Outline new guidelines

ST. LOUIS (KMOX) – On May 12, 2014, the City of St. Louis Department of Health issued a Health Alert regarding Shigellosis cases being reported in the City. This Health Update provides revised guidance on the collection of stool cultures associated with this public health concern. The updated information is underlined and highlighted in blue. Of note, as of this date a total of 55 confirmed cases have been reported.

Shigella is mainly transmitted by direct or indirect fecal-oral contact with a symptomatic patient. Infection may occur after the ingestion of contaminated food and water, as well as from person to person. The incubation period for Shigella ranges from 12 hrs-7 days but usually 1-3 days. A person infected with Shigella is infectious from the time of acute illness until there is no presence of Shigella in the stool, usually for 4 weeks after the illness. Appropriate antibiotic treatment usually reduces duration of carriage Shigella to a few days.

Shigella is found to be resistant to commonly used antibiotics such as ampicillin, trimethoprim-sulphamethoxazole, tetracycline and furoquinolones. Decision on antibiotic use must be guided by local antibiotic susceptibility pattern identified through stool test. Isolates from stool cultures should be sent to the State Public Health Laboratory for further analysis. Azithromycin is currently recommended as the drug of choice for the treatment of cases of Shigellosis.
When a patient is diagnosed with Shigellosis or any other illness transmitted by the fecal-oral route, please advise them that: They must wash their hands frequently and thoroughly with soap and warm water. Smaller children need to be educated regarding proper hand washing techniques and supervised during hand washing. Careful hand washing with soap and water is the single most important control measure to decrease disease transmission.
Shigellosis cases and their symptomatic contacts should be excluded from food handling and the care of children or patients until diarrhea ceases and 1 negative stool culture is obtained. The stool sample needs to be collected, 48 hours AFTER completion of antibiotics. Commercial food handlers and healthcare workers suffering from Shigellosis must provide documentation of 1 negative stool specimen, taken at least 24 hours after diarrhea ceases, not earlier than 48 hours after discontinuation of antibiotics, and at least 24 hours apart before returning to work.

Children receiving antibiotic treatment should complete the course as recommended by the health care provider and should return to daycare only after the cessation of diarrhea, and after 1 stool sample is found to be Shigella free through stool culture. The stool sample should not be obtained earlier than 48 hours AFTER completion of antibiotics.
Caregivers should dispose of diapers from infected children correctly. The diapers should be put in a leak proof container with a closed lid. Caregivers must wash their hands carefully with soap and water after changing or disposing of the diapers. Diaper changing areas should be disinfected with household bleach (1/3 cup per gallon of water) or bactericidal wipes.
They need to practice basic food safety precautions.

Children and adults with diarrhea should remain out of public and private swimming pools, saunas or spas for 2 weeks following the end of diarrhea.

For additional information regarding this Health Alert Network message contact Dr.
Shatrughan Bastola, City of St. Louis Department of Health Communicable Diseases
Bureau Chief at (314) 657-1551.
Shigella cases should be reported to the Local Public Health Department in your
jurisdiction within 24 hours of first knowledge or suspicion by telephone, facsimile
transmission or other rapid means of communication.
St. Louis City Health Department tel: (314 657-1448) fax: (314 612-5267)
St. Louis County Health Department tel: (314 615-1630) fax: (314 615-8346
MO Dept of Health and Senior Services 24/7 Duty officer tel: 1-800-392-0272

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