Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak
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 chi...
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://link.springer.com/article/10.1186/s12879-019-3796-7 |
| _version_ | 1818146848229031936 |
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| author | Cristina Carias Eduardo A. Undurraga Jacqueline Hurd Emily B. Kahn Martin I. Meltzer Anna Bowen |
| author_facet | Cristina Carias Eduardo A. Undurraga Jacqueline Hurd Emily B. Kahn Martin I. Meltzer Anna Bowen |
| author_sort | Cristina Carias |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T12:25:52Z |
| format | Article |
| id | doaj.art-be909acdde5543b4b06f69a849034f9f |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-11T12:25:52Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-be909acdde5543b4b06f69a849034f9f2022-12-22T01:07:25ZengBMCBMC Infectious Diseases1471-23342019-02-011911710.1186/s12879-019-3796-7Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreakCristina Carias0Eduardo A. Undurraga1Jacqueline Hurd2Emily B. Kahn3Martin I. Meltzer4Anna Bowen5National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionNational Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionNational Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionNational Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionNational Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionNational Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and PreventionAbstract 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.http://link.springer.com/article/10.1186/s12879-019-3796-7ShigellosisExclusion policiesChildcare settings |
| spellingShingle | Cristina Carias Eduardo A. Undurraga Jacqueline Hurd Emily B. Kahn Martin I. Meltzer Anna Bowen Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak BMC Infectious Diseases Shigellosis Exclusion policies Childcare settings |
| title | Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak |
| title_full | Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak |
| title_fullStr | Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak |
| title_full_unstemmed | Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak |
| title_short | Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak |
| title_sort | evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak |
| topic | Shigellosis Exclusion policies Childcare settings |
| url | http://link.springer.com/article/10.1186/s12879-019-3796-7 |
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