An outbreak of salmonellosis among children attending a reptile exhibit at a zoo.

OBJECTIVE: In January 1996, an outbreak of diarrhea caused by Salmonella Enteritidis occurred in children attending a Komodo dragon exhibit at a metropolitan zoo. We sought to determine the extent of the outbreak and mode of transmission. STUDY DESIGN: A case-control study was conducted. Controls were randomly selected from zoo membership lists and matched to patients by age group and date of exhibit visit. RESULTS: Of 65 patients identified, 39 had confirmed and 26 had suspected cases. The median age was 7 years (range, 3 months to 48 years); 55% were enrolled in the case-control study. No patients and two (4%) controls reported touching a dragon; however, 83% of patients but only 52% of controls touched the wooden barrier that surrounded the dragon pen (odds ratio = 4.0, 95% CI 1.2 to 13.9). Washing hands at the zoo after visiting the dragons was highly protective (OR = 0.14, 95% CI 0.03 to 0.7). Cultures from the patients, one dragon, and the exhibit barriers yielded Salmonella Enteritidis, phage type 8. On the basis of an attack rate of 4.3% among exhibit attendees under 13 years old on whom data were collected, we estimate that 315 additional cases of salmonellosis occurred among visitors in this age group. CONCLUSION: This large outbreak demonstrates the importance of environmental contamination in the transmission of Salmonella from reptiles, and the protective value of hand washing. Recommendations regarding reptile exhibits and reptilian pets should emphasize this indirect route.

The use of hygiene, cohorting, and antimicrobial therapy to control an outbreak of shigellosis.

Shigellae are easily transmitted in day-care centers to children and adult staff by contamination of diaper-changing surfaces and fomites or directly from person to person. Appropriate antimicrobial therapy may shorten the duration of diarrhea caused by shigellae and eliminate the organism from the feces. Current recommendations of the American Academy of Pediatrics and the American Public Health Association are that infected children be isolated until three and two, respectively, consecutive stool cultures are negative. We utilized a disease control strategy based on use of antibiotics to control diarrheal symptoms and reduce infectiousness, cohorting of asymptomatic infected children in the center, and scrupulous attention to hygiene and environmental cleanliness. This strategy was effective in stopping transmission, was more practical than some of the measures now recommended by the American Academy of Pediatrics and the American Public Health Association, and was well accepted by parents and center staff. The strategy should be evaluated in other day-care settings.

Standards and criteria: group child care for sick children.

With the establishment of several statewide sick child care programs, a group of concerned health professionals recognized the need to develop guidelines and nursing care criteria for these centers. A task force was formed to design guidelines for the planning and development of facilities that provide care for children with recuperating illnesses.