title: Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers.
abstract: OBJECTIVE
  The study's objectives were to assess (1) control of a community 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 Shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared day-care centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable to attendance at day-care centers.
  
  
  RESULTS
  The outbreak abated 3 weeks after the interventions' initiation. Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance.
  
  
  CONCLUSIONS
  Community involvement in increasing hand washing most likely resulted in control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease.
authors.affiliation: Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Mohle-Boetani
authors.forename: M
authors.initials: M
authors.lastname: Stapleton
authors.forename: R
authors.initials: R
authors.lastname: Finger
authors.forename: N H
authors.initials: NH
authors.lastname: Bean
authors.forename: J
authors.initials: J
authors.lastname: Poundstone
authors.forename: P A
authors.initials: PA
authors.lastname: Blake
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D016022:Case-Control Studies; D002656:Child Day Care Centers; D002675:Child, Preschool; D004196:Disease Outbreaks; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D005192:Family Health; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D012307:Risk Factors; D012764:Shigella sonnei