{"id":10145,"date":"2025-03-01T14:02:54","date_gmt":"2025-03-01T19:02:54","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan186\/"},"modified":"2025-03-02T00:48:24","modified_gmt":"2025-03-02T05:48:24","slug":"dhan186","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan186\/","title":{"rendered":"php\/alerts\/dhan186 ~  Division of Public Health &#8211; &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan186.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->186 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->June 5, 2009 1:57 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; Programs<\/a><\/li>\n        <li><a href=\"\/dph\/ofclocations.html\">Office Locations<\/a><\/li>\n        <li><a href=\"\/dph\/contact.html\">Contact Info<\/a><\/li>\n      \n        <li><a href=\"\/calendars.html\" target=\"_blank\">Calendar<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">\n        <li><a href=\"\/dph\/servicesaz.html\">A-Z Services<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/environmental.html\">Air &#038; Water Quality<\/a><\/li>\n        <li><a href=\"\/dph\/ss\/vitalstats.html\">Birth, Death, &#038; Marriage Records<\/a><\/li>\n        <li><a href=\"\/dph\/clinics.html\">Clinics<\/a><\/li>\n        <li><a href=\"\/dph\/healthdatastats.html\">Health Data &#038; Statistics<\/a><\/li>\n        <li><a href=\"\/dph\/php\/emsps.html\">Emergency Preparedness<\/a><\/li>\n        <li><a href=\"\/dph\/healthandwellness.html\">Health &#038; Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; Conditions<\/a><\/li>\n        <li><a href=\"\/dph\/faq.html\">FAQ&#8217;s<\/a><\/li>\n        <li><a href=\"\/dph\/php\/alerts.html\">Health Alerts<\/a><\/li>\n        <li><a href=\"\/dph\/healthylifestyles.html\">Healthy Lifestyles<\/a><\/li>\n        <li><a href=\"\/dph\/hipaa.html\">HIPAA<\/a><\/li>\n        <li><a href=\"\/dph\/regs.html\">Regulations<\/a><\/li>\n        <li><a href=\"\/dph\/forms.html\">Request Forms<\/a><\/li>\n        <li><a href=\"\/dph\/links.html\">Links &#038; Resources<\/a><\/li>\n        <li><a href=\"http:\/\/delaware.gov\/help\/foia_request.shtml\">FOIA Request Form<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li><a id=\"SocialMenuHeader\"><h2>Connect <i class=\"fa fa-thumbs-o-up fa-fw\"><\/i><\/h2><\/a>\n      <ul id=\"SocialMenu\">\n        <li class=\"facebook\"><a href=\"https:\/\/www.facebook.com\/DEPublicHealth\" target=\"_blank\" title=\"Division of Public Health Facebook Page\"><i class=\"fa fa-facebook-square fa-lg\"><\/i> Facebook<\/a><\/li>\n        <li class=\"twitter\"><a href=\"https:\/\/twitter.com\/Delaware_DHSS\" target=\"_blank\" title=\"Delaware Health and Social Services Twitter Account\"><i class=\"fa fa-twitter-square fa-lg\"><\/i> Twitter<\/a><\/li>\n        <!-- <li class=\"googleplus\"><a href=\"#\"><i class=\"fa fa-google-plus-square fa-lg\"><\/i> Google +<\/a><\/li>\n        <li class=\"flickr\"><a href=\"#\"><i class=\"fa fa-flickr fa-lg\"><\/i> Flickr<\/a><\/li>\n        <li class=\"youtube\"><a href=\"#\"><i class=\"fa fa-youtube-square fa-lg\"><\/i> Youtube<\/a><\/li>\n        <li class=\"instagram\"><a href=\"#\"><i class=\"fa fa-instagram fa-lg\"><\/i> Instagram<\/a><\/li>\n        <li class=\"linkedin\"><a href=\"#\"><i class=\"fa fa-linkedin-square fa-lg\"><\/i> Linkedin<\/a><\/li>\n        <li class=\"pinterest\"><a href=\"#\"><i class=\"fa fa-pinterest-square fa-lg\"><\/i> Pinterest<\/a><\/li> -->\n      <\/ul>\n    <\/li>\n  <\/ul>\n\n              <\/div>\n\n            <\/div>\n\n          <\/div>\n\n        <\/div><br>\n\n      <\/div>\n\n\n\n      <div class=\"col-md-9\" id=\"main_content\"> \n\n  \n\n<h2 class=\"center\">Health\n\n<!--[type=EDIT name=\"DHANType\"]-->\n\n\n\n   Advisory<!--[END]-->\n\n<br>\n\n<!--[type=EDIT name=\"DHAN Heading\"]-->\n\n\n\nINCREASE IN <em>SHIGELLA<\/em> INFECTIONS ASSOCIATED WITH MULTI-STATE CLUSTER<!--[END]-->\n\n<\/h2>\n\n\n\n<!--[type=HTMLEDIT name=\"Content\"]-->\n\n\n\n<p>\n\n\n  The Delaware Division of Public Health (DPH) is reporting an increase in shigellosis in New Castle County. This advisory contains\n\n\n  recommendations for community control, information about the increase, and information about shigellosis.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Recommendations for Community Control\n\n\n<\/h3>\n\n\n<p>\n\n\n  Outbreaks of shigellosis occur periodically in Delaware. Documented outbreaks occurred in 1985 and 2002. Childcare facilities have played\n\n\n  an important role in several of these outbreaks. While difficult to control, strict adherence to the following recommendations is\n\n\n  believed to shorten the duration of community wide <em>Shigella<\/em> outbreaks.\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>Proper hand hygiene, disposal of soiled items (e.g., diapers) and disinfection of soiled surfaces is important to limit the spread of\n\n\n  <em>Shigella<\/em>. Anyone with diarrhea must be educated about washing hands after using the bathroom, and before preparing food. Young\n\n\n  children should be supervised using the toilet and instructed to wash their hands. Special care should be taken when handling diapers of\n\n\n  infected children.\n\n\n  <\/li>\n\n\n  <li>Because of the small infective dose, patients with known <em>Shigella<\/em> infections, and their ill contacts, should not be employed\n\n\n  to handle food or to provide child or patient care until 2 successive fecal samples or rectal swabs (obtained at least 48 hours after the\n\n\n  last dose of antibiotic and at least 24 hours apart) are found to be <em>Shigella<\/em>-free.\n\n\n  <\/li>\n\n\n  <li>Children and staff with confirmed <em>Shigella<\/em> infection should have two negative stool cultures, obtained at least 48 hours\n\n\n  after the last dose of antibiotic and at least 24 hours apart, prior to returning to the childcare facility. Older, school age children\n\n\n  may return to school once symptom-free of both diarrhea and fever for 24 hours.\n\n\n  <\/li>\n\n\n  <li>Secondary attack rates in households with infected children are high. Stool specimens from household contacts who have diarrhea also\n\n\n  should be cultured.\n\n\n  <\/li>\n\n\n  <li>Healthcare professionals should always obtain stool cultures from anyone presenting with diarrhea if they participate in childcare,\n\n\n  whether there is a recognized outbreak of gastrointestinal illness or not in the facility. Other bacterial infections (e.g., Salmonella,\n\n\n  Campylobacter) also occur in this age group and need to be identified as they are also subject to similar restrictions.\n\n\n  <\/li>\n\n\n  <li>All symptomatic persons with confirmed <em>Shigella<\/em> in their stool should receive appropriate antimicrobial therapy when\n\n\n  warranted, such as to protect contacts in childcare centers. The choice of antibiotic depends on susceptibility data of individual\n\n\n  isolates as well as local antimicrobial susceptibility patterns. The susceptibility pattern of 12 of the recently reported cases is as\n\n\n  follows:\n\n\n    <ul>\n\n\n      <li>Ampicillin:\u00a0 0% susceptible (one of the 12 did not report ampicillin susceptibilitiy)\n\n\n      <\/li>\n\n\n      <li>Flouroquinolone:\u00a0 100% susceptible\n\n\n      <\/li>\n\n\n      <li>Trimethoprim sulfa:\u00a0 58% susceptible\n\n\n      <\/li>\n\n\n    <\/ul>\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h3>\n\n\n  The Recent Increase in Shigellosis\n\n\n<\/h3>\n\n\n<p>\n\n\n  Since January of this year, 29 cases of <em>Shigella sonnei<\/em> infection have been reported to DPH, compared to 5 during this same time\n\n\n  period in 2008. Twenty six of this year\u2019s cases are in New Castle County and 23 of these cases have been reported since the middle\n\n\n  of April. Of these 23 cases, at least eight are associated with childcare facilities in New Castle County. All of these <em>Shigella<\/em>\n\n\n  cases are linked by Pulsed Field Gel Electrophoresis to an ongoing multi-state cluster identified by the Centers for Disease Control and\n\n\n  Prevention.\n\n\n<\/p>\n\n\n<h4>\n\n\n  About Shigella Infection\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>Clinical Features \u2013 Watery or bloody diarrhea, abdominal pain, fever, and malaise are typical. Most clinical infections are\n\n\n  self-limited (48-72 hours).\n\n\n  <\/li>\n\n\n  <li>Incubation Period \u2013 Usually 1-3 days.\n\n\n  <\/li>\n\n\n  <li>Transmission \u2013 A small inoculum (10 to 200 organisms) is sufficient to cause infection. As a result, spread can easily occur by\n\n\n  the fecal-oral route.\n\n\n  <\/li>\n\n\n  <li>Diagnosis \u2013 Cultures of feces or rectal swab specimens.\u00a0\n\n\n  <\/li>\n\n\n  <li>Infectious Period \u2013 Usually within 4 weeks after illness onset.\n\n\n  <\/li>\n\n\n  <li>Treatment \u2013 Although antibiotics are not required for this generally mild disease, they are often prescribed to shorten the\n\n\n  duration of illness and reduce the infectious period, particularly in childcare center attendees and food handlers.80% of isolates have\n\n\n  been found to be resistant to ampicillin and 47% to TMP\/SMX; 38% resistant to both drugs.,\u00a0 Resistance to fluoroquinolones such as\n\n\n  ciprofloxacin has also occurred.\u00a0 Antidiarrheal agents such as loperamide (Imodium) or diphenoxylate with atropine (Lomotil) can\n\n\n  prolong illness.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h3>\n\n\n  More Information and to Report Cases\n\n\n<\/h3>\n\n\n<ul>\n\n\n  <li>DPH, Bureau of Epidemiology at (302) 744-4541 or 1-888-295-5156 for information and to report cases\n\n\n  <\/li>\n\n\n  <li>CDC: <a class=\"anchors_link\" href=\"http:\/\/www.cdc.gov\/nczved\/dfbmd\/disease_listing\/shigellosis_gi.html#3\">http:\/\/www.cdc.gov\/nczved\/dfbmd\/disease_listing\/shigellosis_gi.html#3<\/a>\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h4>\n\n\n  General References Used in Preparation of this Advisory:\n\n\n<\/h4>\n\n\n<ul>\n\n\n  <li>Red Book, American Academy of Pediatrics, 26th edition.\n\n\n  <\/li>\n\n\n  <li>Control of Communicable Diseases Manual, American Public Health Association, 19th edition.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p class=\"text-center\">\n\n\n  ****\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n<\/p>\n\n\n<p>\n\n\n  If you are not a member and would like to subscribe, please complete the form found online at:\u00a0 <a href=\"\/main\/mailforms\/dph_hanform.aspx\">http:\/\/dhss.delaware.gov\/main\/mailforms\/dph_hanform.aspx<\/a>\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #186 June 5, 2009 1:57 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10145","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10145","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10145"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10145\/revisions"}],"predecessor-version":[{"id":11321,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10145\/revisions\/11321"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10145"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}