I found this story to be a good reminder of some simple sanitation
principles--and disease vectors--often forgotten. News media have
seized on farmers and farming and organic ag as "causes" of /E. coli/
infections. And often taken information out of context, or provided
This story interested me for the reporter's apparent ability to think
beyond a panicky, sensationalist approach to the topic. And also a
willingness to remind people of a common fecal-matter disease vector.
But of course it's easiest to blame farmers for fecal-matter
contamination. There are so few of them.
The last time I suggested to someone that her child's bout with
watery diarrhea could have come from contact with
human-feces-transmitted microbes at day care, and that she might
check on sanitation precautions there, she assured me that couldn't
be so, that it was probably something in the food chain. When I
reminded her that her child ate regular meals at a place where
diapers were routinely changed, and served by the people who changed
those diapers, she opined that that seemed like "a stretch." When I
suggested that human feces, including that of children and infants,
carry many microbes, she indicated that I obviously was not a nice
person, and hated children, to think that little babies would be
As Emo Phillips says, some mornings it's just not worth chewing thru
SHIGELLOSIS - USA (WISCONSIN)
Date: Wed, 08 Sep 1999 18:45:48 -0400
From: Marjorie P. Pollack
Source: The Milwaukee Journal Sentinel, 8 Sep 1999 [edited]
The Milwaukee Health Department is warning physicians about an increase of
diarrheal illness caused by _Shigella_ bacteria, and is urging the public
to practice good hand-washing to prevent its spread.
So far this year, about 200 cases have been confirmed in Milwaukee County;
the normal rate is zero to 10 per month, Health Commissioner Seth Foldy
said. It is not an epidemic and is not transmitted through treated city
water, as the _Cryptosporidium_ epidemic was six years ago, he emphasized.
"It primarily is a person-to-person, fecal-oral spread. It is not in the
water," Foldy said.
"Diapers is where it's at," and two-thirds of cases this year have occurred
among children in diapers or people who handle them, including clusters of
cases at institutional and home-based day care centers, Foldy said. "The
single most important disease control strategy for this illness is
"People need to know that hand-washing will benefit them not only with
(preventing) Shigella but also with their chances of getting many other
An alert to community physicians to watch and test for _Shigella_ among
patients with severe diarrhea is being mailed with this month's Milwaukee
County Medical Society newsletter, Foldy said.
Symptoms [of shigellosis] include watery diarrhea often accompanied by
fever, nausea, vomiting and cramps. Stool often contains blood, mucus and
pus, according to "Control of Communicable Disease in Man," a widely used
reference book on infectious disease published by the American Public
Health Association. Illness often is worse in children than adults. It
lasts an average of four to seven days and usually resolves on its own. The
typical incubation period is one to three days but can be up to a week.
Infection spreads to others in a household 40% of the time - hence, Foldy's
warnings about hand-washing and cleaning under fingernails, which is the
primary way to prevent further transmission. It takes very little bacteria
to produce infection, and someone infected with _Shigella_ can remain
contagious for a month after symptoms abate.
Milwaukee's increase appears to have started in spring 1998, Foldy said.
Once health officials verified the trend and determined it was a sustained
high level of cases rather than an isolated outbreak, they started
interviewing and testing each reported case, along with household and
About 84% of cases this year were among city residents and 16% were in
Milwaukee County suburbs. About 30% involve children under age 6. The
biggest cluster was 21 cases at a day care center.
The species involved in the Milwaukee area cases is _Shigella sonnei_,
which produces less severe illness [than _S. dysenteriae_] and rarely
causes death. It's also possible to be infected and not have symptoms.
"This particular bug is not a killer, nor does it lead to chronic disease
like certain _E. coli_, _Salmonella_ and cryptosporidia," Foldy said.
But if someone gets [shigellosis], it also means they could get one of
those other [infections] through the same pathway - contact with infected
stool, he said. And those other illnesses can be fatal or have serious
consequences such as kidney failure.
Physicians are required to report cases of _Shigella_ infection to public
health officials. Foldy thinks some of the increase is due to a reporting
system instituted about two years ago that makes it easier for suburban
Milwaukee County health departments to notify the Milwaukee Health
Department. But that doesn't account for all or even most of the increase,
and Foldy said federal health experts believe that the true number of cases
in a community is about 20 times the number of confirmed cases reported to
[Byline: Marilynn Marchione]
Center for Integrated Ag Systems, UW-Madison
UW voice mail: 608-262-8018
Home office: 415-504-6474 (504-MISH)
Home office fax: Same as above, phone first for enabling
I'm a problem solver. --Xena, warrior princess
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