A homeless woman sleeps on the sidewalk in downtown San Diego. Photo by Chris Stone

San Diego County reported three new shigellosis cases associated with an ongoing outbreak, bringing the total to 38 confirmed and three probable cases among individuals experiencing homelessness, it was announced Friday.

The investigation shows onset of the bacterial illness dates between Aug. 16 and Nov. 8, with the four new cases occurring between Oct. 23 and Nov. 8.

The 41 cases in the outbreak represent 11% of the 349 total cases reported to date in San Diego County.

The cases are primarily among homeless individuals, primarily among those who resided at multiple locations in central San Diego, a county spokesman said. A case with a known address outside San Diego is being investigated to determine where that individual was residing when they contracted the disease. No source of the outbreak has been identified.

The county is working with the city of San Diego to identify potential exposure sites, promote good hygienic precautions among homeless service providers and food providers, identify additional cases and connect ill individuals to treatment and housing.

Preventive steps include:

  • installation of hand-washing stations.
  • increased cleaning of public bathrooms.
  • sidewalk sanitization.
  • notification by the County Department of Environmental Health and Quality about the outbreak — and precautions — to food facilities in the downtown area, charitable feeding operators, the California Restaurant Association and Gaslamp Quarter Association.
  • public health nurses conducting outreach at shelters.
  • homeless outreach teams distributing shigella information as part of hygiene kits given to the homeless, including an extra 600 the week of Oct. 18.

Shigella is a contagious bacterium typically spread by contaminated surfaces, food or water, or person-to-person. According to the county, those at increased risk include young children, people experiencing homelessness, travelers to locations with poor sanitation and men who have sex with men. In 2020, a total of 240 shigellosis cases were reported in San Diego County residents, while the 426 cases reported in 2019 was the highest number since 1995.

Typical symptoms include diarrhea — sometimes bloody– as well as fever and stomach cramps. While most people will recover fully without antibiotic treatment, some individuals with poor immune systems can develop life-threatening disease and might need further treatment.

People with symptoms that resemble shigellosis should contact their medical care provider. The provider may order stool testing to help with the diagnosis.

Strategies to avoid getting or spreading shigellosis include frequent hand-washing and not preparing food while ill with diarrhea.

City News Service contributed to this article.

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