Original Article

How We Didn’t Clean Up Until We Washed Our Hands: Shigellosis in an Elementary and Middle School in North Texas

Authors: Joann M. Schulte, DO, MPH, Linda Williams, RN, Jawaid Asghar, MBBS, MHA, Thi Dang, MPH, Shelby Bedwell, MPH, Kenzi Guerrero, MPH, Doug Hamaker, BS, Shelley Stonecipher, DVM, MPH, James Zoretic, MD, MPH, Catherine Chow, MD, MPH

Abstract

Background: Shigella outbreaks often continue for months and are linked frequently to poor hygiene and hand washing. Such outbreaks are found often in day care facilities, but rarely are reported in schools. We present the investigation of an outbreak in autumn 2007 at a building that housed an elementary school and a middle school in separate wings in a small Texas city north of Dallas-Fort Worth.


Methods: We canvassed local hospitals, school attendance records, and physician offices for cases. Ill individuals were interviewed using a standard questionnaire for symptoms, disease onset, and the presence of the illness in an ill person’s household.


Results: A music teacher was the index case for this outbreak of gastrointestinal illness caused by S. sonnei. Ten percent of the students in the school building were ill, and 15 households had secondary cases. Installing liquid soap in dispensers in student restrooms was the initial control measure, followed by sustained instruction in hand washing, scheduled hand washing times, and monitored cleaning and disinfection procedures for surfaces and inanimate objects. Enhanced surveillance detected no new cases in the school district.


Conclusions: Appropriate soap supplies and repeated instruction in hand washing and its monitoring were needed to control the outbreak.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Mohle-Boetani JC, Stapleton M, Finger R, et al. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers. Am J Public Health 1995; 85: 812–816.
 
2. Arvelo W, Hinkle CJ, Nguyen TA, et al. Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei. Pediatr Infect Dis J 2009; 28: 976–980.
 
3. Weissman JB, Schmerler A, Weiler P, et al. The role of preschool children and day-care centers in the spread of shigellosis in urban communities. J Pediatr 1974; 84: 797–802.
 
4. Gupta A, Polyak CS, Bishop RD, et al. Laboratory-confirmed shigellosis in the United States, 1989-2002: epidemiologic trends and patterns. Clin Infect Dis 2004; 38: 1372–1377.
 
5. Kotloff KL, Winickoff JP, Ivanoff B, et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health 1999; 77: 651–666.
 
6. Swaninathan KB, Barrett TJ, Hunter SB, et al. PulseNet: the molecular subtyping network for foodborne bacterial disease surveillance, United States. Emerg Infect Dis 2001; 7: 382–389.
 
7. Shane AL, Tucker NA, Crump JA, et al. Sharing Shigella: risk factors for a multi community outbreak of shigellosis. Arch Pediar Adolesc Med 2003; 157: 601–603.
 
8. Sobel J, Cameron DN, Ismail J, et al. A prolonged outbreak of Shigella sonnei infection in traditionally observant Jewish communities in North America caused by a molecularly distinct bacterial subtype. J Infect Dis 1998; 177: 1405–1409.
 
9. Garrett V, Bornschlegel K, Lange D, et al. A recurring outbreak of Shigella sonnei among traditionally observant Jewish children in New York City: the risks of daycare and household transmission. Epidemiol Infect 2006; 134: 1231–1236.
 
10. Bloomfield SF, Aiello AE, Cookson B, et al. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control 2007; 35S: S27–S64.
 
11. Ekanem EE, DuPont HL, Pickering LK, et al. Transmission dynamics of enteric bacteria in day-care centers. Am J Epidemiol 1983; 118: 562–572.
 
12. Kramer A, Schwebke I, Kumpf EE. How long do nosocomial pathogens persist on inanimate surfaces? BMC Infect Dis 2010; 6: 130.
 
13. Islam MS, Hossain MA, Khan SI, et al. Survival of Shigella dysenteriae type 1 on fomites. J Health Popul Nutr 2001; 19: 177–182.
 
14. Nakamura M. The survival of Shigella sonnei on cotton, wood, paper and metal at various temperatures. J Hyg 1962; 60: 35–39.
 
15. Islam MS, Hasan MK, Miah MA, et al. Use of the polymerase chain reaction and fluorescent-antibody methods for detecting viable but nonculturable Shigella dysenteriae type 1 in laboratory microcosms. Appl Environ Microbiol 1993; 59: 536–540.
 
16. Wilson R, Feldman RA, Davis J, et al. Family illness associated with Shigella infection: the interrelationship of age of the index patients and the age of household members in acquisition of illness. J Infect Dis 1981; 143: 130–132.
 
17. Hardy AV, Watt J. Studies of the acute diarrheal diseases XVIII. Epidemiol Public Health Rep 1948; 12: 363–378.
 
18. Lee TS, Chang YC, Chang LL, et al. One predominant type of genetically closely-related Shigella sonnei prevalent in four sequential outbreaks in school children. Diagn Microbiol Infect Dis 2003; 45: 171–181.
 
19. Luby SP, Agoatwalla M, Painter J, et al. Effective of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized control clinical trial. JAMA 2004; 291: 2547–2554.
 
20. Master D, Hess-Longe SH, Dickson H. Scheduled hand washing in an elementary school population. Fam Med 1997; 29: 336–339.