Shigellosis (Reportable by mail, telephone, facsimile, or electronically as soon as possible, within three days)

Section 690 Section 690.640  Shigellosis (Reportable by mail, telephone, facsimile, or electronically as soon as possible, within three days) a)         Control of Case 1)         Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers Cases with shigellosis (regardless of the specimen source) shall not work as food handlers or in sensitive occupations until diarrhea has ceased for at least 48 hours and two consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification. 2)         Health Care Workers Local health authorities may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding patients, assisting patients with eating, providing or preparing meals for patients, denture or oral care, hygienic practices of the worker, dispensing or administering oral medications, or as part of an investigation of a cluster). Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered. Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care. When specimen submission is required, health care workers who feed patients or assist patients with eating, provide or prepare meals for patients, provide denture or oral care, or dispense or administer oral medications, shall be restricted from these duties until two negative stool specimens are obtained or the local health department determines that monitoring is no longer warranted. 3)         Day Care Attendees Cases of Shigella shall be excluded from attending a child care facility, an adult day care facility, or a facility for the developmentally disabled if below five years of age or incontinent of stool until the case has been symptom free for 24 hours.  Local health authorities may require more strict requirements, such as release specimens before returning to day care, if the local health department determines it is necessary to prevent the spread of infection. 4)         Cases shall avoid swimming in public recreational water venues (e.g., swimming pools, whirlpool spas, wading pools, water parks, interactive fountains, lakes) while symptomatic, and for two weeks after cessation of diarrhea. b)         Control of Contacts 1)         Contacts Who Have Not Had Diarrhea during the Previous Four Weeks A)        Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers i)          There are no work restrictions while submitting release specimens for contacts who are employed as food handlers or in sensitive occupations and who have had no symptoms of Shigella infection during the previous four weeks. ii)         Contacts to cases of shigellosis who are employed as food handlers or in sensitive occupations shall submit two consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  These contacts shall be restricted from their occupations if they do not begin submitting release specimens within one week after notification. Release specimens shall be submitted at least once per week until two consecutive negative specimens are obtained or the individual shall be restricted from working as food handlers. iii)        If either of the two release specimens is positive for Shigella, contacts shall be considered cases and shall comply with subsection (a)(1). B)        Health Care Workers Local health authorities may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding patients, assisting patients with eating, providing or preparing meal for patients, denture or oral care, hygienic practices of the worker, dispensing or administering oral medications, or as part of an investigation of a cluster). Specimens shall be obtained at least 24 hours apart.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care. 2)         Contacts Who Currently Have, or Have Had, Diarrhea during the Previous Four Weeks A)        Food Handlers or Persons in Sensitive Occupations, Not Including Health Care Workers i)          All contacts to cases of shigellosis employed as food handlers or in sensitive occupations, and who currently have diarrhea or have had diarrhea during the previous four weeks, shall not work in their occupations until diarrhea has ceased for at least 48 hours and they have submitted two consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification. ii)         If either of the two release specimens is positive for Shigella, contacts shall be considered cases and shall comply with subsection (a)(1). B)        Health Care Workers Local health authorities may require specimens from health care workers or those who work in occupations requiring standard precautions if there is reason to believe that specimen testing is necessary (e.g., the nature of the work, including feeding patients, assisting patients with eating, providing or preparing meals for patients, denture or oral care, hygienic practices of the worker, dispensing or administering oral medications, or as part of an investigation of a cluster). Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart, and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification, or the individual shall be restricted from patient care. When specimen submission is required, health care workers who feed patients or assist patients with eating, provide or prepare meals for patients, provide denture or oral care, or dispense or administer oral medications, shall be restricted from these duties until two culture negative specimens are obtained or if the public health authority determines that monitoring is no longer warranted. c)         Shigella Outbreaks at a Facility Where Food Handling Takes Place When an outbreak occurs in a facility where food handling occurs, food handlers at the facility shall be considered contacts to cases, and shall submit two consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Local health authorities, in consultation with the Department, may require two consecutive negative specimens from food handlers at the facility before food handlers return to work if there is reason to believe these individuals may be the source of the illnesses or could transmit disease.  In all other outbreaks where there is no reason to believe these individuals may be the source of the illness or could transmit disease, food handlers shall be restricted from their occupations if they do not begin submitting specimens within one week after notification, and specimens shall be submitted at least once per week until two consecutive negative specimens are obtained, or the individual shall be restricted from food handling. d)         Sale of Food, Milk, etc. (See Section 690.30(b).) e)         Laboratory Reporting 1)         Laboratories shall report to the local health authority patients from whom Shigella has been isolated or patients who have a positive result on any laboratory test indicative of and specific for detecting Shigella infection and antibiotic susceptibility test results. 2)         Laboratories shall forward clinical materials positive for Shigella to the Department's laboratory in accordance with the Department's specimen submission criteria. 3)         Laboratories shall report and submit to the Department's laboratory any Shigella-positive food or environmental samples resulting from an outbreak investigation.