Shigella blooms in South Central Idaho

South Central Public Health District warns the community of increases cases of infectious disease Shigellosis, also known as Shigella, in South Central Idaho Thursday.

my.own.private.idahoIn 2015, 17 cases of Shigellosis were reported in the region. Since the beginning of 2016, 14 cases have been reported. The infectious disease has been reported in Blaine, Minidoka, Twin Falls and Jerome counties.

“Many people are unfamiliar with Shigella and what causes it,” said Tanis Maxwell, SCPHD Epidemiologist, in a news release. “Shigella is a bacteria present in the fecal matter of an infected individual. The symptoms of Shigella are watery or bloody diarrhea, abdominal pain, and fever.”

Restaurant owner blames homeless restroom users for outbreak

There’s a lot of amateur epidemiology going on this week. The latest comes from the owner of San Jose’s Mariscos San Juan #3, which reopened yesterday after being linked to 182 illnesses including 12 hospitalizations.

According to ABC 7, owner Segio Cruz says that homeless individuals using his restroom may have introduced the pathogen. Public health folks believe it was a food handler.1052002_630x354

“This is first time this happened in my store, I opened my store in 2000,” said Segio Cruz, the restaurant owner.

Cruz owns three restaurants. He says since the shigella outbreak, business has dropped off 70 percent. He says even more damaging is the negative reputation generated by the incident, which he feels his restaurant does not deserve. “You can get sick in your house, your office, anywhere,” insists Cruz.

Cruz said homeless people often use the bathroom inside his restaurant and that perhaps could be another contributing factor. But again, there is still no definitive answers as to what caused this massive, and now mysterious, outbreak.

If his theory is correct, how did the Shigella get from the restroom to the food?

San Jose restaurant no longer gettin’ shiggy wit it

Marisco’s San Juan #3 restaurant linked to 200 cases of shigellosis is due to be open for business tomorrow according to KCRA. Although a source of the outbreak wasn’t confirmed, the working theory is that an infected food handler was to blame.

The Department of Environmental Health reinspected Marisco’s San Juan #3, which has been closed since Oct. 18, and approved it for reopening after finding it no longer poses a risk to public health from shigella bacteria, officials said.

County officials said the restaurant’s owners voluntarily discarded all food products on site, cleaned and sanitized the facility and retrained all employees in proper food handling methods. Employees who tested negative for shigella are being allowed to return to work.

Health officials determined that an outbreak of illness connected with the restaurant at 205 N. Fourth St. that caused 190 people to become sick was caused by shigella, a contagious diarrhoeal illness.

The source was most likely from an infected food handler at the restaurant who contaminated the entrees with their hands, officials said. But the exact source of the outbreak has not been determined, and officials have said it might never be identified.

182 sick: Shigella cases continue to climb linked to California restaurant

The Santa Clara County Public Health Department on Monday reported an additional 41 people sick with Shigella, bringing the total to 182.

A majority of the sick ate food last weekend from Marisco’s #3 Mexican Sea Food restaurant, located at 205 N. 4th Street in San Jose and public health officials say they expect to see more secondary cases, in which people had contact with someone who ate the restaurant.

Shigella is extremely contagious and causes severe fever, diarrhea and stomach pain and can be spread quickly to others
. County health officials say people with diarrhea must not work, especially food service workers, healthcare providers and childcare workers. Symptoms can take as long as a week to appear, but most often begin one to four days after infection.

County health experts say thorough and frequent hand washing is extremely important in preventing the continued spread of the outbreak.

Can Yelp help in tracking outbreaks of food poisoning?

Doug Powell, a former professor of food safety at Kansas State University who now lives in Australia and writes for, regards Yelp and social media as potentially useful tools for public-health investigators.

yelp-395“But it doesn’t replace boots on the street, the epidemiological work that people have to do,” he said. “All these things have to be taken with a grain of salt, because Yelp is a business.”

That’s what I told Barbara Feder Ostrov, writing for The Atlantic and PBS, who says that when an outbreak of Shigella sickened 98 diners at a San Jose restaurant last weekend, Yelp reviewers were on the case, right alongside public health officials.

“PLEASE DO NOT EAT HERE!!!!” Pauline A. wrote in her Oct. 18 review of the Mariscos San Juan #3 restaurant. “My sister in and brother-in-law along with his parents ate here Friday night and all four of them ended up in the hospital with food poisoning!!!”

That same day, the Santa Clara County Public Health Department shut down the restaurant. Two days later, officials announced that more than 80 people who had eaten there had become acutely ill, with many requiring hospitalization. Twelve diners went to intensive care units.

Since then, the outbreak has grown to more than 90 cases in Santa Clara and Santa Cruz counties.

Some health researchers and public health professionals believe consumer review sites like Yelp might just help them identify and investigate food poisoning outbreaks similar to this one. It’s not unlike using Google searches to track potential flu and Dengue outbreaks.

Public health workers in New York, aided by Columbia University researchers, scanned thousands of Yelp reviews in 2012 and 2013 to find previously undetected food-borne illness, unearthing nearly 900 cases that were worthy of further investigation by epidemiologists. Ultimately, the researchers found three previously unreported restaurant-related outbreaks linked to 16 illnesses that would have merited a public health investigation if officials had known of them at the time. Follow-up inspections of the restaurants found food-handling violations.

In another study, researchers from Boston Children’s Hospital analyzed more than 5,800 Yelp reviews of food services businesses near 29 colleges in 15 states, concluding that reviews describing food poisoning tracked closely with food-borne illness data maintained by the U.S. Centers for Disease Control and Prevention. The timeliness and often-graphic details of the reviews could prove useful for public health agencies investigating food poisoning outbreaks, the researchers concluded.

Researchers also have examined Twitter and Facebook as possible food-borne illness surveillance tools, and Chicago’s public health agency automatically sends information about its Foodborne Chicago reporting site to local Twitter users who complain of food poisoning.

But Yelp’s usefulness for epidemiologists is going to depend a lot on how it handles food poisoning complaints down the road.

The company has been accused of approaching restaurants to remove negative reviews in exchange for advertising dollars, although a class action lawsuit on those grounds was dismissed.

On Tuesday, the company placed an “Active Cleanup Alert” notice on Mariscos San  Juan #3’s review page noting that because the business “recently made waves in the news,” Yelp would “remove both positive and negative posts that appear to be motivated more by the news coverage itself than the reviewer’s personal consumer experience with the business.”

While some reviews were easily visible, others were segregated into Yelp’s “not currently recommended” category, which requires readers to click to see them and do not figure in the establishment’s overall rating.

98 sick: Shigella cases linked to San Jose restaurant

Officials said 11 people are hospitalized in intensive care after contracting Shigella at a San Jose restaurant, prompting the Santa Clara County Public Health Department to issue a warning. patients ate at the Mariscos San Juan restaurant in downtown San Jose on either Friday or Saturday, according to authorities. The restaurant is now closed.

Officials also said the number of suspected cases of Shigella has now risen to 98.

Food is often contaminated with Shigella if it is prepared by someone whose hands are covered in fecal matter.

Time to revise the don’t eat poop mantra (or at least cook the poop).


150 cases of Shigella in Kansas City

There have reportedly been 150 confirmed cases of Shigella in Kansas City, Missouri, prompting city health officials to warn the public of the disease outbreak that causes high fever and abdominal problems.

shigellaFox 4 KC, citing newly released numbers from the Kansas City Health Department on Friday, reports the city usually sees 10 cases of Shigella per year, but so far in 2015 there have already been 150 reported cases. From Jan. 1 to July 1, there were only 16 cases, but in the last two months there have been 134 additional cases. The outbreak is 15-times the annual average.

Gettin’ shiggy wit it: There’s a lot of Shigella being shared at child care centers in Missouri

Unfortunately no one in the public knows exactly where though.

According to the Columbia Tribune reported cases of shigellosis is more than 4 times the expected rate in the Columbia area, and most illnesses are linked to child care settings.

The Columbia/Boone County Department of Public Health and Human Services reports 25 cases of shigellosis, also called shigella, occurring in the past two weeks. Spokeswoman Andrea Waner said the department has averaged six cases a year for the past five years.dirty-hands-medium-new

Waner said most of the cases involve children attending day care. The Missouri Code of State Regulations prohibits her from identifying the locations, she said.

Michelle Baumstark, spokeswoman for Columbia Public Schools, said the district had only one case, several weeks ago. The student was the sibling of a child who was in day care at a location where shigella was reported.

She said because school-age children are toilet trained there isn’t a big concern about the illness spreading in the schools.

A couple of years ago I collaborated with Clemson’s Angie Fraser on a set of USDA NIFA funded food safety and infection factsheets for childcare facilities including using exclusion of ill staff and children as an outbreak control measure. The sheets can be downloaded here and hereAngie just published a bunch of the observation work that led to the the factsheets in the American Journal of Infection Control (abstract below). The work provides some insight on how pathogens might move around a center.

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina


American Journal of Infection Control 43 (2015) 107-11

Angela Fraser, Kelly Wohlgenant, Sheryl Cates, Xi Chen, Lee-Ann Jaykus, You Li, Benjamin Chapman

Background: Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.

Methods: Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.

Results: Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children’s clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high- touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.

Conclusion: General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.

Importance of epi: Outbreak of diarrheal illness caused by Shigella flexneri — American Samoa, May–June 2014

The U.S. Centers for Disease Control reports that on May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea.

American Samoa.schoolBased on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15–June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. Cases were widely distributed across the island. The highest number of cases occurred in children aged 0–9 years. Across age groups, cases were similarly distributed among males and females. These patterns are not consistent with the epidemiology of disease caused by E. histolytica, which tends to cause more cases in males of all ages.

Hypothesis-generating interviews with families of 13 patients did not reveal any common water, food, sewage, or event exposures. Eight participants reported having ill household contacts, with family contacts often becoming ill within 1–3 days after the participant’s illness onset. Six stool specimens were sent to CDC. All were negative for ameba, including E. histolytica, by multiple laboratory methods. All six specimens were also negative for Cryptosporidium and Giardia by a polymerase chain reaction test. However, an invasion plasmid antigen H (ipaH) gene sequence, a genetic marker of Shigella, was identified in four specimens. Additionally, seven Shigella isolates sent to the Hawaii Department of Health and CDC were identified as Shigella flexneri serotype 7 (proposed; also referred to as provisional 88-893 or 1c), and five shared an indistinguishable pulsed-field gel electrophoresis pattern.

american.samoa.peopleShigella causes an estimated 500,000 cases of shigellosis per year in the United States (1). Most persons infected with Shigella develop diarrhea (sometimes bloody), fever, and stomach cramps 1–2 days after they are exposed to the bacteria. The illness usually resolves in 5–7 days. Careful and frequent hand washing and strict adherence to standard food and water safety precautions are the best defense against shigellosis (2).

Together, epidemiologic and laboratory data suggest this was a shigellosis outbreak with person-to-person transmission. This investigation highlights the importance of building epidemiologic and laboratory capacity for enteric illnesses and enhancing basic hand hygiene and prevention strategies in U.S. territories.

‘Never happened in 27 years’ Shigella strikes again: Four sickened at second California restaurant

Zov’s restaurant in Irvine was forced to shut down briefly Wednesday in the wake of a foodborne illness probe tied to four sick customers, health department officials said Thursday.

Zov’s on PortolaThe sickened guests ate at Zov’s on Portola on three different dates between Sept. 16-22, said Deanne Thompson, a spokeswoman for the county’s Health Care Agency. All four people tested positive for shigella, an intestinal disease that triggers severe diarrhea.

Health investigators cleared Zov’s to reopen the same day after the restaurant’s owners took quick action during a four-hour closure to sanitize the restaurant and discard all ready-to-eat foods including fresh produce.

Employees, who cannot return to work until they are medically cleared by the health agency, were also given training on proper hand-washing, Thompson said.

The restaurant reopened late Wednesday using staff from the other restaurants, said Armen Karamardian, vice president of operations at Zov’s – which has locations in other parts of Orange County.

“We are reviewing all policies and procedures to ensure that such an incident will not be repeated. In 27 years of operating restaurants, this is the first such case we’ve experienced,” Karamardian said.