Section 690.640  Shigellosis (Reportable by mail, telephone, facsimile or electronically as soon as possible, within 7 days)

a)         Control of Case.

1)         Standard Precautions shall be followed.  Contact Precautions shall be followed for diapered or incontinent persons or during institutional outbreaks until absence of diarrhea for 24 hours.

2)         Food Handlers or Persons in Sensitive Occupations, not including Health Care Workers.  Cases with shigellosis shall not work as food handlers or in sensitive occupations until diarrhea has ceased for at least 24 hours and 2 consecutive negative stool specimens are obtained.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification.

3)         Health Care Workers.  Local health departments may require specimens from health care workers or those who work in occupations requiring Standard Precautions if there is reason to believe specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).

4)         If an antimicrobial agent has been given, the specimens shall be collected at least 48 hours after treatment was completed.  If Cary-Blair media is used to transport the specimen, the specimen shall arrive at the Department's laboratory or an acceptable laboratory within 72 hours after collection.  Because of the fragility of the Shigella organism, specimens submitted using other transport media shall arrive at a Department laboratory or an acceptable laboratory within 6 hours after passage.

b)         Control of Contacts.

1)         Contacts Who Have Not Had Diarrhea During the Previous 4 Weeks.

A)        Food Handlers or Persons in Sensitive Occupations, not including Health Care Workers.

i)          There are no work restrictions while submitting release specimens for contacts who are employed as food handlers or in sensitive occupations and who have had no symptoms of Shigella infection during the previous 4 weeks.

ii)         Contacts to cases of shigellosis who are employed as food handlers or in sensitive occupations shall submit 2 consecutive negative stool specimens obtained at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  These contacts shall be restricted from their occupations if they do not begin submitting release specimens within one week after notification. Release specimens shall be submitted at least once per week until 2 consecutive negative specimens are obtained or the individual shall be restricted from working.

iii)         If either of the 2 release specimens is positive for Shigella, contacts shall be considered cases and shall comply with subsection (a)(2) of this Section.

B)        Health Care Workers.  Local health departments may require specimens from health care workers or those who work in occupations requiring Standard Precautions if there is reason to believe specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).

2)         Contacts Who Currently Have, or Have Had, Diarrhea During the Previous 4 Weeks.

A)        Food Handlers or Persons in Sensitive Occupations, not including Health Care Workers.

i)          All contacts to cases of shigellosis employed as food handlers or in sensitive occupations, and who currently have diarrhea or have had diarrhea during the previous 4 weeks, shall not work in their occupations until diarrhea has ceased for at least 24 hours and they have submitted 2 consecutive negative stool specimens.  Specimens shall be obtained following clinical recovery of the patient, at least 24 hours apart and not sooner than 48 hours after the last dose of antimicrobials, if administered.  Specimens shall begin to be submitted within one week after notification.

ii)         If either of the 2 release specimens is positive for Shigella, contacts shall be considered cases and shall comply with subsection (a)(2) of this Section.

B)        Health Care Workers.  Local health departments may require specimens from health care workers or those who work in occupations requiring Standard Precautions if there is reason to believe specimen testing is necessary (e.g., the nature of the work, including feeding or oral care, hygienic practices of the worker or as part of an investigation of a cluster).

c)         Sale of Food, Milk, etc. (See Section 690.1000(b).)

d)         Laboratory Reporting.

1)         Laboratories shall report to the local health authority patients from whom Shigella has been isolated or patients who have a positive result on any laboratory test indicative of and specific for detecting Shigella infection.

2)         Laboratories shall forward clinical materials positive for Shigella to the Department's laboratory .

3)         Laboratories shall report and submit to the Department's laboratory any environmental Shigella isolates resulting from an outbreak investigation.

(Source:  Amended at 32 Ill. Reg. 3777, effective March 3, 2008)