Illness sweeps through day-care centers

ST. LOUIS -- Dr. Alexis Elward has seen a parade of toddlers through the doors of St. Louis Children's Hospital over the past six months, little ones suffering from diarrhea, headaches and vomiting.

St. Louis has been particularly hard hit by an outbreak of shigellosis, an infectious disease most prevalent among children ages 1 to 4. The illness isn't typically life-threatening, but can cause severe flu-like symptoms that can last for several days.

Since Nov. 1, 648 people statewide -- mostly children ages 4 and younger, with most of the rest being their caregivers -- have come down with shigellosis, and most of the children attend day-care centers. All but about 100 of those illnesses were in the region that includes St. Louis and surrounding counties, said Larry Phelan, an epidemiologist for the Missouri Department of Health and Senior Services. Southeast Missouri has also reported a few cases.

"We do consider that virtually all of these cases are day-care associated," Phelan said.

The disease is typically characterized by diarrhea, headaches, nausea, vomiting, stomach aches and cramps.

Elward, an infectious disease specialist, said the outbreak is much worse than in recent years. Before November, only nine cases were reported last year in the St. Louis area.

"Our emergency room has been seeing a really, really high volume," she said.

According to the Centers for Disease Control and Prevention in Atlanta, shigellosis is an infectious disease that typically lasts five to seven days. The diarrhea -- sometimes bloody -- can be severe enough that young children and the elderly may require hospitalization. A severe infection with high fever can also cause seizures in children younger than 2.

The illness is treated with antibiotics.

About 18,000 cases are reported in the United States each year, but the CDC believes that because the illness is often mild and undiagnosed, the actual number of infections may be 20 times greater.

Most infections occur when bacteria passes from stools or soiled fingers of one person to another, making toddlers who are not fully toilet-trained particularly vulnerable. Drinking or swimming in contaminated water can also be a culprit. So is food that becomes contaminated when touched by someone with shigellosis.

CDC said basic hygiene and good hand-washing habits -- with soap -- can help stop spread of the disease. Day care operators should take care to watch over hand-washing habits of children. Toys, eating areas and toilet and diaper-changing areas should be kept clean and disinfected.

Experts say even that may not be enough.

"Shigellosis is hard to stop," Phelan said. "Even with your average hand-washing you're bound to miss a few bacteria."

Elward said it is important for parents to take their children to pediatricians if they suspect infection. The antibiotic treatment not only helps the child recover more quickly but reduces the risk of others becoming infected by reducing the duration of the illness, she said.