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Although many types of
Loose stools, which may be watery and bloody
Abdominal pain
May have fever
Incubation period: Average 3 to 4 days for Shiga toxin-producing
Contagious period: For Shiga toxin-producing
Ingesting the bacteria through food or water contaminated with human or animal (eg, cattle, sheep, deer) feces, undercooked ground beef, unpasteurized milk, or other products contaminated with cattle feces. Contamination has occurred in improperly treated apple cider, raw vegetables, yogurt, and drinking water in recreation areas.
Fecal-oral route: Contact with feces of children who are infected. This generally involves an infected child contaminating his own fingers and then touching an object that another child touches. The child who touched the contaminated surface then puts her fingers into her own mouth or another person's mouth.
Exposure to animal feces by direct contact with animals, as in petting zoos, farms, or other contact between animals and people.
Outbreaks in water parks have been reported.
Use good hand-hygiene technique at all the times listed in Chapter 2, especially after toilet use or handling soiled diapers and before anything to do with food preparation or eating.
Ensure proper surface disinfection that includes cleaning and rinsing of surfaces that may have become contaminated with stool (feces) with detergent and water and application of a US Environmental Protection Agency?registered disinfectant according to the instructions on the product label.
Ensure proper washing of raw vegetables (eg, grape and cherry tomatoes).
Ensure proper cooking and storage of food. Cook all ground beef thoroughly so there is no pink meat. Use only pasteurized milk and juice products.
Exclude infected staff members who handle food.
Prevent contamination with human and animal feces.
Make sure someone has notified local public health authorities that the infected child or adult attends or works at a child care facility if Shiga toxin-producing
They may close the facility to new enrollees.
Prevent enrolled children from being transferred for care to other groups or facilities where they may expose other susceptible children.
Pay close attention to reducing communal exposure to water, such as water tables where the play occurs in a fashion that enhances the risk of transfer of germs from one child to another. Water tables with free-flowing fresh water or separate water bins for each child reduce this risk.
Exclusion for specific types of symptoms (see the section Exclude From Group Setting?).
A child or staff member with Shiga toxin-producing
There are multiple causes of bloody diarrhea. The following recommendations apply for a child or staff member with diarrhea from any cause (see
Report the condition to the staff member designated by the child care program or school for decisionmaking and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms and notifies the health consultant.
Ensure staff members follow the control measures listed in the section How Do You Control It?
Report outbreaks of diarrhea (more than 2 children or staff members in the group) to the health consultant, who may contact the local health department.
If you know a child or staff member has Shiga toxin-producing
Follow the advice of the child's or staff member's health professional.
Report the infection to the local health department, as the health professional who makes the diagnosis may not report that the infected person is a participant in an early education/child care program or school, and this could lead to loss of precious time for controlling the spread of the disease.
Reeducate staff members to ensure strict and frequent handwashing, diapering, toileting, food handling, and cleaning and disinfection procedures.
Follow the direction of the local health department. A potential outbreak with Shiga toxin-producing
Yes, if Shiga toxin-producing
The local health department determines exclusion is needed to control an outbreak.
Stool frequency exceeds 2 stools above normal for that child during the time the child is in the program because this may cause too much work for teachers/caregivers and make it difficult for them to maintain sanitary conditions.
There is blood or mucus in stool.
The ill child or adult has stool that is all black.
The child has a dry mouth, no tears, or no urine output in 8 hours (suggesting the child's diarrhea may be causing dehydration).
The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.
Yes, when all the following criteria are met:
Test results from 2 stool cultures are negative for Shiga toxin-producing
Once diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet- trained children do not have toileting accidents.
Once stool frequency is no more than 2 stools above normal for that child during the time the child is in the program, even if the stools remain loose.
When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.
Outbreaks of Shiga toxin-producing
Antibiotics are not recommended for diarrhea caused by Shiga toxin-producing
Many child care programs and schools include visits to petting zoos or visits by animals into the classroom as a routine activity. The risk of exposure of young children to animal feces in such activities is very high. The feces are picked up on all body parts of the animal as it lies in bedding materials or brushes against other animals. Increasing numbers of petting zoos are providing hand-hygiene facilities adjacent to animal contact areas. Nevertheless, even with great vigilance on the part of teachers/caregivers, young children are very likely to touch an animal or have their skin and clothing touched by an animal and then put their contaminated hands or something touched with their contaminated hands into their mouths. Safely managing this contamination when dealing with infants, toddlers, and young preschool- aged children is extremely difficult. The significant risks of such animal contact should be weighed against the benefits.
Adapted from
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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.