Gotta keep 'em separated: cohorting can be effective in limiting spread in childcare facilities
Posted: December 23rd, 2011 - 10:49pm by Ben Chapman
Jack made it through his first child care season without much disease excitement -- just a little bit of pink eye and a couple of runny noses. Child care facilities are notorious illness-spreading sites; children and care providers pass around pathogens like rotavirus, norovirus, Shigella and E. coli. As hand hygiene usually isn't the best in these facilities, outbreaks are often started by or extended by ill people (staff included) showing up while shedding. Cohorting (separating the already sick from the healthy) can be an effective way to limit spread.
Except sick kids aren't always kept home and staff don't always stay away.
In an early-release article in Pediatric Infectious Disease, investigators of an outbreak of E. coli O26:H11 linked to a Colorado child care center say that it could have been worse had health authorities hadn't pushed for cohorting. Part of the strategy was to test every staff member and child for STEC - those who were carrying the bug were separated from those who weren't. Sixty percent of the kids and staff at the center were carrying the outbreak strain (41 ill - 4 asymptomatically) and health authorities aggressively kept sick folks away until they stopped shedding.
Some gems for child care providers from the abstract:
- The median duration of shedding among symptomatic confirmed cases was 30.5 days.
- The risk of being a case as in children <36 months was twice the risk among children 36-47 months.
- Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness.
Outbreak of Shiga toxin-producing Escherichia coli serotype O26: H11 infection at a child care center in Colorado
Pediatric Infectious Disease Journal
Brown, Jennifer A. DVM, MPH; Hite, Donna S. BS; Gillim-Ross, Laura A. PHD; Maguire, Hugh F. PHD; Bennett, Janine K. MS; Patterson, Julia J. BA; Comstock, Nicole A. MSPH; Watkins, Anita K. MPH; Ghosh, Tista S. MD, MPH; Vogt, Richard L. MD
Background: Shiga toxin-producing Escherichia coli (STEC) O26:H11 is an emerging cause of disease with serious potential consequences in children. The epidemiology and clinical spectrum of O26:H11 are incompletely understood. We investigated an outbreak of O26:H11 infection among children younger than 48 months of age and employees at a child care center.
Methods: Every employee at the center (n=20) and every child <48 months (n=55) were tested for STEC and administered a questionnaire. Thirty environmental health inspections and site visits were conducted. A cohorting strategy for disease control was implemented.
Results: Eighteen confirmed and 27 suspect cases were detected. There were no hospitalizations. The illness rate was 60% for children and for employees. The risk of being a case as in children <36 months was twice the risk among children 36-47 months (risk ratio: 2.10; 95% confidence interval: 1.00, 4.42). The median duration of shedding among symptomatic confirmed cases was 30.5 days (range: 14-52 days). Four (22%) confirmed cases were asymptomatic and 3 (17%) shed intermittently. Nearly half (49%) of the household contacts of confirmed cases developed a diarrheal illness. The outbreak was propagated by person-to-person transmission; cohorting was an effective disease control strategy.
Conclusions: This was the largest reported outbreak of O26:H11 infection in the United States and the largest reported non-O157 STEC outbreak in a U.S. child care center. Non-O157 STEC infection is a differential diagnosis for outbreaks of diarrhea in child care settings. Aggressive disease control measures were effective, but should be evaluated for outbreaks in other settings.