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 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.