Several were juveniles, but none were younger than 15.

There were several other cases reported in Mercer County, but health officials there could not be reached for more information.

The wedding was catered by a business that has its own facilities, and left-over food was disposed of before health officials were called in to investigate. There is more in today's Daily News.

School Ending In Wisconsin Did Not Halt Outbreak of Shigella Cases In Racine

Shigella Attorney — Wed, 15 Jul 2009 10:21:45 -0800

“Shigella used to be very uncommon,” said Dr. William Little, chairman of the Racine Board of Health. “In all my years of practice I don’t remember seeing anything like this.”

If dealing with Swine Flu was not bad enough, Racine, Wisconsin is finding itself with a growing Shigella outbreak. When Shigella cases first began to be reported in the spring, health officials figured the outbreak would end with the end of the school year.

But, that did not happen. In May, Racine had 12 confirmed cases of Shigella. In June, the number rose to 23.

Typically Racine has only has 11 or 12 cases per year of shigella, Teri Hicks, director of community health programs, told the Journal-Times.

Racine health officials are working with the state but have not yet determined a cause for the increase in the number of cases, Hicks said.

“They have noticed it’s abnormal,” she said.

Surrounding counties have not experienced the uptick in Shigela cases. There's more in the Racine Journal-Times.

Baltimore Bio Tech Company Gets Army Contract To Fight Shigella

Shigella Attorney — Sun, 05 Jul 2009 15:27:35 -0800

Intralytix Inc. announced last week that it has been awarded a contract from the United States Army to develop a bacteriophage-based food safety product for reducing or eliminating contamination from pathogenic Salmonella and Shigella spp.

The product would be used to eliminate or significantly reduce contamination of fruits, vegetables and other food products.

Intralytix Inc is a Baltimore-based biotechnology company focused on improving human health through the development and commercialization of innovative products for food safety and human therapeutics using its core bacteriophage (or phage) technology platform.

“We are very pleased with the award because it helps to enrich Intralytix’s portfolio of phage-based, food safety products, and it demonstrates the confidence that the U.S. Army has in Intralytix’s leadership in developing bacteriophage-based preparations for food safety applications for military and civilian populations,” stated Dr. Alexander Sulakvelidze, Intralytix’s Vice-President for Research and Development and Chief Scientist.

For more see the company’s press release.

American Society for Microbiology (ASM) Honors Pioneering Shigella Researcher, Dr. Philippe Sansonetti

Shigella Attorney — Tue, 09 Jun 2009 12:35:43 -0800

The 2009 American Society for Microbiology (ASM) GlaxoSmithKline International ASM Member of the Year Award has been presented to pioneer Shigella researcher Philippe Sansonetti, M.D., director, Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, Paris.

This award recognizes a distinguished microbiologist who has exhibited exemplary leadership in the international microbiological community. It was presented during the recent 109th General Meeting of the ASM in Philadelphia.

Known as one of the founders of the field of cellular microbiology, Dr. Sansonetti received his M.D. from the University of Paris and did his postdoctoral work in the Department of Enteric Diseases at the Walter Reed Army Institute of Research in Washington, D.C. This is where he began his work on Shigella pathogenesis, an area of science that has been dominated by Dr. Sansonetti and his lab for the past 20 years.

Dr. Sansonetti established his lab at the Institut Pasteur where he created the Unité de Pathogénie Microbienne Moléculaire. He has supervised 30 postdoctoral fellows and mentored 20 Ph.D. students. His teaching has been recognized with visiting professorships at Harvard Medical School, Rockefeller University, the University of Tennessee, the University of Texas, and Washington University.

In 2008, Sansonetti was named professor and chair of microbiology and infectious diseases at the Collège de France, which was founded in 1530 to "teach science in the making" to the general public. In 1998, he co-founded the journal, Cellular Microbiology, to address a growing new multidisciplinary field of research and continues to serve as the editor of this international, high impact journal.

Dr. Sansonetti's laboratory is credited with some of the most important contributions to our understanding of intracellular pathogens and seminal discoveries that established the importance of cytoplasmic sensing in surveillance of intracellular pathogens. This work has led to key outcomes resulting in the understanding of how innate immune responses are regulated in response to intracellular pathogens.

ASM claims to be the world's oldest and largest life science organization with more than 43,000 members worldwide. ASM's mission is to advance the microbiological sciences and promote the use of scientific knowledge for improved health and economic and environmental well-being.

Cleveland Is Also Trying To Defeat Shigella, Especially At Its Day Care Centers

Shigella Attorney — Tue, 02 Jun 2009 12:26:14 -0800

Over the weekend, the Cleveland Plain Dealer did a wrap-up on the ongoing Shigella outbreak in Cuyahoga County, Ohio.

The newspaper reported that: “Infections from the shigella bacteria began soaring in 2007 and show no signs of slowing down. Cuyahoga County reported 218 cases last year, after averaging about 30 cases a year the prior five years. The county is on pace to top last year's numbers, while the Cleveland Department of Public Health this year has responded to five outbreaks at day-care centers through April.

"We've never seen these kind of numbers, at least not in the last six or seven years," said Cleveland Health Director Matt Carroll. "I don't think we have a lot of understanding as to why we're seeing it."

Much of the outbreak is focused on day care centers in the Greater Cleveland area. "It can go right through a day care because it doesn't take much to get infected," said Dr. Blaise Congeni, director of pediatric infectious diseases at Akron Children's Hospital.

For more from the Plain Dealer, go here.

Local Health Officials In KS, MO, GA, and TX Issue Warnings About Shigella

Shigella Attorney — Tue, 26 May 2009 08:36:46 -0800

Communities combating shigella since last fall are counting on the end of the school year to break the back of the far-flung outbreaks.

In Macon County, GA, the local health department continues to encourage people to wash their hands and to stay away from home or school if they come down with diarrhea. There were 31 cases of shigella in Macon County in April and 23 so far in May.

Up north in Sedgwick County, KS there have been 52 confirmed cases of Shigella this year, compared to only 20 cases in all of 2008. Kansas’s health officials are stepping up their warnings to parents.

In nearby Missouri, nearly a dozen people have come down with Shigella this month, causing the Springfield-Greene County Health Department to issue a warning.

And down in the Texas panhandle, Lubbock is looking for the end of its eight-month Shigella outbreak. The infection rate for the diarrheal illness peaked last fall with 308 reported cases in November, according to department records. Anything more than eight cases per month is considered an outbreak, Lubbock Public Health Coordinator Beckie Brawley said.

The Shigella bacteria causes diarrhea, fever, vomiting, and cramps. You'll catch it a day or two after exposure. Symptoms can last as long as a week.

Local health officials say the bacteria is often passed through fecal matter. They urge people to wash their hands frequently. Parents should also make sure their children clean up after using the bathroom.

Transmission of Shigella can also occur from eating contaminated food which may look and smell normal. Food can become contaminated by infected food handlers who practice inadequate hand washing. Vegetables can be contaminated if they are harvested from a field with sewage in it.

You can also get Shigella drinking or swimming in contaminated water. Water may become contaminated if sewage runs into it, or if someone with shigella swims in it.

Other ways to help prevent infection of Shigella includes:

Frequently and carefully wash your hands with soap and running water for at least 20 seconds.
Always wash your hands before preparing, serving or eating food.
Be sure to wash your hands after using the restroom.
Always wash your hands after changing soiled diapers.
People who have shigella should not prepare food or pour water for others. If you are a food handler and experience these symptoms, do not go to work.
Wash fruits and vegetables before eating.

There's A "Shigella Scare" In Springfield & Green County, Missouri; But Few Facts About It

Shigella Attorney — Wed, 20 May 2009 06:42:10 -0800

Missouri's Springfield-Greene County Health Department put this statement on their website yesterday:

Hand washing protects you from a number of different illnesses, including colds, viruses and diarrheal illnesses like shigellosis. Greene County has seen an increase in shigellosis cases in the past month. Shigellosis is caused by the Shigella bacteria and is spread easily from person-to-person by dirty hands. The best way to stop this cycle and slow the spread of shigellosis in our community is for each of us to wash our hands frequently -- after using the bathroom, after changing a diaper and before eating or drinking.

Without saying, or apparently anybody asking, how many cases, the Health Department managed to get good coverage of its warning. See this KY3 News story, for example. Under a "Shigella Scare" headline, the warning was enough to get Greene County Health Department Director Kendra Williams on camera without giving up much in the way of facts.

From the comments on the KY3 website, however, it appears that Greene County may have a shigella problem in its dare care facilities. Any reporter there want to take this a bit further please?