The Journal News reports: When schools that serve young children in the Jewish community closed for Pesach in April, Rockland County health officials thought an outbreak of a highly contagious bacterial disease would end.

To their surprise, the number of shigellosis cases among children in Monsey continued to rise. The disease is now being reported in New Square, as well as in New York City and in the town of Monroe in Orange County.

As of yesterday, 130 cases of shigellosis have been reported to county health officials, said Dr. Joan Facelle, Rockland’s health commissioner.

All of the current cases occurred in youngsters who attend private Jewish schools in Monsey and New Square. No cases have been reported outside of those communities.

The bacterial disease first was seen among a few children in January, with a majority of the infections occurring in early April.

Outreach workers with the Health Department have been meeting with community leaders, including rabbis in Monsey and New Square, and visiting schools where cases have been reported.

“Now that the school year is ending, we will make an effort in the summer camps as well,” Facelle said.

“We continue to stress the importance of hand-washing,” she said, as key to preventing outbreaks.

EDITORS NOTE: As the summer vacation starts, and children will be in camps ad bungalow colonies, YWN suggests taking a few moments to educate yourselves about Shigella, courtesy of the CDC. Please take the time to read it, and protect your children – and yourselves.

What is shigellosis?

Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. The diarrhea is often bloody. Shigellosis usually resolves in 5 to 7 days. Persons with shigellosis in the United States rarely require hospitalization. A severe infection with high fever may be associated with seizures in children less than 2 years old. Some persons who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others.

How can Shigella infections be diagnosed?

Many different kinds of germs can cause diarrhea, so establishing the cause will help guide treatment. Determining that Shigella is the cause of the illness depends on laboratory tests that identify Shigella in the stools of an infected person. The laboratory can also do special tests to determine which antibiotics, if any, would be best to treat the infection.

How can Shigella infections be treated?

Persons with mild infections usually recover quickly without antibiotic treatment.   However, appropriate antibiotic treatment kills Shigella bacteria, and may shorten the illness by a few days. The antibiotics commonly used for treatment are ampicillin, trimethoprim/sulfamethoxazole (also known as Bactrim* or Septra*), ceftriaxone (Rocephin*), or, among adults, ciprofloxacin. Some Shigella bacteria have become resistant to antibiotics.  This means some antibiotics might not be effective for treatment.  Using antibiotics to treat shigellosis can sometimes make the germs more resistant. Therefore, when many persons in a community are affected by shigellosis, antibiotics are sometimes used to treat only the most severe cases. Antidiarrheal agents such as loperamide (Imodium*) or diphenoxylate with atropine (Lomotil*) can make the illness worse and should be avoided.

How do people catch Shigella?

The Shigella bacteria pass from one infected person to the next. Shigella are present in the diarrheal stools of infected persons while they are sick and for up to a week or two afterwards. Most Shigella infections are the result of the bacterium passing from stools or soiled fingers of one person to the mouth of another person. This happens when basic hygiene and handwashing habits are inadequate. It is particularly likely to occur among toddlers who are not fully toilet-trained. Family members and playmates of such children are at high risk of becoming infected.

Shigella infections may be acquired from eating contaminated food. Contaminated food usually looks and smells normal. Food may become contaminated by infected food handlers who forget to wash their hands with soap after using the bathroom. Vegetables can become contaminated if they are harvested from a field with sewage in it. Flies can breed in infected feces and then contaminate food. Water may become contaminated with Shigella bacteria if sewage runs into it, or if someone with shigellosis swims in or plays with it (especially in splash tables, untreated wading pools, or shallow play fountains used by daycare centers). Shigella infections can then be acquired by drinking, swimming in, or playing with the contaminated water.

What can a person do to prevent this illness?

Frequent and careful handwashing is important among all age groups. Handwashing among children should be frequent and supervised by an adult in daycare centers and homes with children who have not been fully toilet trained.

If a child in diapers has shigellosis, everyone who changes the child’s diapers should be sure the diapers are disposed of properly in a closed-lid garbage can, and should wash his or her hands and the child’s hands carefully with soap and warm water immediately after changing the diapers. After use, the diaper changing area should be wiped down with a disinfectant such as diluted household bleach, Lysol* or bactericidal wipes.  When possible, young children with a Shigella infection who are still in diapers should not be in contact with uninfected children.

Basic food safety precautions and disinfection of drinking water prevents shigellosis from food and water. However, people with shigellosis should not prepare food or drinks for others until they have been shown to no longer be carrying the Shigella bacterium, or if they have had no diarrhea for at least 2 days.  At swimming beaches, having enough bathrooms and handwashing stations with soap near the swimming area helps keep the water from becoming contaminated.  Daycare centers should not provide water play areas.

Simple precautions taken while traveling to the developing world can prevent shigellosis. Drink only treated or boiled water, and eat only cooked hot foods or fruits you peel yourself. The same precautions prevent other types of traveler’s diarrhea.

(Dov Gordon – YWN / YW-112 / LoHud)