Jc. Mohleboetani et al., COMMUNITY-WIDE SHIGELLOSIS - CONTROL OF AN OUTBREAK AND RISK-FACTORS IN CHILD DAY-CARE-CENTERS, American journal of public health, 85(6), 1995, pp. 812-816
Objectives. The study's objectives were to assess (1) control of a com
munity 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 s
higella sonnei infections occurred in Lexington-Fayette County, Ky; 14
licensed child day-care centers were involved. Communitywide promotio
n of hand washing was instituted along with diarrhea surveillance. A c
ase-control study compared-daycare Centers that had confirmed cases of
shigellosis with centers that had none. A family transmission study d
etermined those cases attributable able to attendance at day-care cent
ers. Results. The outbreak abated 3 weeks after the interventions' ini
tiation, Day-care centers with outbreaks were more likely than those w
ith no cases to have a food handler who changed diapers and to provide
transportation for children from their homes to the Center. These cen
ters also had a higher toddler-to-toilet ratio than control centers (2
1 vs 12). In 58% of families with shigellosis, the first person with d
iarrhea during the outbreak was a child younger than 6 years; 92% of d
iarrheal 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. Di
arrhea prevention strategies in day-care centers could prevent substan
tial communitywide disease.