Spokane Regional Health District reports diarrhea-causing Shigella outbreak in Spokane’s homeless community

Spokane is facing an outbreak of Shigella, a diarrhea-inducing bacterial infection, among homeless people in the community, according to the Spokane Regional Health District.

As of Tuesday, there have been 57 confirmed cases of the disease, predominantly among those experiencing homelessness. The Panhandle Health Direct in North Idaho has also identified four cases in Kootenai County, but it is unknown if cases across the state border are connected.

SRHD epidemiologist Mark Springer said yearly Shigella transmission in Spokane County has ranged between three and 23 cases over the past five years. So far, Spokane has seen nearly 60 cases since the last week of October.

Calling it the “first really large outbreak” of Shigella seen in Spokane, Springer urged residents to take precautions to prevent further transmission within and outside the homeless community.

“It is something that we want people to be aware of, because the things that people can do at this time of the year can help prevent it coming into the broader community,” Springer said.

Shigella is a bacterial infection that causes a bout of diarrhea, bloody stool, stomach pain and other intestinal issues. Unlike many other gastrointestinal infections, Shigella typically also causes fever. The presence of all these symptoms should prompt individuals to seek medical attention, according to Springer.

“As soon as we start seeing fever in addition to these symptoms, that’s more indicative of a bacterial source of that infection,” he said. “Sometimes people want to minimize – to think its just a bug – and not to seek care when they should.”

Symptoms typically begin between one and four days after infection and last approximately seven days. An individual’s feces continues to be infectious up to two weeks after symptoms have ended. While symptoms can be mild, they can be fatal in rare cases and lead to dangerous dehydration.

“If we have someone who’s older, who has chronic medical conditions like kidney or renal disease that are impacted by diarrhea or dehydrations, there’s certainly the potential for serious complications,” Springer said.

In Spokane’s outbreak, a “large proportion” of infected people has been hospitalized overnight, he added.

Homeless people are more at risk of contracting the infection because it is a disease of sanitation that is spread by an individual’s mouth or other orifice coming into contact with another individual’s feces.

“It’s not spread through vomiting or urine. It’s spread through feces,” Springer said. “If not thoroughly cleaned, feces can contaminate surfaces or get in the soil or water or food.”

Shigella is unlikely to transmit in settings where there is access to showers, bathrooms and laundry. Those experiencing homelessness have less access to these amenities and are at greater risk of coming into contact with the organism.

The health district has advised local shelters to increase frequency of cleaning and access to hand sanitizer, which can kill bacteria.

Though transmission has predominantly occurred among homeless people, others in the community may want to take precautions. Springer called it a “fuzzy boundary” that could leap to the broader population. He recommends “strict hand-washing,” frequent cleaning of high-touch surfaces and hand sanitizer use.

Other groups at higher risk of Shigella infection include those who have recently traveled internationally, children younger than 5, men who have sex with men and those with weakened immune symptoms. Food establishments can also be vectors for Shigella transmission.

“We are seeing community-wide transmission among those experiencing homelessness,” Health Officer Dr. Francisco Velazquez said in a statement. “At the end of the day, if we’re mindful of hygiene and sanitization, then we can prevent the spread of communicable diseases.”