The use of hygiene, cohorting, and antimicrobial therapy to control an outbreak of shigellosis
R. E. Hoffman and P. J. Shillam
Colorado Department of Health, Denver 80220.
Shigellae are easily transmitted in day-care centers to children and adult
staff by contamination of diaper-changing surfaces and fomites or directly
from person to person. Appropriate antimicrobial therapy may shorten the
duration of diarrhea caused by shigellae and eliminate the organism from
the feces. Current recommendations of the American Academy of Pediatrics
and the American Public Health Association are that infected children be
isolated until three and two, respectively, consecutive stool cultures are
negative. We utilized a disease control strategy based on use of
antibiotics to control diarrheal symptoms and reduce infectiousness,
cohorting of asymptomatic infected children in the center, and scrupulous
attention to hygiene and environmental cleanliness. This strategy was
effective in stopping transmission, was more practical than some of the
measures now recommended by the American Academy of Pediatrics and the
American Public Health Association, and was well accepted by parents and
center staff. The strategy should be evaluated in other day-care settings.
