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San Jose homeless encampments face Shigella outbreak, public health department says

San Jose Mercury News - 6/18/2024

An outbreak of the gastrointestinal illness Shigella has been identified in encampments of people experiencing homelessness in San Jose since June 3, according to Santa Clara County’s public health department.

There have been three confirmed cases of Shigella related to the outbreak, as well as four cases under evaluation and at least 19 suspected cases, said Dr. Monika Roy, assistant health officer and communicable disease controller for Santa Clara County. Two of the cases have resulted in hospitalization, which is how officials learned of the outbreak, she added at a Tuesday news conference.

Shigella is a gastrointestinal illness that causes nausea, vomiting, diarrhea and abdominal cramping, Roy said. It primarily spreads through contact with infected stool or eating or drinking contaminated food, according to the county’s Shigella fact sheet. While most individuals will resolve the disease on their own, some cases require antibiotics, Roy added, and it is only fatal in “rare cases.”

Shigella is an “extremely infectious disease,” Roy explained. It takes only a small amount of bacteria to cause the illness, and it spreads quickly in areas with limited access to sanitation and hygiene, making encampments particularly prone to spread.

“What’s concerning about this outbreak isn’t the absolute number. We do regularly see Shigella cases,” Roy said. “What’s concerning more is the number that are related to each other.”

The cases have primarily affected encampments in the Columbus Park area, Roy said, but other encampments in San Jose have also experienced cases or suspected cases.

“We are working aggressively to get testing out to all these individuals and get those test kits back, but it is a challenge,” Roy said. “It will be difficult to identify every single person that may be infected.”

The public health department is focusing primarily on two areas to address the outbreak, Roy said: identifying cases to provide testing and treatment, and preventing further spread of the disease. The department sent out field teams to encampments of concern to provide hygiene and test kits, then returned later to collect completed tests. Disease investigators, physicians and nurses have also been working with the effort.

“The best way to address this outbreak or contain it is really by improving sanitation, hygiene and offering clean water to residents who may be ill or at risk,” Roy said.

This outbreak is particularly challenging to address because the county suspects more individuals contracted the illness but were not sick enough to seek treatment, Roy said. “That is why we have a large number of suspect cases,” she added.

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The city has increased the number of portable toilets and hand washing stations in the areas of the encampments and started supplying drinking and washing water, Harkness said. The city has also implemented regular cleaning and disinfecting of these facilities.

“We will continue to follow any guidance or direction from public health,” Harkness said, and will continue “providing the services and support that our unhoused residents need to ensure their safety and the safety of the community.”

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