The Arkansas Department of Health (ADH) is alerting Arkansans of a recent increase in Shigella cases. The Shigella germ is spread by direct contact with an infected person and occasionally from eating or drinking contaminated food or water. It is a fairly common disease. Most cases are seen in the summer and early fall and occur as single cases or outbreaks. Daycare centers are high risk areas due to diaper changing and children who are not able to practice proper toileting and hand washing.
Shigella can also easily spread in restaurants and other food service facilities when proper food handling and hygiene is not practiced. This usually occurs when an infected food worker does not wash their hands properly and has contact with food. Foods most often associated with Shigella outbreaks are salads and sandwiches that involve a lot of hand contact in their preparation, and raw vegetables contaminated in the field.
It takes only a few Shigella bacteria to make you sick. Shigella can spread very easily. Symptoms of Shigella can include mild or severe diarrhea, often with fever and traces of blood or mucous in the stool. This may be accompanied by abdominal cramps. Some infected people may not show any symptoms.
Basic food safety precautions and disinfection of drinking water prevents shigellosis from transmission by food and water. However, people with shigellosis should not prepare food or drinks for others until they have been shown to no longer be carrying the Shigella bacterium and if they have had no diarrhea for at least 2 days.
Because this infection spreads quickly in daycare settings, the infection requires removal of children from daycare until diarrhea-free for 24 hours and five days of an appropriate antibiotic. Day care staff members also require treatment and exclusion depending on their stool culture results and symptoms.
General steps to lessen the risk of infection:
- Proper cleaning and food preparation of raw vegetables.
- Proper hand washing is very important in the prevention of Shigella infections. Good hand washing and cleaning are important even after the children and employees return to daycare or food services.
- Food service workers should use gloves, deli tissues, or tongs. Bare hand contact with food that has already been cooked or will not be cooked should be completely eliminated.
- If hands are contaminated, every surface that is touched can be a potential source of infection. Sink faucets, door handles, light switches, toys, and changing tables are all examples of items that are handled often and can easily be contaminated.
- When cases are recognized, sanitize all surfaces to eliminate the possibility of bacteria being present. One tablespoon of unscented bleach per gallon of water is an effective sanitizer against Shigella. After washing and rinsing, dishes and toys with hard surfaces should be submerged in sanitizer for 30 seconds and then be removed to air dry. Other cleaned surfaces should be sprayed/wiped with sanitizer and left to dry.
- Flies must be under control. Flies can land on contaminated surfaces and carry the bacteria to many locations throughout your daycare or food establishment and put everyone potentially at risk.
Because Shigella is so easy to spread, an environmental health specialist and public health nurse are required to do an inspection of the daycare or food service facility when two or more cases are reported. If this occurs, ADH will work with you to verify control measures are in place