2008 Georgia data summary: Shigellosis [2008]

2008 Georgia Data Summary
SHIGELLOSIS

Shigella Quick Fact: Shigella can spread easily in household or childcare settings.

OVERVIEW
Shigellosis is a bacterial infection affecting the intestinal tract. Most cases are seen in the summer and early fall and occur as single cases or in association with outbreaks. Shigella case numbers can vary from year to year, in a cyclical pattern over 5-6 years. Common symptoms include fever and bloody diarrhea.
Mode of Transmission: Mainly by fecal-oral transmission from an ill person or carrier. Shigella is spread either directly by physical contact or indirectly in food and water contaminated by feces of an infected person. The infectious dose is very small (10 or more organisms). Secondary attack rates in households can be as high as 40%.

Figure 2

SURVEILLANCE
All Georgia physicians, laboratories and other health care providers are required by law to report both labconfirmed and clinical diagnoses of cases of Shigellosis.
Active Surveillance for Shigellosis is conducted through FoodNet. For more information, please visit: http://health.state.ga.us/eip/ http://www.cdc.gov/foodnet/

INCIDENCE
In 2008, 1183 cases of Shigellosis were reported, for a rate of 12.2 per 100,000 population (Figure 1). Many of the counties that have higher incidence rates experienced outbreaks in 2008 (Figure 2).

Figure 1.

Shigellosis, 1998-2008

Cases Rate per 100,000 population

2000

25

1800

1600

20

1400

1200

15

1000

800

10

600

400

5

200

0

0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

DEMOGRAPHICS
In 2008, of the reported cases with known race and ethnicity, 54% of cases were White, 32% of cases were Black, 12% of cases were Hispanic, and 2% of cases were other race/ethnicities (Figure 3).
Shigella rates are higher among children in age groups one to less than five, and five to less than ten years old, as compared to other age groups (Figure 4).
Figure 3.

All Reported Cases of Shigella with Known Race/Ethnicity, 2008

HISPANIC 12%

OTHER 2%

BLACK 32%

WHITE 54%

Cases

Rate

Figure 4.

All Reported Cases of Shigellosis with Known Gender/ Age Group, 2008

Age Group

250
200 150
100 50
0 < 1- 5- 10- 18- 30- 40- 50- 60+
1YR <5 <10 <18 <30 <40 <50 <60 Case s

FEMALE MALE

PREVENTION
Carefully and frequently wash hands with soap and
water;
Keep young children with shigellosis who are still in
diapers away from uninfected children;
Do not prepare food for others if you are carrying the
Shigella bacterium;
Avoid consuming inadequately treated water,
particularly from lakes, streams, rivers, and ponds.
In developing countries, drink only treated or boiled
water, and eat only cooked hot foods or fruits you peel yourself.

IMPACT
Hospitalizations Of the total 1,184 cases of Shigella in 2008, 182 (15%) individuals were hospitalized, while an additional 179 (15%) were seen in the Emergency Room.

For more information:
http://health.state.ga.us/epi/foodborne

Persons at Risk Anyone can become infected with shigellosis. Those at increased risk include young children in day care centers, persons in custodial institutions, the elderly, the immunocompromised, travelers to developing countries, and men who have sex with men (MSM).

Routes of Transmission Shigella bacteria are found in the intestinal tract and stools of infected people. The bacteria are spread by direct contact with an infected person or by consuming contaminated food or water. The spread of Shigella often occurs:
Among toddlers who are not toilet trained; Infected food handlers may contaminate food by
forgetting to wash their hands with soap and water after using the toilet;
Water may become contaminated if sewage
runs into it, or if someone with shigellosis swims in it.

Exclusion Criteria Since Shigella are in the feces, only people with active diarrhea who are unable to control their bowel habits (infants, young children, etc.) should be isolated or placed together only with other children with active diarrhea. Most infected people may return to work or school when their stools become formed provided that they carefully wash their hands after toilet visits.

**Food handlers, health care workers and children in day care centers must obtain the approval of the local or state health department before returning to their jobs, schools, and day care centers.