The use of hygiene, cohorting, and antimicrobial therapy to control an outbreak of shigellosis.

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.