COMMUNITY-WIDE SHIGELLOSIS - CONTROL OF AN OUTBREAK AND RISK-FACTORS IN CHILD DAY-CARE-CENTERS

Objectives. The study's objectives were to assess (1) control of a community outbreak of shigellosis through the promotion of handwashing, (2) risk factors in day-care centers, and (3) shigellosis attributable to attendance at a day-care center. Methods. In 1991, an outbreak of shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared-daycare Centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable able to attendance at day-care centers. Results. The outbreak abated 3 weeks after the interventions' initiation, Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the Center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance. Conclusions. Community involvement ment in increasing hand washing most likely resulted control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease.