Qu’est-ce que Shigella ?

• Shigella est une bactérie qui va d’une personne à l’autre via une contamination transmise par la voie fécale-orale (ce qui signifie la présence de selles dans les aliments, sur les mains ou sur les surfaces).
• Les symptômes habituels peuvent comprendre du sang et du mucus dans des selles fréquentes (diarrhée), souvent appelée dysenterie.
• Si une personne est malade, elle peut transmettre Shigella aux autres personnes longtemps après que les symptômes ne soient plus présents.
• Shigella peut être transmis même si la personne ne montre pas de symptômes.

Les manipulateurs d’aliments peuvent transmettre Shigella dans leurs selles sans même montrer de symptômes

52 cas de shigellose liés à un manipulateur d’aliments sur une période de 2 mois

Que pouvez-vous faire ?
• Si vous êtes malade avec des vomissements, de la nausée ou une diarrhée, ne manipulez pas d’aliments ;
• Les manipulateurs d’aliments doivent se laver les mains avant de préparer les aliments et après passage aux toilettes.
• Les étapes du lavage des mains comprennent :
mouiller les mains, appliquer du savon, frotter les mains, les rincer et se sécher les mains avec un essuie-mains à usage unique.

Une récente étude parue dans Epidemiology and Infection a rapporté une épidémie de shigellose liée à la consommation dans une cafétéria belge. Les enquêteurs ont examiné les situations possibles conduisant à la maladie, analysé les aliments et réalisé des prélèvements de selles du personnel. Après analyse des prélèvements et après enquête auprès du personnel de maladie et de voyage récent, un membre du personnel a été identifié comme la source de l'épidémie.

Les enquêteurs ont découvert que le manipulateur d'aliments impliqué s'était rendu au Maroc peu de temps avant que des cas de maladies aient commencé à apparaître chez les clients. Ce membre du personnel est revenu travailler après le voyage et ne présentait pas de symptômes de la maladie. Seuls 13 des 52 cas signalés ont été confirmés par coproculture. Sept de ces cas ont été découverts avec la même souche de la maladie comme cela a été vu au Maroc au même moment.

Pour plus d’information contactez Ben Chapman, benjamin_chapman@ncsu.edu ou Doug Powell, dpowell@ksu.edu
 

On Nov. 13, 2009, a Belgian physician notified authorities about an apparent cluster of Shigella sonnei; ultimately, 52 cases were identified over two months, and most were linked to a canteen in a public institution building. Best guess is that a food handler who travelled to Morocco shortly before detection of the first laboratory-confirmed case, picked up shigella, and then transmitted it through food.

The details can be found in the current issue of Epidemiology and Infection, where researchers report on a matched case-control study to test an association between shigellosis and canteen-food consumption.

The three food handlers working permanently in the canteen responded to the questionnaire. Food handler A travelled to Turkey from 23 September to
4 October 2009. She started working on 7 October. She prepared sandwiches, washed dishes and served food. She fell ill on 20 October, and had been exposed to canteen food during the 4 days prior to disease onset. Food handler B travelled to Morocco from 23 September to 1 October. This person started working on 4 October and was involved in vegetable washing, preparation of hot meals, sandwiches, cold dishes involving vegetables and cleaning the canteen. He did not declare having fallen sick. Food handler C was also involved in all activities except in hot meal preparation. He had not travelled, been absent or fallen sick.

Of the 52 shigella cases found in 708 employees of a public institution in Flemish Brabant province, Belgium, between September and November 2009, seven cases were confirmed as S. sonnei. There was a common PFGE profile which resembled those from archived specimens from Morocco. Cases of
shigellosis were associated with canteen-food consumption.

Investigators worked with three hypotheses: (i) waterborne transmission through a contaminated water dispenser, (ii) person-to-person transmission or via surfaces (toilets), or (iii) foodborne transmission (through previously contaminated food or during the preparation process by a contaminated food handler).

Foodborne transmission through canteen food is supported by the results of the employee survey and by the matched case-control study. This led us to think that a food handler might have been the source of the outbreak. Food handler B returned from Morocco shortly before the appearance of the first confirmed cases. He did not report any symptoms and worked continuously since his return.

Foodborne transmission might have happened had he been an asymptomatic case. Healthy carriers can shed 102 Shigella c.f.u./g of feces during 1 month.
Thus, food handler B could have unintentionally acted as an intermittent source of food contamination during the period of faecal shedding. Conversely, food handler A, who had travelled to Turkey, could not be the source of the outbreak, since her onset of disease happened after the onset of symptoms of some confirmed cases.

The researchers recommend:
• washing hands with soap and water before eating and after defecation for employees and food handlers;
• preventing sick food handlers from working until full recovery or until negative fecal culture in the case of laboratory confirmation;
• maintaining surveillance of further possible cases of shigellosis through the institution’s prevention service; and,
• collecting information on the workplace when interviewing notifiable cases in order to detect infectious disease clusters early.

Shigellosis outbreak linked to canteen-food consumption in a public institution: a matched case-control study
01.feb.11
Epidemiology and Infection
I. Gutiérrez Garitano, M. Naranjo, A. Forier, R. Hendriks, K. De Schrijver, S. Bertrand, K. Dierick, E. Robesyn, and S. Quoilin
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8024291
Abstract
On 13 November 2009, the authorities of Flemish Brabant, Belgium, received an alert concerning a potential outbreak of Shigella sonnei at a public institution. A study was conducted to assess the extent, discover the source and to implement further measures. We performed a matched case-control study to test an association between shigellosis and canteen-food consumption. Water samples and food handlers' faecal samples were tested. The reference laboratory characterized the retrospectively collected Shigella specimens. We found 52 cases distributed over space (25/35 departments) and time (2 months). We found a matched odds ratio of 3·84 (95% confidence interval 1·02–14·44) for canteen-food consumption. A food handler had travelled to Morocco shortly before detection of the first laboratory-confirmed case. Water samples and food handlers' faecal samples tested negative for Shigella. Confirmed cases presented PFGE profiles, highly similar to archived isolates from Morocco. Foodborne transmission associated with the canteen was strongly suspected.
 

A new report says more than 60 per cent of restaurant employees choose to show up for work instead of staying home when they’re sick because they have no insurance and no paid sick time.

Kim Severson of the New York Times writes the report, called “Serving While Sick,” is based on more than 4,000 surveys and hundreds of interviews with employers and employees. It is intended to put pressure on the restaurant industry to improve conditions for its workers. The Restaurant Opportunities Centers United is one of two groups presenting the report at a Congressional briefing today.