Shigellosis Infections In Childcare

Shigellosis is an intestinal infection caused by the bacteria Shigella. In the U.S., thousands of people are infected with shigellosis each year; most are preschoolers ages 2-4 years old.

Shigellosis, which causes mild to severe diarrhea, is most common during the summer months. Childcare settings can be a breeding ground for shigellosis because personal hygiene practices may be difficult to control for children and staff.

How Shigella is Spread

The germ called Shigella actually is a family of germs that can cause diarrhea. These microscopic living creatures pass from person to person.

Shigella is usually spread in young children by the fecal-oral route. Young children explore their environment by taste and touch. It is not uncommon for toddlers to reach into diapers then touch toys, objects, and other children.

Shigella also can be spread through feces-contaminated food, drink, or water. Shigellosis is highly contagious. It only takes a very few swallowed Shigella bacteria to cause infection. Illness can be spread easily in families and childcare facilities where children share contaminated toys, for example.

Signs and Symptoms

Shigella bacteria attack the lining of the large intestine, causing swelling, ulcers, and bloody diarrhea. In children, bowel movements generally are watery with traces of blood or mucus, which may lead to dehydration.

Symptoms of shigellosis include:

• Stomach cramps
• High fever
• Loss of appetite
• Nausea, vomiting, and convulsions in children
• Painful bowel movements
• Diarrhea with blood or mucus

Children with diarrhea can quickly become dehydrated. Some may require fluids to prevent dehydration. When dehydrated, children may show signs of:

• Thirst
• Irritability
• Restlessness
• Lethargy
• Dry mouth, tongue, and lips
• Sunken eyes
• A dry diaper for several hours in infants or fewer trips to the bathroom to urinate in older children.

Treatment

Most people with shigellosis will recover on their own within five-seven days. Antibiotics can be used for more severe cases although some strains of Shigella are resistant to antibiotics.

Antibiotics also may be used in situations where this is a high probability of the carrier spreading the disease, such as for a food handler, or where many cases of the disease have been reported in a close community, such as a childcare setting or school.

Prevention

Because diarrhea can be caused from many diseases, a laboratory test examining the stool or fecal lining can confirm the presence of Shigella. Once a case of shigellosis has been discovered in the childcare setting, the best way to prevent its spread is careful and proper handwashing with soap and running water.

Waterless or alcohol-based hand sanitizers can be used when water is not readily available, such as on a field trip, but should not substitute for frequent and thorough soap and water handwashing.

Stringent handwashing policies will help reduce the spread of contagious diseases, such as the Shigella bacteria. Caregivers should wash children’s hands often, especially after they cough, sneeze, use the toilet, or have diapers changed. As an activity, teach children how to properly wash their hands.

In the event of a case of shigellosis in the early care and education setting, all parents should be notified. A “Dear Parent” letter, along with a Shigella fact sheet, is an one way to notify parents of Shigella and provide suggestions to follow at home. The letter also should inform them of the steps the childcare program will follow to resolve and monitor the illness.

Shigella prevention includes the following:

• Wash hands thoroughly before and after using the toilet and changing diapers.
• Wash hands thoroughly before and after handling, preparing, and serving food and beverages.
• Keep children with diarrhea at home.
• Dispose of diapers in a sealed garbage can.
• Wipe the diaper changing area with disinfectant after each use.
• Wash and disinfect toys thoroughly and often.

Should Infected Children be Excluded?

Since Shigella bacteria are spread through the feces of an infected person, children with active diarrhea, or those unable to control bowel habits, should be isolated or excluded. To further prevent the spread of infection, parents should be counseled not to take the child to a different childcare facility while the child shows signs of infection.

Infected adults should be excluded from handling, preparing, or serving food, changing diapers, and possibly the childcare setting in general. Most infected children may return to school when the child’s diarrhea stops and they provide a “return to school notice” from the pediatrician or family physician.

Handwashing and exclusion policies help reduce the spread of illness and disease such as shigellosis in childcare settings. Policies also serve to enforce guidelines and protocols that help ensure the well-being of staff, volunteers, children, and parents and siblings of enrolled children. Policies, education, and training alert childcare staff and parents that the facility is committed to a safe and healthy environment where children can learn, grow, and explore.

Shigellosis is a nationally-reportable disease. Contact your local health department to report any occurrence of Shigellosis. Your health department may be a good resource for information on this disease to send home with parents.

Phyllis Wallace, DrPH
Adjunct Faculty, Health Sciences, Head Start Consultant

INTERNET RESOURCES

Centers for Disease Control & Prevention, www.cdc.gov/ncidod/dbmd/diseaseinfo/shigellosis_g.htm

KidsHealth, Shigella Infections, www.kidshealth.org/parent/infections/bacterial_viral/shigella.html

King County, Washington Shigellosis Fact Sheet, www.metrokc.gov/health/prevcont/shigellosis.htm

Minnesota Department of Health, Age Appropriate Hand Washing Curriculum, www.health.state.mn.us/handhygiene/curricula/curriculum.html

Scrub Club Hand Washing Curriculum, www.scrubclub.org/home.aspx