Shigella outbreak continues ahead of weekend cold snap, now spreading beyond homeless population

Spokane’s outbreak of Shigella has continued into the new year and is now spreading among the general population.

The Spokane Regional Health District first announced an outbreak of the gastrointestinal disease in mid-December. At the time, there were 59 cases in Spokane County. As of December 9, there have now been 138 cases.

While cases last month were predominantly concentrated among people who are homeless in Spokane, the disease has now spread to a much larger population.

According to SRHD epidemiologist Mark Springer, approximately 65% of cases in Spokane are among those who are not homeless.

“This is not something that is restricted to people who are homeless or who a have some interface with the homeless community. We want to really encourage people to just be aware,” Springer said. “It’s really important to keep kids home if they have diarrheal symptoms and to pay attention to washing and protecting yourself.”

Shigella is a bacterial infection that causes a bout of diarrhea, bloody stool, stomach pain and other intestinal issues. Unlike many other gastrointestinal infections, Shigella typically also causes fever. The presence of all these symptoms should prompt individuals to seek medical attention.

Symptoms typically begin between one to four days after infection and last approximately seven days. An individual’s feces continue to be infectious up to two weeks after symptoms have ended. While symptoms can be mild, they can lead to dangerous dehydration and in rare cases be fatal.

People who are homeless are more at risk of contracting the infection because it is a disease of sanitation that is spread by an individual’s mouth or other orifice coming into contact with another individual’s feces. Infected stool can be spread from small amounts on surfaces, food or water.

Shigella is unlikely to transmit in settings where there is access to showers, bathrooms and laundry. Those experiencing homelessness have less access to these amenities and are at greater risk of coming into contact with the organism.

Having peaked in mid-December, the health district now believes the disease is on a downward trajectory. Asked if the cold weather and crowded shelters could exacerbate the spread of Shigella, Springer said it was unlikely if shelters are kept clean.

“There is always a risk in congregate settings because you have a lot of people all together. But the real risk is a lack of sanitation,” he said.

The health district has advised local shelters to increase frequency of cleaning and access to hand sanitizer that can kill bacteria.

Other people at higher risk of Shigella infection include those who have recently traveled internationally, children younger than 5, men who have sex with men, and those with weakened immune systems. Food establishments can also be vectors for Shigella transmission.