San Diego County health officials are advising gay and bisexual men, homeless individuals, and people with compromised immune systems that they could be at an increased risk for the intestinal disease shigellosis.


Last year, the County saw the highest number of cases in 20 years, including a disproportional increase in the gay and bisexual community and among the homeless population.

The number of cases typically increases in the late summer and fall and there have already been 98 cases of shigellosis reported in the county so far in 2018. In 2017, a total of 334 cases were reported, representing a 37 percent increase compared to 2016 when there were 232 cases.

A larger proportion of 2017 cases (63 percent) were among men, many of whom self-identified as gay or bisexual, compared to previous years. Additionally, the percentage of homelessness cases also experienced an increase from 7 percent of total cases to 12 percent from 2016 to 2017.

So far in 2018, 25 percent of the reported cases involve gay or bisexual men and 7 percent involve homeless people.

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“Shigellosis is a very contagious disease, but there are many steps people can take to reduce their chances of getting it,” said Wilma Wooten, M.D., M.P.H., County public health officer. “The infection can be prevented by conducting frequent and thorough hand washing; disinfecting any areas that may be contaminated, such as restrooms or diaper changing areas; avoiding swallowing water from untreated pools and ponds, and not preparing or serving food to others when having diarrhea.”


Shigellosis is an acute bacterial disease of the intestines caused by several species of the bacter9ium, Shigella. It is typified by loose stools, frequently containing blood and mucus (dysentery), accompanied by fever, vomiting, cramps and occasionally toxemia.

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More severe complications may include convulsions in children, Reiter’s syndrome and hemolytic uremic syndrome depending on the species of Shigella implicated.

It is transmitted primarily by fecal-oral person to person means. It can also occur through contaminated food or water. Those that are primarily responsible for transmission are those that fail to wash their hands thoroughly after defecation.

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Because Shigella is resistant to gastric acid, a person can get infected with as little as 10 organisms.

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After getting infected symptoms usually appear 1-3 days later. It can be transmitted during the acute phase of infection until approximately four weeks after illness when the organism is no longer present in the feces. Asymptomatic carriers can also infect others.

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Diagnosis is confirmed through bacteriological culture of feces. Treatment of shigellosis may include fluid and electrolyte replacement if there are signs of dehydration.

Antibiotics can shorten the course of infection, the severity of illness and the period of time a person may excrete the pathogen. Because of some antibiotic resistance, a antibiotic susceptibility test should be performed to determine which antibiotic will be effective.