Influenza and Shigella 12/9/14

December 9th, 2014

Influenza

It seems that the influenza season might be a bit early this year!  We are hearing of a large number of students being sent home from school due to fever and cough.  Unfortunately, given the season of year and all of the associated holiday shopping and gatherings we might see increased transmission of flu in our community.

Please remember to counsel families about the following:

  • Patients with influenza should stay home when sick until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius, measured by mouth) or signs of a fever (chills, feeling very warm, flushed appearance, or sweating) without the use of fever-reducing medicine.
  • Encourage patients including students and parents to take antiviral drugs as needed.

Shigella

The Indiana State Department of Health continues to investigate an increase in shigellosis cases reported in Indiana, especially among school/daycare-aged children in Central Indiana. Between March 3 and December 3, 2014, over 1,000 ill individuals have been identified, and at least 880 of those have tested positive for Shigella sonnei.  Nearly two-thirds of Shigella isolates tested from this outbreak show resistance to trimethoprim/sulfamethoxazole. According to the 2012 Red Book published by the American Academy of Pediatrics, children infected with sulfa-resistant Shigella strains may be treated with azithromycin. If susceptibility testing is not done, do not empirically treat with sulfa drugs.

Shigellosis is an extremely contagious, bacterial diarrheal illness transmitted through the fecal-oral route usually though the consumption of contaminated foods or beverages, contaminated water, person-to- person contact, or contact with contaminated objects. Symptoms generally appear between 1-3 days after exposure and include diarrhea (bloody or non-bloody), fever, stomach cramps, nausea, and vomiting. Without proper antibiotic treatment, those infected may continue to shed bacteria up to one month after symptoms cease.

Health care providers are encouraged to:

  • Request cultures and sensitivities on persons with diarrhea lasting longer than 24 hours, especially on contacts of a shigellosis case.
  • Prescribe antibiotic treatment based on case-specific resistance patterns.
  • Report shigellosis cases immediately to the appropriate local health department. Exclusion Criteria (Communicable Disease Reporting Rule, 410 IAC 1-2.3):
  • Exclude cases from attending school until they are asymptomatic for at least 24 hours AND have received antimicrobial therapy for at least 48 hours OR have two successive negative stool samples.
  • Exclude cases from attending preschool or daycare until they are asymptomatic for at least 24 hours

AND have completed effective antimicrobial therapy OR have two successive negative stool samples.

  • Exclude cases who are food handlers, daycare workers, and healthcare workers until they are asymptomatic for at least 24 hours AND have two successive negative stool samples.

REMEMBER TO TAKE A WORK HISTORY ON ALL PATIENTS WITH DIARRHEA

For questions or to report cases, please contact your local health department or the Indiana State Department of Health at 317-233-7125.

Questions call Deb McMahan, MD