Contact: Collette DuValle, 317-373-2391

Local Shigella Outbreak Now In Sixth Month

Marion County's Shigella outbreak has entered its six-month and local health officials are concerned that the highly contagious disease will gain momentum now that school-aged children have returned from spring break.

The health department has already received 16 new cases this week after receiving 15 new cases last week. More than 325 individuals, mainly pre-school and school-aged children, have been diagnosed with Shigella since the outbreak began in October of 2007. An untold number of others likely have the disease, but have not sought treatment from their health care provider.

During the last outbreak in 2000, Marion County experienced an increase in the number of cases from 15 just before Spring break to more than 120 in the weeks immediately following spring break.

Shigella is a common, highly contagious infection transmitted primarily from person-to-person through the fecal-oral route. Outbreaks can occur in areas where large groups of people gather. The risk of becoming ill with Shigella and passing it to others can be greatly reduced through frequent and thorough hand washing especially after changing diapers or going to the bathroom.

The usual symptom is diarrhea often accompanied by cramping, abdominal pain, chills, a feeling of illness, headache or fever. The diarrhea often contains blood and mucus, but sometimes neither is present with the disease. People may shed the virus and infect others even after the symptoms go away.

Local health officials have contacted area day care centers, childcare providers, schools, doctors and other health care providers with information about Shigella. The health department has distributed hand washing instruction sheets, educational coloring books and posters encouraging good hand washing to local schools, day care centers and other childcare providers.

Public health nurses have visited large day care centers to talk with students and staff about good hand washing technique. Smaller childcare providers have received phone calls from the health department with offers of educational materials. Indoor pool operators are being contacted by health officials, warning of the outbreak and how to take appropriate precautions. City busses are now carrying a hand washing message to help educate the public about the threat posed by Shigella.

Still, the health department continues to see double-digit new cases being reported each week. Bringing an end to the outbreak poses many challenges.

Parents, who do not have paid sick time or vacation time and are dependent on childcare, often find it difficult to keep their children out of day care for several days, especially if the parent does not receive pay for missed work. Children must be excluded from day care, pre-school and school until stool cultures indicate the child is no longer contagious or until treatment has been completed.

Another challenge is that in non-outbreak situations, testing and the prescribing of antibiotics is not generally completed for diarrhea. However, during the current Shigella outbreak, the health department is encouraging physicians to test persons with diarrhea and to treat those found to have Shigella. It is important that children and adults are identified and treated for Shigella before they return to day care, preschool or school so they no longer can infect others. Otherwise, children returning to day care and school settings may inadvertently spread the disease.

The bottom line is that health department officials want those with diarrhea to exclude themselves from work and to exclude their children from childcare while they have symptoms or until they are seen by their healthcare provider, tested and if appropriate, treated.

For more information about Shigella, contact the Marion County Health Department at (317) 221-2117.

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