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title: Multnomah County reports increase in Shigella-related illness

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"Multnomah County, encompassing Portland, Oregon, has recently experienced a notable surge in Shigella infections, a bacterial illness that leads to severe gastrointestinal distress. This uptick has raised public health concerns, particularly among vulnerable populations such as individuals experiencing homelessness and those with substance use disorders.

**Understanding Shigella and Its Transmission**

Shigella is a bacterium that causes shigellosis, characterized by symptoms like diarrhea (often bloody), fever, and stomach cramps. The infection typically manifests one to two days after exposure and can last up to a week. Transmission occurs via the fecal-oral route, meaning ingestion of even a minuscule amount of contaminated fecal matter can lead to infection. Common transmission methods include:

- Consuming contaminated food or water.

- Direct person-to-person contact, especially in settings with inadequate sanitation.

- Engaging in sexual activity that involves exposure to fecal matter.

The bacterium is highly contagious, and individuals can shed the bacteria in their stool for several weeks after recovery, potentially infecting others during this period. 

**Recent Trends in Multnomah County**

Since 2012, Multnomah County has observed a gradual increase in Shigella cases. However, a significant spike occurred in recent years:

- In 2023, the county reported 96 cases, more than doubling the 43 cases documented in 2022.

- The upward trend continued into 2024, with 158 cases reported, all acquired locally.

- In January 2025 alone, 40 cases were confirmed, with health officials suspecting the actual number to be higher, especially among the homeless population. 

These statistics highlight a concerning escalation in Shigella infections within the county.

**Populations at Elevated Risk**

The recent surge in cases has disproportionately affected certain groups:

- **Individuals Experiencing Homelessness**: Approximately 56% of the recent cases are among the homeless. Limited access to sanitation facilities and clean water exacerbates the spread of Shigella in this community. 

- **Substance Users**: There is a notable association between Shigella infections and individuals using methamphetamines or opiates. Substance use can impair judgment and reduce adherence to hygiene practices, increasing infection risk. 

- **Men Who Have Sex with Men (MSM)**: Historically, Shigella has affected MSM populations due to certain sexual practices that may involve exposure to fecal matter. Local data indicate that fecal-oral spread through intimate activity accounts for up to half of cases without international travel history. 

**Challenges in Treatment**

A significant concern in the current outbreak is the emergence of antibiotic-resistant Shigella strains:

- Strains circulating in Multnomah County exhibit resistance to multiple antibiotics, complicating treatment protocols. citeturn0search2

- The presence of drug-resistant strains necessitates careful selection of antibiotics, often requiring susceptibility testing to ensure effective treatment.

This resistance underscores the importance of prudent antibiotic use and the need for ongoing surveillance to monitor resistance patterns.

**Public Health Interventions**

To address the outbreak, Multnomah County health officials have implemented several measures:

- **Temporary Housing**: Providing short-term housing, such as motel vouchers, for infected individuals experiencing homelessness. This approach ensures access to sanitation facilities and reduces the potential spread within the community. 

- **Hygiene Promotion**: Distributing hygiene kits and setting up temporary hand-washing stations, especially in areas with limited access to sanitation.

- **Healthcare Provider Alerts**: Issuing alerts to clinicians to consider Shigella in patients presenting with compatible symptoms, particularly among high-risk groups. Providers are advised to conduct appropriate testing and report cases to local health departments promptly. 

**Preventive Measures for the Public**

While the general public's risk remains low, adhering to preventive practices is crucial:

- **Hand Hygiene**: Regular and thorough handwashing with soap and water, especially after using the bathroom, changing diapers, and before preparing or consuming food. citeturn0search3

- **Safe Food Practices**: Ensuring food is prepared and stored safely to prevent contamination.

- **Avoiding Sexual Activity During Illness**: Refraining from sexual contact with individuals currently or recently experiencing diarrhea.

- **Exclusion from Sensitive Occupations**: Individuals diagnosed with Shigella should avoid working in food service, healthcare, or childcare until cleared by health authorities.

**Conclusion**

The rise in Shigella infections in Multnomah County highlights the intricate link between public health and social determinants such as housing and access to healthcare. Addressing the outbreak requires a multifaceted approach that includes medical intervention, public health strategies, and social support systems. By focusing on prevention, timely treatment, and addressing underlying social issues, the community can work towards curbing the spread of this infection and safeguarding the health of all its members.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
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