Shigellosis is a diarrheal illness caused by the Shigella group of bacteria. The fecal-oral route spreads infection. Only a few bacteria are needed to cause an infection and, unlike many of the diarrheal agents in child care settings, shigella may spread through groups of children who are toilet trained as well as through groups of children who are in diapers.

Depending on the infectious dose, infection with shigella may be very mild or it may result in severe bloody diarrhea, fever, cramping, nausea and vomiting. Numerous outbreaks have been reported from childcare settings. Children may spread infections acquired in childcare facilities to their parents and siblings and whole families may be ill within a matter of days. Deaths have been reported from this illness and it is one of the more serious infections providers are likely to encounter in the childcare setting.

If you suspect a case of shigellosis in your child care facility:

Contact your state or local health department. Prompt intervention may help prevent the spread of shigellosis to others and your health department should be in a position to give assistance and advice.

Exclude the ill child and any children who subsequently develop diarrhea from childcare until they no longer have diarrhea and have been shown to be free of the shigella bacteria. In many areas, public health regulations require proof that an infected person is no longer excreting shigella bacteria before they can return to their normal activities. Your health department should be able to tell you when infected persons can return to childcare.

Make sure all children and adults use careful hand washing and that staff are practicing good diapering practices.

Make sure procedures for cleaning and disinfecting toys are being followed; that toys are being cleaned and disinfected between use by children who are likely to put them in their mouths, especially in groups where there have been ill children.

Notify parents of children in the involved classroom of the illness; ask that they have any child with diarrhea, vomiting or severe cramping evaluated by a physician and that they inform you of diarrheal illness in their child and family. Explain to them the value of hand washing with soap and running water in stopping the spread of infection in the home. In the event of an outbreak, your health department may recommend a more extensive notification of parents

© January 1997