Content Information
A. Isolation and Quarantine Requirements
Food handlers, healthcare providers, child care providers and children in child care with shigellosis must be excluded.
Minimum Period of Isolation of Patient
For food handlers, child care providers, and healthcare providers, two negative stool cultures must be obtained after resolution of diarrhea before they may return to work/child care. For child care attendees, the child must be excluded until 48 hours after the resolution of diarrhea or if prescribed antibiotics, until 24 hours after treatment with antibiotics has started AND 24 hours after diarrhea stops.
If a case has been treated with an antibiotic, the stool specimen shall not be submitted until at least 48 hours after completion of therapy. The two specimens required, must be taken at least 24 hours apart.
Shigella cases should not cook for others until at least 48 hours after diarrhea has resolved.
Minimum Period of Quarantine of Contacts
Food handlers, healthcare providers and child care attendees who are contacts to a case and symptomatic with diarrhea shall be considered the same as a case and they must comply with the above requirements.
Note: A food handler is any person directly preparing or handling food. This can include a patient-care or child care provider.
B. Protection of Contacts of a Case
- Wash your hands carefully and frequently with soap and water, especially after using the bathroom.
- Do not prepare food for others while you are sick. After you get better, wash your hands carefully with soap and water before preparing food for others.
- Stay home from childcare, school and food service facilities while sick. Your local health department may have a policy on when to return to childcare or school. Refer to your local health department website for more information.
- Avoid swimming until you have fully recovered.
- Wait to have sex (vaginal, anal, and oral) for one week after you no longer have diarrhea.
C. Managing Special Situations
Reported Incidence Is Higher than Usual/Outbreak Suspected Child Care
Since shigellosis may be easily transmitted person-to-person through the fecal-oral route and fecal contamination is common in toddlers, it is important to carefully follow up on cases of shigellosis in child care settings. General recommendations include:
Children with Shigella infection who have diarrhea should be excluded until 48 hours after resolution of diarrhea or until 24 hours after treatment with antibiotics has started AND 24 hours after diarrhea stops.
- Children with Shigella infection who have no diarrhea but do have positive stool cultures should be excluded as above.
- Staff with Shigella infection should be excluded until their diarrhea is gone and they have 2 negative stool cultures. If treated with antibiotics, wait at least 48 hours after completion of antibiotics before obtaining the first stool specimen. Allow at least an additional 24 hours before obtaining the second specimen.
- Always ensure thorough cleaning of the child care and disinfection of classroom materials (such as toys).
School
Shigellosis may be easily transmitted person-to-person via the fecal-oral route in schools. General recommendations include:
- Students or non food-handling staff with Shigella infection who have diarrhea should be excluded until their diarrhea is gone.
- Students or staff who handle food and have Shigella infection (symptomatic or not) must not prepare food until their diarrhea is gone and they have two negative stool tests (submitted at least 48 hours after completion of antibiotic therapy, if antibiotics are given, and taken at least 24 hours apart).
- Ensure routine thorough cleaning of the environment.
Community Residential Programs
Actions taken in response to a case of shigellosis in a community residential program will depend on the type of program and the functional level of the residents.
In long-term care facilities, residents with shigellosis should be placed on Standard (including enteric) Precautions until their symptoms subside. Staff members who provide direct patient care (e.g., feed patients, provide mouth or denture care, or give medications) should be excluded until two stools test negative as described above. Staff members with Shigella infection who do not provide direct patient care and are not food handlers should not work until their diarrhea is completely resolved. Routine thorough cleaning of the environment must also occur.
Reported Incidence Is Higher than Usual/Outbreak Suspected
If the number of reported cases of shigellosis in your city/town seems higher than usual, or if an outbreak is suspected, more intensive investigation is warranted. Consult with your field epidemiologist in CADE for guidance on prevention and surveillance for additional cases.
Note: Refer to Iowa’s Foodborne Illness Outbreak Investigation Manual.
D. Preventive Measures
Educate families with cases in households on ways to control spread.
Environmental Measures
If a food item is potentially implicated samples of the food should be obtained before any disposal of food items. The decision about testing the food can be made in consultation with the CADE and SHL. If a commercial product is suspected, CADE will coordinate follow-up with relevant agencies such as Iowa Department of Inspections and Appeals (DIA).
The general policy of SHL is to test only food samples implicated in suspected outbreaks, not single cases.
To prevent Shigella and other pathogens transmitted by the fecal-oral route, it is recommended that people:
- Wash your hands carefully and frequently with soap and water, especially after using the bathroom.
- Do not prepare food for others while you are sick. After you get better, wash your hands carefully with soap and water before preparing food for others.
- Stay home from childcare, school and food service facilities while sick. Your local health department may have a policy on when to return to childcare or school. Refer to your local health department website for more information.
- Avoid swimming until you have fully recovered.
- Wait to have sex (vaginal, anal, and oral) for one week after you no longer have diarrhea.
Updated 1/2018