Almost three weeks after health officials in Upstate New York announced they were investigating a Shigella outbreak affecting 25 people, the estimated victim count has grown to 45. The outbreak is affecting residents of Onondaga County, which includes the city of Syracuse and is located in the northern central part of the state. “There are currently 45 cases of Shigella,” reported the Onondaga County Health Department in a statement to Food Safety News. “This includes confirmed, probable, and what New York State Department of Health is considering suspect (cases). We continue to investigate each and every case for linkages but the source remains unknown.” Shigella infection is characterized by fever, stomach cramps and diarrhea that can be painful and contain blood or mucous. Symptoms usually appear 1 to 3 days after exposure and resolve in about a week. The Onondaga County Health Department is urging area residents to take the following precautions to avoid the spread of Shigella, which is transferred through food or water contaminated with fecal matter carrying the bacteria. – Carefully wash all fruits and vegetables. Cook foods to the appropriate temperatures. Minimize cross-contamination of foods by washing cutting boards/knives and other shared surfaces. – Do not prepare food for others while ill with diarrhea – Wash hand with soap carefully and frequently especially after using the bathroom, after changing diapers, and before preparing foods or beverages. – Supervise hand washing of toddlers and small children after they use the toilet – Dispose of soiled diapers properly – Disinfect diaper-changing areas after using them – Keep children with diarrhea out of child care settings