Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak

• Main Authors: Cristina Carias, Eduardo A. Undurraga, Jacqueline Hurd, Emily B. Kahn, Martin I. Meltzer, Anna Bowen
• Format: Article
• Language: English
• Published: BMC 2019-02-01
• Series: BMC Infectious Diseases
• Subjects: Shigellosis; Exclusion policies; Childcare settings
• Online Access: http://link.springer.com/article/10.1186/s12879-019-3796-7

Abstract Background In the event of a shigellosis outbreak in a childcare setting, exclusion policies are typically applied to afflicted children to limit shigellosis transmission. However, there is scarce evidence of their impact. Methods We evaluated five exclusion policies: Children return to childcare after: i) two consecutive laboratory tests (either PCR or culture) do not detect Shigella, ii) a single negative laboratory test (PCR or culture) does not detect Shigella, iii) seven days after beginning antimicrobial treatment, iv) after being symptom-free for 24 h, or v) 14 days after symptom onset. We also included four treatments to assess the policy options: i) immediate, effective treatment; ii) effective treatment after laboratory diagnosis; iii) no treatment; iv) ineffective treatment. Relying on published data, we calculated the likelihood that a child reentering childcare would be infectious, and the number of childcare-days lost per policy. Results Requiring two consecutive negative PCR tests yielded a probability of onward transmission of < 1%, with up to 17 childcare-days lost for children receiving effective treatment, and 53 days lost for those receiving ineffective treatment. Conclusions Of the policies analyzed, requiring negative PCR testing before returning to childcare was the most effective to reduce the risk of shigellosis transmission, with one PCR test being the most effective for the least childcare-days lost.