Shigellosis control guideline: Appendix A. Response procedure for shigellosis notification (testing flowchart)

Notification: Faecal multiplex PCR positive Shigella/EIEC

1. Create new probable shigellosis case on NCIMS.
   1. Contact doctor:
      1. to check culture requested – If culture was not originally requested, ask doctor to add-on
      2. to ask if case is a high risk case, has travelled overseas, if case is on antibiotics and which antibiotic. If patient is high risk confirm that full sensitivities have been requested by the doctor
      3. for permission to contact case.
   2. If case is:
      1. high risk1: ensure case has received appropriate advice on hygiene and exclusion. Contact case if Doctor has not/is unable. If case is MSM, ask if visited SOPV.
      2. Aboriginal: if relevant, discuss with local Aboriginal Health Workers & if ongoing infection in community is a risk, enact appropriate response.
   3. Check culture result²
      1. For EIEC PCR results (Westmead only) - Enteroinvasive E.coli PCR positive exclude NCIMS record
      2. For culture negative or culture not done:
         1. If no Epi link: NCIMS remains as Probable. No further action.
         2. If Epi link:
            1. Confirm on NCIMS
            2. Contact primary lab to:
               1. Ensure Shigella isolate has been sent to ICPMR for serotyping
               2. If a high risk case¹, obtain copy of full sensitivities³. If necessary, discuss sensitivity results with treating doctor
            3. Contact case for full questionnaire
      3. For culture positive Shigella species
         1. Confirm on NCIMS
         2. Contact primary lab to:
            1. Ensure Shigella isolate has been sent to ICPMR for serotyping
            2. If a high risk case¹, obtain copy of full sensitivities³. If necessary, discuss sensitivity results with treating doctor.
         3. Contact case for full questionnaire

Notification: Shigella species culture positive notification

1. Check culture result²
   1. For EIEC PCR results (Westmead only) - Enteroinvasive E.coli PCR positive exclude NCIMS record
   2. For culture negative or culture not done:
      1. If no Epi link: NCIMS remains as Probable. No further action.
      2. If Epi link:
         1. Confirm on NCIMS
         2. Contact primary lab to:
            1. Ensure Shigella isolate has been sent to ICPMR for serotyping
            2. If a high risk case¹, obtain copy of full sensitivities³. If necessary, discuss sensitivity results with treating doctor
         3. Contact case for full questionnaire
      3. For culture positive Shigella species
         1. Confirm on NCIMS
         2. Contact primary lab to:
            1. Ensure Shigella isolate has been sent to ICPMR for serotyping
            2. If a high risk case¹, obtain copy of full sensitivities³. If necessary, discuss sensitivity results with treating doctor.
         3. Contact case for full questionnaire

References

1. Includes food handler, healthcare worker, childcare worker, child in childcare and men who have sex with men (or who otherwise engage in anal play)
2. Usually 2-3 days, but may be same day. Follow process regardless.
3. Usually available at the same time as the culture result, from the primary diagnostic laboratory.