Shigellosis

What Is It? 

Shigellosis is a diarrheal illness caused by the Shigella group of bacteria.

What Are the Symptoms? 

Illness generally begins one to four days after accidental swallowing of the bacteria. 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 child care settings. Children may spread infections acquired in child care facilities to their parents and siblings, and whole families may be ill within a matter of days. Deaths have been reported from this illness: it is one of the more serious infections providers are likely to encounter in the child care setting. 

Although symptoms usually disappear without treatment after four to seven days, bacteria may still be passed out in the stool for several more weeks.

Who Gets It and How? 

Shigellosis is most common in children under five and can be a significant problem in child care facilities. 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. 

Infection is spread by the fecal-oral route. It is spread when diarrheal stools get on hands or objects and then onto other children’s hands and mouths. It can also be spread through stool-contaminated food, drink, or water. 

Children and adults who have Shigella in their stool should receive antibiotic medication which shortens both the duration of the illness and the length of time that bacteria are passed with the stools.

When Should People with this Illness Be Excluded? 

The child should not attend child care and return to group until completion of five days of antibiotics or until two successive stool cultures are negative.

Where Should I Report It? 

• Licensing requires that child care providers report to their local health department and to Licensing if there are two or more known or suspected cases of shigellosis in a child care program. However, the American Academy of Pediatrics strongly recommends that child care providers report even if there is only a single case, to ensure that the local Public Health Department is aware that this serious illness is present in a child care setting.
• Notify parents of children in the involved classroom of the illness. Keep the identity of the infected child confidential. Ask that they have any child with diarrhea, vomiting or severe cramping evaluated by a health care provider, 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.

How Can I Limit the Spread of Shigellosis? 

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. 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 child care until they no longer have diarrhea and have been shown to be free of the Shigella bacteria.
• 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, and that toys are being cleaned and disinfected between uses by children who are likely to put them in their mouths, especially in groups where there have been ill children.