Downtown Eastside Hit with Dysentery Again

A Vancouver doctor is warning about an uptick in cases of shigellosis in the Downtown Eastside, a bacterial infection that causes diarrhea, fever and stomach cramps and can be severe enough to require treatment in hospital. The illness is also known as dysentery.

In March, at least 24 people became sick with the illness, and 16 people needed to go to hospital.

Dr. Victor Leung turned to Twitter this weekend to share that he’s seen an increase in shigellosis patients at St. Paul’s Hospital in downtown Vancouver.

Vancouver Coastal Health says there have been six cases so far in November. The health authority says the cases are so far isolated, and no connection has yet been found between the cases.

Leung told The Tyee it’s concerning to see the increase in cases, because the number of sick people could “expand quickly if prevention and control measures are not implemented in a timely manner.”

He said he decided to tweet about the uptick in patients with shigellosis because community members need to have the information “in as many ways as possible.”

Shigella flexneri is a bacteria present in feces that can spread when people don’t have access to proper hand-washing options, safe food preparation or clean bathrooms.

All of those conditions are common in the Downtown Eastside, where many residents are homeless or live in single-room occupancy hotels with shared bathrooms where they may not have consistent access to soap and hot water.

In his tweet, Leung said the strain of shigella flexneri appeared to be “drug resistant.” He clarified to The Tyee that the shigella is resistant to an antibiotic that is commonly used, but other antibiotics have been working well to treat the illness.

He said the previous strain of the illness seen in March had the same “antibiotic susceptibility profile” as the current cases.

Appears to be ongoing transmission of highly infectious multi-drug resistant Shigella flexneri 2a in the DTES. @kwardvancouver @JenStDen

Time to open up washroom and shower facilities.

— Dr. Victor Leung, MD (@VicLeungIDdoc) November 22, 2021

In response to the March outbreak, Vancouver Coastal Health told housing providers to ensure that bathrooms and showers are kept clean, that staff and tenants have access to frequent hand washing and hand sanitizer, and that bathrooms are regularly stocked with soap and hand sanitizer.

The city has since opened more public bathrooms, but Leung said more needs to be done to make sure all residents have access to safe, clean bathrooms and showers.

“If someone has shigella and doesn’t clean their hands well enough, even a small amount could lead to transmission,” Leung told his colleague, Dr. Ben Huang, for a story that Huang wrote for the Conversation about the March shigellosis outbreak. Shared bathrooms raise the risk of transmission, Leung said.

In his story, Huang called dysentery a “disease of poverty” and said the outbreak in the Downtown Eastside was unusual for a rich country like Canada.

During the last shigellosis outbreak, Karen Ward, a Downtown Eastside resident and advocate, called out Vancouver Coastal Health for not warning residents in the neighbourhood.

The shigellosis outbreak in March only became public knowledge after a doctor messaged Ward who then raised the alarm with City of Vancouver staff and councillors.

Ward is again frustrated that it took a tweet from Leung to get information out about the current increase in cases.

Many residents who live in the Downtown Eastside are in poor health, and some residents frequently get gastrointestinal symptoms after drinking the water in SRO hotels. Ward said some people may not realize they could have shigellosis and may need to seek medical help.

“Evidence shows that communities are better at dealing at situations when they have all the information,” Ward said. “We don’t have to wait until it becomes a disaster — we don’t have to die before our lives are saved.”

Carmen Lansdowne, the executive director of First United, said it’s helpful to get information about infectious diseases as soon as possible.

First United operates a shelter at Hastings and Gore as well as several residential buildings, and Lansdowne said she was not aware of the increase in shigellosis cases in the neighbourhood until she was contacted by The Tyee.

“So many of our community are physically vulnerable or have complex medical needs,” she wrote in a message to The Tyee.

“Having clear information as soon as possible helps us to help keep people as safe and healthy as possible. Our health system needs to start thinking about this community as their most important public health priority and be creative in solutions to keep people safe and treat them quickly and treat them well.”

In response to questions from The Tyee, VCH sent a statement saying it would “work with housing providers and others in the community to provide information, investigate possible sites and sources of transmission, and to seek to identify further cases.”

The health authority says vigorous handwashing with soap, not sanitizer, is the best way to avoid transmitting shigella.