FSHN0517

Preventing Foodborne Illness: Shigellosis1

Keith R. Schneider, Soohyoun Ahn, and Renée M. Goodrich-Schneider2

What is Shigella?
Shigella is a Gram-negative, non-motile, non-spore-form­
ing, rod-shaped bacterium capable of causing disease in
humans. Disease occurs when virulent Shigella organisms
are consumed and invade the intestinal mucosa, result­
ing in tissue destruction. Some Shigella strains produce
enterotoxin and Shiga-toxin. Humans and higher primates
are the only known hosts of Shigella. Depending on age and
condition of the host, less than 200 cells can be enough to
cause disease (FDA, 2012).

What causes the foodborne illness

shigellosis?
Shigellosis is an infectious disease caused by bacteria of the
genus Shigella. There are four different groups of Shigella
species: Shigella dysenteriae (group A), Shigella flexneri
(group B), Shigella boydii (group C), and Shigella sonnei
(group D). S. sonnei causes most shigellosis illnesses in Figure 1. Computer-generated image of a number of rod-shaped,
the developed countries, and accounts for approximately drug-resistant Shigella bacteria, based upon scanning electron
70% of shigellosis cases in the United States. Conversely, micrographic imagery. Credits: U.S. Centers for Disease Control and
S. flexneri is the prevalent species associated with illness Prevention - Medical Illustrator
in the developing world (CDC, 2009). The Centers for What are the symptoms of
Disease Control and Prevention (CDC) estimated that
Shigella causes over 130,000 cases per year in the US, which shigellosis?
accounts for 1.4% of total foodborne illnesses (Scallan et al, Shigellosis is characterized in humans by sudden and severe
2011). diarrhea (gastroenteritis or bacillary dysentery), which
is often bloody. Most infected people also develop fever

1. This document is FSHN05-17, one of a series of the Food Science and Human Nutrition Department, UF/IFAS Extension. First Published: September
2005. Revised: July 2012. Reviewed: October 2015. Visit the EDIS website at http://edis.ifas.ufl.edu/.

2. Keith R. Schneider, professor; Soohyoun Ahn, assistant professor; Renée M. Goodrich-Schneider, professor; Food Science and Human Nutrition
Department, UF/IFAS Extension, Gainesville, FL 32611. The authors wish to acknowledge the following persons for their contributions to previous
editions of this publication: Michael J. Mahovic, former graduate student, Plant Pathology Department, University of Florida, and Riya Shukla, then
program co-coordinator, C. Wayne Ellett Plant and Pest Diagnostic Clinic, The Ohio State University.

The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services
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U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County
Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.
and stomach cramps within 1–2 days after exposure to include salads (potato, shrimp, tuna, chicken, turkey,
the bacteria. Symptoms typically last 5–7 days, and most macaroni, fruit, and lettuce), chopped turkey, rice balls,
shigellosis cases resolve without need for hospitalization. beans, pudding, strawberries, spinach, raw oysters,
Shigella thrives in the human intestine and is commonly luncheon meat, and milk. Contamination of these or other
spread through both food and person-to-person contact. foods is through the fecal–oral route. This means the food
Some persons who are infected may show no symptoms at has come in contact with water that has been contaminated,
all, but may still pass the Shigella organism to others. or has been handled under other unsanitary conditions.
It is possible for any food that has been mishandled to
Long-term Effects of Shigellosis become contaminated and spread the disease.
Up to 3% of persons who are infected with Shigella may
later develop chronic joint pain, swelling and irritation Prevention
of the eyes, and sometimes painful urination. This is a The best was to prevent the spread of Shigella is through
reaction to the previous gastroenteritis and is called reactive basic personal hygiene and frequent handwashing. You
arthritis. It is a rare autoimmune disease that can occur should wash hands with soap carefully, especially after
after a bout of gastroenteritis from Salmonella or Shigella. going to the bathroom, before preparing foods, and after
changing diapers. Toddlers and small children should be
How is Shigella spread? supervised for proper handwashing.
Shigellosis typically occurs by fecal–oral contamination. Other tips to prevent shigellosis are shown below:
Most Shigella infections are spread by stools or soiled fin­
gers of an infected person to the mouth of another person • Do not prepare food for others while ill with diarrhea.
when basic hygiene and handwashing are not properly • Avoid swallowing water from ponds, lakes, or untreated
done (for example, when people do not wash their hands pools.
with soap and water after using the restroom or changing • Dispose of soiled diapers properly, and disinfect chang­
a diaper). Shigella infections can be also acquired from ing areas after using them.
consuming food contaminated by infected food handlers
(through poor personal hygiene). In rare cases, swimming • When traveling in developing countries, drink only
water in ponds, lakes, and pools can also spread Shigella if treated or boiled water.
not properly treated and if enough water is swallowed. Such
contamination may originate from sewage leaks or infected
How can you minimize the risk
swimmers (particularly infected swimmers who have or of shigellosis in your plant or
recently have had diarrhea).
establishment?
One of the most important sanitation steps to reduce the
Tests and Treament spread of shigellosis is the treatment of municipal water
Shigella is not a normal inhabitant of the human colon, supplies. Water treatment for public consumption is a safe
but cultures are sometimes falsely negative. This is because and highly effective preventative measure that has been in
Shigella shares several characteristics with normally place for many years. Additionally, the treatment of sewage
occurring colon bacteria (native flora), making it difficult alleviates the spread of Shigella and many other disease-
to isolate it from a stool specimen. Diagnosing Shigella as causing organisms, including Shigella. For this reason, use
the causal agent of an illness requires laboratory testing of municipal water supplies is recommended for all food-
to identify the bacteria in the stool of a possibly infected handling facilities.
individual. Lab tests can also tell which species of Shigella
are present to help determine which antibiotics are suitable Improved worker and facility hygiene at picking and
for treatment. packing facilities is a major step in preventing shigellosis
caused by contaminated produce. To increase the safety of
What foods have been commonly domestically produced foods, both the US Department of
Agriculture (USDA) and the Food and Drug Administra­
associated with Shigella? tion (FDA) have established a hazard analysis and critical
A wide variety of foods can be contaminated with Shigella. control points system (HACCP) for several sectors of
Foods that have been identified in Shigella outbreaks the food industry. In hopes of further minimizing the
risks of foodborne illness, the FDA has since considered

Preventing Foodborne Illness: Shigellosis 2

establishing similar food safety standards throughout • PHF should be received with no evidence of temperature
other areas of the food industry, including domestic and abuse, such as thawing.
imported food products.
HANDLING AND SANITATION
Before and after use, clean and sanitize all cooking equip­
Sanitary conditions for food product ment, utensils, and work surfaces with a mild food grade
receiving, handling, processing, and bleach solution (100–200 ppm of free chlorine) or chemical
storage sanitizers listed in 21 CFR 178.1010. Sanitizing solutions
The stringent requirements of the HACCP program have should be used in accordance with instructions on the
been argued as being too cumbersome or inappropriate for EPA-approved manufacturer’s label.
some food handling operations—specifically minimally
• Let air-dry, if possible. Otherwise, use clean or single-
processed foods. For these facilities, adoption of a program
use disposable kitchen towels / paper towels.
of general good manufacturing practices for food (GMPs),
as defined by the FDA Code of Federal Regulations, Title • Use only potable water to wash and prepare food.
21, Part 110 (FDA, 2009), is suggested. An outline of such • For display or service, select perishable foods last and
GMPs is available from the FDA Center for Food Science put them away first.
and Applied Nutrition and suggests the minimum general
• Rinse and sanitize dishcloths often (or use single-use
sanitation requirements for an FDA-inspected food han­
disposable towels) and use separate ones for each part of
dling and processing facility. To address any specific needs
the kitchen.
of an individual facility (such as for a particular procedural
step or for the safe use of a particular piece of equipment), • Keep foods covered. Flies, other insects, or accidental
sanitation standard operating procedures (SSOPs) should splashing during preparation of other foods can spread
also be developed and followed. Each facility should also be contaminants.
aware of and adhere to any appropriate state and/or local PROCESSING
regulations. The Florida statues for retail food establish­
The easiest way to prevent foodborne illnesses is to ensure
ments can be found at http://www.leg.state.fl.us/statutes,
that foods are thoroughly cooked. It should be noted that
Title 29: Chapter 381, and Title 33: Chapter 509.
certain foods that are typically served uncooked, such as
raw vegetables and fresh fruits, would obviously not benefit
The FDA Food Code outlines appropriate processing and
from a cooking process where none exists. For these items,
cooking requirements for many food products processed in
other factors such as washing, sanitation, worker hygiene,
a retail facility. However, if certain high-risk food products
and proper storage take on much greater importance. For
(such as seafood, sushi, fresh juice, specialty meats, and
specific recommendations, consult the 2009 FDA Food
others) are processed in the retail establishment, additional
Code.
controls and the issuance of a variance (government
permission for exception in the application of a given
law, ordinance, or regulation) by the regulatory authority
STORAGE
is required before processing can occur (Food Code Once a product has been received and/or processed, it is
3-502.11). usually displayed or stored. Some guidelines that will help
prevent contamination at this time include the following:
RECEIVING • Frozen food should remain frozen until it is used.
Specifications for receiving can be found in section
• If frozen food is displayed in a refrigerated case, it
3-202.11 of the 2009 Food Code. The following guidelines
should remain at or below 41°F (5°C).
cover the basic points to be addressed during receiving:
• Product must be cooled adequately; refer to sections
• Potentially hazardous foods (PHFs) should be at a 3-501.14 and 3-501.15 of the Food Code.
temperature of 41°F (5°C) or below when received,
unless otherwise specified by law (e.g., milk, shellfish). • Hold cooked product above 140°F (60°C) while display­
ing and under 41°F (5°C) while storing.
• Raw shell eggs should be received at an ambient air
temperature of 45°F (7°C) or less. • Properly label all stored product.

• PHFs that are received hot should be at a temperature of • Refrigerate at or below 41°F (5°C) or freeze at 0°F
140°F (60°C) or above. (-18°C).

Preventing Foodborne Illness: Shigellosis 3

 • Avoid cross-contamination: keep raw foods away from
ready-to-eat foods while shopping, storing, and prepar­
ing foods.
PERSONAL HYGIENE
The #1 method of avoiding contamination of food with
viral, bacterial, and/or parasitic disease is for all food
handlers to regularly and properly wash their hands.

When to wash hands

While regular handwashing is recommended, some events
should always be followed/preceded by thorough hand-
washing with soap and warm water for 20 seconds:
Figure 2. CLEAN: Wash Hands And Surfaces Often · SEPARATE:
• Before handling, preparing, or serving food Separate Raw Meats From Other Foods · COOK: Cook To The Right
Temperature · CHILL: Refrigerate Food Promptly · Check your steps at
• Before handling clean utensils, or dishware
FoodSafety.gov
• After using the restroom
FDA. Bad Bug Book, 2nd Ed. Apr 2012. pp. 25–28. Last
• After touching your face, cuts, or sores date of access: 9 Apr 2012. http://vm.cfsan.fda.gov/~mow/
• After smoking, eating, or drinking chap19.html
• After handling raw meat—especially poultry
Food and Drug Administration. 2009. Food Code 2009. U.S.
• After touching unclean equipment, working surfaces, Public Health Service. Accessed 1 April 2013. http://www.
soiled clothing, soiled wipe cloths, etc. fda.gov/Food/FoodSafety/RetailFoodProtection/FoodCode/
• After collecting and taking out the garbage FoodCode2009/default.htm
• Before and after assisting someone with diarrhea, after Mead, P. S., L. Slutsker, V. Dietz, L. F. McCaig, J. S. Bresee,
cleaning the bathroom, and after changing diapers C. Shapiro, P. M. Griffin, and R. V. Tauxe. 1999. Food-
related illness and death in the United States. Emerging and
Proper procedure for handwashing
Infectious Diseases 5:607–25. Last date of access: 3 August
1. Wet your hands with warm water.
2005. Available as .pdf at http://www.cdc.gov/ncidod/eid/
2. Apply soap and wash your hands for 20 seconds. Pay vol5no5/pdf/mead.pdf
attention to hard-to-reach areas like knuckle creases,
between fingers, and under finger nails. Include the Ringrose J. H., A. O. Muijsers, Y. Pannekoek, B. A. Yard, C.
forearm past the wrist as you wash. J. P. Boog, L. Van Alphen, J. Dankert, and T. E. W. Feltkamp.
3. Rinse and then dry with a single-use paper towel. 2001 Influence of infection of cells with bacteria associated
with reactive arthritis on the peptide repertoire presented
Some other hygienic tips are: by HLA-B27. J. Med. Microbiol. 50:385–89.
• Do not share food, drinks, spoons, or straws.
Scallan et al. 2011. Foodborne illness acquired in the
• If you have a child in day-care who has diarrhea, inform United States – Major pathogens. Emerging Infectious
the day-care providers so they can make sure germs are Pathogens 17:7–15. http://wwwnc.cdc.gov/eid/article/17/1/
not spread to other children. p1-1101_article.htm
• Do not let anyone who has diarrhea use a pool or swim
in a pond while sick. Stehulak, N. (n.d.). Ohio State University Extension fact
sheet, HYG-5563-98. Shigella: An infectious foodborne
References illness. Last date of access: 3 August 2005. http://ohioline.
osu.edu/hyg-fact/5000/5563.html
CDC. 2009. National Center for Emerging and Zoonotic
Infectious Diseases: Shigellosis website. Last date of access:
The Florida Legislature. 2011. The 2005 Florida Statues. Last
3 Apr 2012. http://www.cdc.gov/nczved/divisions/dfbmd/
date of access: 29 March 2012. http://www.leg.state.fl.us/
diseases/shigellosis/
statutes

Preventing Foodborne Illness: Shigellosis 4