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

For the past five weeks, Toronto night nurse Keren Elumir has been handing out clean underwear and electrolyte packets at a safe consumption and overdose prevention site in Moss Park.

She's been seeing more and more people with the telltale signs of a Shigella infection, also known as shigellosis: diarrhea, stomach cramps and fever.

Toronto has an outbreak of 11 confirmed cases, all among homeless people, who don't always have reliable access to facilities like washrooms.

"You'll hear people yelling, 'I gotta go, I gotta go,'" she said. "So we're trying to make space so people can access the washroom."

The bacterial infection, one of the main causes of dysentery, spreads easily from person to person through an infected person's stool. It takes as few as 10 bacteria units on contaminated surfaces, or in food or water, to get someone sick. The bacteria also remains contagious for weeks after episodes of intense diarrhea. 

The spread is preventable through simple hygiene and sanitation measures. But it's impacting some of the most vulnerable in Canadian cities — and becoming increasingly resistant to antibiotics.

Elumir believes total cases are undercounted in Toronto.

"It's almost impossible to catch all of it," she said. "People are embarrassed. They don't necessarily want to talk about it."

It's a suspicion Dr. Shovita Padhi at Toronto Public Health shares.

"Most people will resolve the infection on their own. So we're really only capturing those who are seeking medical attention, going to the hospital to get tested."

Preventive methods, like washing hands and taking showers regularly, are challenges for homeless people, the main group affected by the outbreak. Many have a hard time even accessing a washroom, says Elumir.

"You have to pay often to have access to a washroom, and not everybody has money." 

Toronto is not the only city that's seeing a Shigella outbreak. In Edmonton, there have been on and off outbreaks since September 2022. Alberta Health Services says it has identified 447 people with Shigella since August 2022 — 309 of whom were hospitalized.

Edmonton public health officials were able to get case numbers down by helping people find a place to shower, use the washroom, do their laundry and get a change of clothes.