Shigella Outbreak in Nebraska Affects Families and Daycares

Shigella is a family of bacteria which cause shigellosis. More than 100 confirmed cases have been reported in Nebraska. (Image courtesy World of Microbiology)
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August 27, 2014 - 6:30am

A recent outbreak of shigella, bacterium which cause flu-like illness, has been sweeping through daycare centers in Nebraska. It’s easily transmitted and while not as widespread as the flu, the cost of shigella on families and daycares can be tremendous.

At their home in Lincoln, Jeremy and his wife Jill (we're not using their last name for this story at their request) checked the times of an upcoming football game while their 6-year-old son, Johnathan, watched a cartoon. It was 1:30 in the afternoon in the middle of the work week. On a normal day, Johnathan would have been at daycare, but things hadn’t been normal in this home for five weeks.

“I just got sick and I had diarrhea, and then got to stay home,”  Johnathan explained.

While at daycare, Johnathan was exposed to bacteria known as shigella, which causes a disease called shigellosis.

Johnathan’s mother, Jill, said if she didn’t know shigella was going around daycare, “I would have brought him to the emergency room. It was very gross. Very scary. Blood and mucus and yeah…”

After their son’s diagnosis, Jill and Jeremy had to keep Johnathan completely isolated. He wasn’t allowed to be around other kids until the shigella left his system. They say they’re lucky, because Jill works days and Jeremy works nights so they didn’t miss much work.

“I feel bad for Johnathan, because he’s stuck at home," Jeremy said.  "We’ve bonded really good, but he doesn’t get the interaction that he should have like when he goes to daycare and school. You really can see the difference in the way he acts and his attitude when he’s interacting with other children.”

The Centers for Disease Control says shigella is actually a family of bacteria. Symptoms of shigellosis include diarrhea, vomiting, fever, and body aches.

Dr. Joseph Acierno says the easiest way to prevent the spread of shigella is to wash your hands after using the restroom. Acierno says in addition to children, the elderly and infirm are more at risk if infected with shigella, because the diarrhea and dehydration can affect them more severely. (Image courtesy of Nebraska DHHS)

Dr. Joseph Acierno is the Chief Medical Officer and Director of the Division of Public Health for the Nebraska Department of Health and Human Services. He said most people infected with shigella stop having symptoms after about a week, but they could still be contagious.

“As far as how it spreads, very basically it goes from one person’s gastrointestinal tract to another person’s. How that is done is basically someone who has an infection through their stool, they get contaminated and by some vehicle. It could be a toy. It could be just their hand hits something, or another person’s hand hits it and they go to their mouth, and now basically you’ve started the cycle.”

This year in Nebraska, DHHS reported more than 100 confirmed cases of shigellosis. Dr. Acierno said he expects that number to rise as more cases are confirmed, but there won’t be as many cases as there are with illnesses like the flu or common cold, because the way shigella spreads is very different.

But of the people who do develop shigellosis, Acierno said they might be in for a rough couple of days.

“Many illnesses seem innocuous. Seem innocuous, until somebody has it and has something that’s a little more serious than the next person,” Acierno said.

Preventing the spread of shigella is relatively easy. Acierno said if everybody washed their hands after using the restroom, shigella would be almost a non-issue.

It sounds simple enough, but not every person grasps the importance of not putting their fingers in stuff they shouldn’t. Like at childcare centers where young, curious minds are often too busy to be hampered with the constructs of good hygiene.

Most of the shigella cases in Nebraska are from daycares, like the one in Lincoln where 6-year-old Johnathan, the boy who’s been at home sick with shigellosis, was infected.

The director of the daycare agreed to an interview, so long as she and her facility could remain anonymous.

“We didn’t grow it here. It just showed up unfortunately. We cracked down on our hand-washing again really hard and more bleach. We invested in Clorox, and hopefully wiped it out,”  she said.

The daycare director, who we’ll call “Sandy”, said this is the first shigella outbreak at her facility in 28 years. This time around, Sandy said about 15 kids showed shigella-like symptoms. Of those, 7 tested positive for the bacteria.

Sandy said once a child tests positive, the daycare itself is essentially put on quarantine: no field trips or leaving the center, and certainly no new kids can start attending. A difficult situation during what Sandy called her busy season.

“It took a little bite. Of course if the kids aren’t here and I let them not pay anything, we’ve taken a cut that way. Some of those children who are subsidized by the state who had it didn’t come. We can’t bill the state because they weren’t here. It took a bite. We were down pretty low. There were some days we only had 15-20 kids when normally we would have 60,” Sandy said.

Sandy also said what makes shigella so bad, is just how long it takes to clear up.

“It can range, at the minimum two weeks probably. You take a stool sample in, that can take three days to get the results back. If you test positive, you’re put on a 4 to 10 day antibiotic regimen. Then you have to wait 48 hours after you finished the medicine to be tested again, to see if you’re negative or positive. Then you can come back. So right there you’ve got close to 15 days, right there,” Sandy explained.

Once the outbreak was identified and dealt with, Sandy’s daycare didn’t have any new cases of shigella. And after testing positive twice and spending 5 weeks at home, Johnathan was finally able to return to daycare for a few days before he started first grade.

He was also able to finally celebrate his 6th birthday with his friends. He missed it while stuck at home.



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