Endless diarrhea and exhaustion: the stomach bug making the rounds among the most vulnerable in Canada

Toronto night nurse Keren Elumir has been working tirelessly for the past five weeks at a safe consumption and overdose prevention site in Moss Park. She has been distributing clean underwear and electrolyte packets to those in need, but she has also noticed a troubling trend. More and more people are showing symptoms of a Shigella infection, also known as shigellosis. This bacterial infection causes diarrhea, stomach cramps, and fever, and it has been spreading rapidly among Toronto’s homeless population.

Currently, there are 11 confirmed cases of Shigella in Toronto, all of which have been among homeless individuals who lack access to proper sanitation facilities. The bacteria can be easily transmitted from person to person through contaminated surfaces, food, or water. It only takes a small number of bacteria units to make someone sick, and the infection remains contagious for weeks after the initial symptoms appear.

Preventing the spread of Shigella is crucial, but it can be challenging for homeless individuals who struggle to find a place to shower, use the restroom, or change their clothes. Many public health officials, like Dr. Shovita Padhi from Toronto Public Health, believe that the actual number of cases is underreported due to the stigma surrounding the infection.

In Edmonton, a similar outbreak has been ongoing since September 2022, with 447 confirmed cases and 309 hospitalizations. Public health officials have been working hard to provide homeless individuals with access to hygiene facilities and laundry services to curb the spread of the infection. Despite their efforts, the outbreak persists among the inner-city population.

In Vancouver, the demographics of those affected by Shigella have shifted over the years. Dr. Aleksandra Stefanovic, a clinical professor at the University of British Columbia, notes that before 2020, the infection primarily affected men who have sex with men. However, it has now become more prevalent among homeless individuals, leading to more severe cases and hospitalizations.

One of the biggest challenges in treating Shigella is the increasing antibiotic resistance of the bacteria. In Toronto and Vancouver, oral antibiotics have proven ineffective in most cases, requiring IV antibiotic treatment for more severe infections. This poses a significant strain on the healthcare system, especially for those who do not have easy access to medical care.

Experts like Dr. Rohit Vijh from Vancouver Coastal Health stress the importance of prevention in combating the spread of Shigella. By providing homeless individuals with access to hygiene and sanitation services, such as public washrooms and washing sinks, the spread of the infection can be mitigated. It is crucial for different partners to come together to address this complex issue and ensure the health and well-being of vulnerable populations in Canadian cities.