{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T21:17:41Z","timestamp":1762377461933,"version":"3.40.5"},"reference-count":24,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2023,10,23]],"date-time":"2023-10-23T00:00:00Z","timestamp":1698019200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:p>During October 2021, the County of San Diego Health and Human Services Agency identified five cases of shigellosis among persons experiencing homelessness (PEH). We conducted an outbreak investigation and developed interventions to respond to shigellosis outbreaks among PEH. Confirmed cases occurred among PEH with stool-cultured <jats:italic>Shigella sonnei<\/jats:italic>; probable cases were among PEH with <jats:italic>Shigella<\/jats:italic>-positive culture-independent diagnostic testing. Patients were interviewed to determine infectious sources and risk factors. Fifty-three patients were identified (47 confirmed, 6 probable); 34 (64%) were hospitalised. None died. No point source was identified. Patients reported inadequate access to clean water and sanitation facilities, including public restrooms closed because of the COVID-19 pandemic. After implementing interventions, including handwashing stations, more frequent public restroom cleaning, sanitation kit distribution, and isolation housing for ill persons, <jats:italic>S. sonnei<\/jats:italic> cases decreased to preoutbreak frequencies. Improving public sanitation access was associated with decreased cases and should be considered to prevent outbreaks among PEH.<\/jats:p>","DOI":"10.1017\/s0950268823001681","type":"journal-article","created":{"date-parts":[[2023,10,23]],"date-time":"2023-10-23T09:30:05Z","timestamp":1698053405000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Shigellosis outbreak among persons experiencing homelessness\u2014San Diego County, California, October\u2013December 2021"],"prefix":"10.1017","volume":"152","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7524-0664","authenticated-orcid":false,"given":"Elizabeth C.","family":"Ohlsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Angel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azarnoush","family":"Maroufi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annie","family":"Kao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria J.","family":"Victorio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynnie S.","family":"Cua","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akiko","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayla","family":"Vanden Esschert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naeemah","family":"Logan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Temet M.","family":"McMichael","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark E.","family":"Beatty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2023,10,23]]},"reference":[{"key":"S0950268823001681_r4","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/159.6.1126"},{"key":"S0950268823001681_r20","unstructured":"[20] San Diego Regional Task Force on Homelessness (2022) Point in Time Count Data Released. (Press release). Available at https:\/\/www.rtfhsd.org\/updates\/2022-point-in-time-count-data-released\/ (accessed 24 October 2022)."},{"key":"S0950268823001681_r22","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18115812"},{"key":"S0950268823001681_r23","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz788"},{"key":"S0950268823001681_r5","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.211"},{"key":"S0950268823001681_r15","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/37.1-2.17"},{"key":"S0950268823001681_r21","unstructured":"[21] Barry-Jester, AM , Hart, A (2020) Hard lives made harder by COVID: Homeless endure a \u2018slow-moving train wreck\u2019. (News) California Healthline. Available at https:\/\/californiahealthline.org\/news\/hard-lives-made-harder-by-covid-homeless-endure-a-slow-moving-train-wreck\/ (accessed 26 October 2022)."},{"key":"S0950268823001681_r6","unstructured":"[6] Vancouver Coastal Health (2021) Shigella flexnari (sic) in the Downtown Eastside. Physician\u2019s Update. Available at http:\/\/www.vch.ca\/Documents\/26%20Feb%202021%20Physicians%20Update%20Shigella%20Outbreak%20Hep%20A%20Cases.pdf (accessed 10 December 2021)."},{"key":"S0950268823001681_r16","unstructured":"[16] Alvarez, JA (2022) County Determines Shigella Outbreak Over (News article). Available at https:\/\/www.countynewscenter.com\/county-determines-shigella-outbreak-over\/ (accessed 29 July 2022)."},{"key":"S0950268823001681_r8","unstructured":"[8] Colopy, K (2018) Health Department Responds to Outbreak of Shigellosis among Persons Experiencing Homelessness. (Memorandum). City of Long Beach. Available at https:\/\/www.longbeach.gov\/globalassets\/city-manager\/media-library\/documents\/memos-to-the-mayor-tabbed-file-list-folders\/2018\/october-19--2018---health-department-responds-to-outbreak-of-shigellosis-among-persons-experiencing-homelessness (accessed 10 May 2022)."},{"key":"S0950268823001681_r17","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2005.076190"},{"key":"S0950268823001681_r19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1006885"},{"key":"S0950268823001681_r12","unstructured":"[12] NCBI Pathogen Detection Isolates Browser. Available at https:\/\/www.ncbi.nlm.nih.gov\/pathogens\/ (accessed 28 July 2022)."},{"key":"S0950268823001681_r1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30475-4"},{"key":"S0950268823001681_r14","unstructured":"[14] Centers for Disease Control and Prevention PulseNet (2022). Available at https:\/\/www.cdc.gov\/pulsenet\/index.html (accessed 1 August 2022)."},{"key":"S0950268823001681_r24","unstructured":"[24] Centers for Disease Control and Prevention (2022) Prevent Shigella infection. Available at https:\/\/www.cdc.gov\/shigella\/prevention-control.html (accessed 26 October 2022)."},{"key":"S0950268823001681_r3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33296-8"},{"key":"S0950268823001681_r9","unstructured":"[9] CBS Bay Area (2014) SF Public Health Officials Report Spike in Diarrhea-Inducing Shigella Bacterial Disease Cases. (News). SF\u00a0Public\u00a0Health\u00a0Officials\u00a0Report\u00a0Spike\u00a0in\u00a0Diarrhea-Inducing\u00a0Shigella\u00a0Bacterial\u00a0Disease\u00a0Cases\u00a0-\u00a0CBS\u00a0San\u00a0Francisco\u00a0(cbsnews.com) (accessed 5 July 2022)."},{"key":"S0950268823001681_r10","unstructured":"[10] Public Health Insider (2021) Update on shigellosis outbreak among people experiencing homelessness in King County. Available at https:\/\/publichealthinsider.com\/2021\/05\/17\/update-on-shigellosis-outbreak-among-people-experiencing-homelessness-in-king-county\/ (accessed 5 July 2022)."},{"key":"S0950268823001681_r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2017.11.010"},{"key":"S0950268823001681_r13","unstructured":"[13] PulseNet (2022) Whole Genome Sequencing. Available at https:\/\/www.cdc.gov\/pulsenet\/pathogens\/wgs.html (accessed 28 August 2022)."},{"key":"S0950268823001681_r2","unstructured":"[2] Francois Watkins, LK , Appiah, GD (2019) Shigellosis. CDC Yellow Book. Available at https:\/\/wwwnc.cdc.gov\/travel\/yellowbook\/2020\/travel-related-infectious-diseases\/shigellosis\u00a0(accessed\u00a05\u00a0July\u00a02022)."},{"key":"S0950268823001681_r18","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2021.0153"},{"key":"S0950268823001681_r11","unstructured":"[11] California Department of Public Health (2020) IDB Guidance for Managing Select Communicable Diseases. Shigellosis. Available at https:\/\/www.cdph.ca.gov\/Programs\/CID\/DCDC\/CDPH%20Document%20Library\/IDBGuidanceforCALHJs-Shigellosis.pdf (accessed 1 November 2022)."}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268823001681","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T09:38:45Z","timestamp":1713433125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268823001681\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,23]]},"references-count":24,"alternative-id":["S0950268823001681"],"URL":"https:\/\/doi.org\/10.1017\/s0950268823001681","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"type":"print","value":"0950-2688"},{"type":"electronic","value":"1469-4409"}],"subject":[],"published":{"date-parts":[[2023,10,23]]},"assertion":[{"value":"\u00a9 The Author(s), 2023. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e61"}}