Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, December 2008)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An acute infection of variable severity characterized by diarrhea (may be bloody or contain mucous), fever, nausea, cramps, and tenesmus (sensation of needing to pass stool, accompanied by pain, cramping, and straining).

B. REPORTING CRITERIA: Laboratory confirmation.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of Shigella sp. from a clinical specimen.

D. WISCONSIN CASE DEFINITION: A laboratory confirmed case.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

• Acute and Communicable Diseases Case Report (DPH 4151).
• Routine Enteric Follow-up Worksheet – (See page 1 of the Worksheet for specific recommendations regarding which sections are recommended during routine follow-up)

C. PUBLIC HEALTH INTERVENTIONS:

• Educate public about proper hand washing after using the toilet or handling contaminated clothing or linens, before cooking, or associating with high-risk individuals.

• Assess patient’s activities for high-risk settings.

• Exclude infected individuals from high-risk settings until they are asymptomatic AND two consecutive negative stool cultures (collected at least 24-hours apart and obtained at least 48 hours after discontinuance of antimicrobial therapy) are obtained.

• Educate and advise high-risk patients and food handlers on enteric precautions.

• Source investigation by LHD.

• Determine if case is potentially outbreak-related and notify DPH Regional Office or CDES.

NOTE: More detailed guidelines are provided in the DPH Shigellosis Control Guidelines (November 2008) which can be obtained from the Communicable Disease Epidemiology Section at 267-7422 or 267-9009.

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-9009.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / BACTERIOLOGY: (608) 263-3421.

IV. RELATED REFERENCES

1. “Shigellosis” DPH Disease Fact Sheet Series, (Rev. 12/03).
http://dhs.wisconsin.gov/communicable/factsheets/Shigellosis.htm

2. Heymann DL, ed. SHIGELLOSIS. In: Control of Communicable Diseases Manual. 18th ed. Washington, DC: American Public Health Association, 2004: 487-491.

3. Pickering LK, ed. Shigella Infections. In: Red Book: 2006 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003:551-553.

V. DISEASE TRENDS
Of the 1608 reported cases of Shigella in Wisconsin between 1999 – 2003, 1046 (67%) were from 6 counties (Brown, Dane, Kenosha, Milwaukee, Racine, Waukesha).

Table 1. Reported Shigella serogroups
Shigella serogroup	No. of cases
Shigella sp. (not serogrouped)	251
Shigella boydii	10
Shigella dysenteriae	0
Shigella flexneri	65
Shigella sonnei	1282
Total	1608