Daycare diarrhea cases prompt hygiene warning

NEW YORK (Reuters Health) - In 2005, Kansas, Kentucky, and Missouri experienced outbreaks of shigellosis, a diarrheal disease, that were related to exposure at daycare centers.

In the Morbidity and Mortality Weekly Report released Thursday, researchers from the Centers for Disease Control and Prevention describe the outbreaks and urge prevention measures based on appropriate hygiene practices.

Shigellosis is an infectious disease caused by bacteria of the Shigella family-in the present outbreaks, the organism was Shigella sonnei. Diarrhea, which is often bloody, as well as fever and stomach cramps, are common symptoms of the disease. Infected patients release the bacteria in their stool and, without adequate hand-washing practices, they can pass the organism to others who ingest it and become infected themselves.

Both the Kansas and the Missouri outbreaks involved the Kansas City Metropolitan Area. The former involved 201 confirmed cases and the latter involved 645 confirmed and 85 probable cases that occurred between May and December 2005. In both outbreaks, the typical patient was about 7 years old.

In the Kansas outbreak, information about daycare exposure was not obtained. Such information was obtained in the Missouri outbreak and it was estimated that up to 82 percent of patients or their household contacts had been exposed to a daycare center. In both outbreaks, the microbe was usually resistant to the antibiotics ampicillin and TMP/SMX, whereas no resistance to ceftriaxone or ciprofloxacin was seen.

The Kentucky outbreak, which arose between May and August 2005, involved 148 confirmed cases of S. sonnei infection. Patients were commonly 4 years of age and 93 percent of cases involved direct or indirect exposure to a daycare center. The Shigella showed the same resistance pattern as noted in the other two outbreaks.

Case investigations in all three states were conducted by public health officials who visited the daycare centers to encourage hand-washing and appropriate diapering and food preparation practices. Children with shigellosis were excluded from daycare centers until two consecutive stool cultures, following antibiotic therapy, showed no Shigella.

Doctors were made aware of the outbreaks and the S. sonnei resistance patterns and were advised to confirm the identity of the organism by taking a sample to grow a culture and to treat patients with a suitable antibiotic.

"Public health measures should focus on prevention of shigellosis outbreaks through appropriate hygiene practices" and, when possible, have groups of infected children convalesce together in daycare centers, the report recommends.

SOURCE: Morbidity and Mortality Weekly Report, October 5, 2006.