Multnomah County Issues Clinician Alert for 2023 drug-resistant Shigella diarrheal illness cluster

November 30, 2023 – Multnomah County: Clinician Alert – 2023 drug-resistant Shigella diarrheal illness cluster

Area public health officials have been tracking clusters of drug-resistant Shigella infections, with 16 reported cases in the Portland metro area since September 2023.

Consider Shigella infection in the differential diagnosis for patients presenting with crampy and/or bloody diarrheal symptoms, especially among persons experiencing houselessness (PEH), persons with substance use disorders, and men who have sex with men (MSM).

Situation

Shigella is spread via the fecal-oral route through contaminated food or drink, water, fomites or direct contact including intimate contact. In our area, Shigella has historically primarily affected men who have sex with men (MSM) and international travelers. Other recent outbreaks of illness have occurred via food service and contaminated freshwater bodies.

Since 2015, Shigella has caused multiple outbreaks among persons experiencing houselessness (PEH) in the Portland area(link is external). This population remains at high risk of infectious diarrheal disease.

Shigella is a notifiable condition(link is external) in Oregon, with cases to be reported to local public health departments within one working day.

Providers, clinics and hospitals can help respond to this outbreak:

Test for Shigella with PCR, while ensuring reflex culture and drug sensitivities for positive samples. Clinical laboratories should promptly forward specimens testing positive for Shigella by PCR to the Oregon State Public Health Lab for further analysis.
Avoid antibiotic use for uncomplicated illness, reserving treatment for those with severe illness necessitating hospital admission and/or HIV diagnosis with CD4 count < 200.
Wait for antibiotic sensitivities before treatment when possible.
Provide supportive care for patients as a first priority.
Report positive Shigella cases to the local health department in the patient’s county of residence.
Collect current contact information to facilitate public health contact investigation, especially for unstably housed individuals who are likely to have Shigella.
Work with public health or homeless service providers to provide outpatient short-term housing and access to hygiene (e.g., hotel vouchers) for patients with unstable housing.
Provide detailed health education to patients about reducing spread (including through modified sexual activity), identifying recurrent illness for prolonged infection, and personal hygiene to limit spread and prevent disease. See below for further information.
Persons with Shigella infection should generally be excluded from daycare, school, food service and health care work. Public Health will determine when the individual can return to these settings.

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