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Diarrhea caused by Shigella, rotavirus, and Giardia in day-care centers: prospective study
Insights
Day-care centers (DCC) are significant sources of gastroenteritis outbreaks, with Shigella, rotavirus, and Giardia being common causes. These infections spread from children to staff and family members, highlighting DCC
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Gastroenteritis is a common illness in young children.
- Day-care centers (DCC) are environments where infectious diseases can easily spread.
- Understanding the pathogens and transmission dynamics is crucial for prevention.
Purpose of the Study:
- To investigate the occurrence, causes, and transmission of gastroenteritis in children attending DCC.
- To identify specific enteropathogens responsible for outbreaks.
- To assess the role of DCC in the wider community transmission, including staff and family members.
Main Methods:
- A 19-month prospective study was conducted across 20 day-care centers.
- Outbreaks and individual cases of diarrhea were monitored.
- Enteropathogens were identified in affected individuals.
- Secondary transmission to household contacts was evaluated.
Main Results:
- Fifteen outbreaks of diarrhea involving 195 patients occurred in nine centers.
- Shigella, rotavirus, and Giardia were identified as causative agents, with multiple pathogens found in some outbreaks.
- Rotavirus and Giardia were primarily seen in children under 3 years old, while Shigella affected all ages.
- Gastroenteritis in DCC led to secondary cases in 11% of evaluated family members, with varying secondary attack rates (Shigella 26%, rotavirus 15%, Giardia 17%).
Conclusions:
- Day-care centers are important settings for the occurrence and transmission of gastroenteritis in the United States.
- Specific pathogens like Shigella, rotavirus, and Giardia pose significant risks within DCC populations.
- Effective control measures in DCC are essential to limit the spread of gastroenteritis to families and the community.
Abstract:
We conducted a 19-month prospective study of children attending 20-day-care centers to determine the occurrence, causes, and transmission of gastroenteritis among children, staff, and family members. Nine centers had 15 outbreaks of diarrhea involving 195 patients. An enteropathogen was identified in all outbreaks. Shigella was detected in five outbreaks, rotavirus in two, giardia in one, and in the remaining seven multiple enteropathogens were identified. Rotavirus and Giardia occurred only in children less than 3 years of age; shigellosis occurred at all ages. In six DCC 68 single cases of diarrhea were not associated with an outbreak; an enteropathogen was identified in only three (4%) persons. Thirty-four family members (11%) developed diarrhea associated with the occurrence of gastroenteritis in children in six DCC evaluated for this problem. Secondary attack rates of diarrhea in families according to organisms identified in the DCC outbreaks were: Shigella 26%, rotavirus 15%, and G. lamblia 17%. DCC may play an important role in the epidemiology and transmission of gastroenteritis in the United States.