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Independence is providing this information from the Philadelphia
Department of Public Health regarding the recent increase in Shigellosis
infections in Philadelphia:
The Philadelphia Department of Public Health (PDPH) has detected a
significant increase in the number of shigellosis reports received over the
past 6 months. Cases are being identified throughout the city but are most
concentrated in West Philadelphia. Approximately 45% of the 2016 cases are
in children ages 5 and younger, with 66% attending daycare facilities. As
in previous years, there is a high level of resistance to some commonly used
antibiotics, including ampicillin (86% of tested isolates) and
trimethoprim-sulfamethoxazole (Bactrim®) (45% of tested
isolates).
Shigellosis has a very low infectious dose, is highly contagious, and is
spread through the fecal-oral route. Symptoms of shigellosis typically begin
one to four days after exposure and include diarrhea, fever, abdominal cramps,
nausea, and/or vomiting. Severe complications including dehydration,
bacteremia, and seizures may develop in young children, the elderly, and
immunocompromised individuals.
Health care providers are advised to culture the stool of patients
presenting with symptoms consistent with shigellosis and to request
antimicrobial susceptibility testing on all Shigella isolates. Antibiotic
therapy may help to shorten the duration of illness and reduce disease
transmission, but is typically reserved for patients with severe disease, who
are immunocompromised, or working in high-risk settings (childcare, health
care, food handling). Treatment should be tailored on the basis of
antimicrobial susceptibility testing. Individuals who work in or attend
high-risk settings are to be excluded from these settings until two negative
stool cultures are obtained after completion of antimicrobial therapy. Both
symptomatic and asymptomatic household contacts who work in or attend high-risk
settings are also to be excluded until two negative stool cultures are
obtained.
Report all cases of shigellosis to the PDPH by calling 215-685-6748
or faxing a disease report form to 215-238-6947.
Careful attention to hand hygiene is important in limiting the spread of
infection. All patients should be reminded to wash hands with soap and water
after using the bathroom or changing diapers. In addition, as the PDPH has
noted an increase in the number of sexually-acquired shigellosis infections
particularly among the MSM demographic over the last few years, health care
providers are encouraged to educate adult patients that shigellosis can be
acquired via sexual activity, particularly through oral-anal and oral-genital
contact. The use of latex barriers such as condoms and dental dams can reduce
the risk of transmission.
To view the PDPH Health Advisory, click here.
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