Two More Cases of Shigella Reported Amongst City's Homeless Population Bringing Total to 26

San Diego County reported two new shigella cases associated with an ongoing outbreak, bringing the total to 26 confirmed and three probable cases among individuals experiencing homelessness, it was announced Thursday.

The continuing investigation shows an onset of the bacterial illness dates between Aug. 16 and Oct. 21, with the three new cases occurring between Oct. 18 and Oct. 21.

The 29 cases in the outbreak represent 9% of the 295 total cases reported to date in San Diego County.

"That Is definitely concerning having lived downtown for the last decade and a half, it is concerning that there is a public health issue here," said San Diego resident Ardy Arianpour.

The cases are all among homeless individuals who resided at multiple locations in central San Diego, a county spokesman said. Three cases outside the city are now under investigation. 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.

President of Father Joe's Villages, Deacon Jim Vargas says they are helping get the word out to the community.

"There are many individuals whom we interact with. We provide some level of housing to over 2500 individuals and that's anywhere from a shelter all the way up to affordable housing and permanent supportive housing," Vargas said. "So that allows us actually to get the word out as far as Shigella is concerned or any disease that's out there, any bacterial disease or viral disease to make sure that people are aware of what needs to be done in order to keep them safe."

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 diseases 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.