Thursday, July 12, 2001

Cases mount in shigella outbreak




By Tim Bonfield
The Cincinnati Enquirer

        Hundreds of Greater Cincinnati families are dealing with an ongoing outbreak of shigella, a diarrhea-causing illness most often found among toddlers.

        Cincinnati and Hamilton County health officials had issued public warnings about shigella last month to day-care centers, swimming pool operators and the public because 130 cases of the illness were reported in May. Since then, 341 more cases were reported in June and another 64 have been confirmed as of Tuesday.

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        That totals 574 cases so far this year — more than 30 times more than last year's total and more than twice as many as any local previous outbreak in the past 14 years, according to the Cincinnati Health Department, which is leading the local effort to stop the illness.

        The outbreak could last another few months, said Dr. Judith Daniels, medical director for the department.

        Shigella is a bacteria-caused illness marked by fever and diarrhea that is rarely dangerous. Nearly all cases can be cured with antibiotics.

        But the illness and its treatment can force families of children in day care to have to make alternative arrangements for as long as two weeks.

        “In pediatrics, this is the true cost of illness ... parents not able to work because their children have an annoying illness,” said Dr. Jeff Drasnin, a pediatrician whose Hyde Park office has reported 25 cases since March. “This can be a real hardship for single moms and other people who really depend on day care.”

        The vast majority of cases have been concentrated in Hamilton County, including Springdale, Norwood, Sharonville and nearly every Cincinnati neighborhood. None has been reported in Northern Kentucky and only a few have been spotted in Butler and Warren counties, said Dr. Daniels.

        Most cases have involved diaper-wearing toddlers who are spreading the illness in day-care settings and among their families. So far, few — if any — cases have been linked to eating contaminated food or swimming in contaminated water, Dr. Daniels said.

        “Chlorine, at the proper levels, does kill this bacteria,” Dr. Daniels said. “If we saw clusters involving swimming pools, we'd inspect them and, if necessary, close them.”

        According to state law, children with shigella cannot return to day-care centers until after they've completed a five-day course of antibiotics, waited two days, and then provided two stool sample tests showing no signs of the bacteria.

        The tests require doctor visits, must be performed at least 24 hours apart, and can each take more than a day to produce results.

        In a typical case, a 2-year-old girl came into Dr. Drasnin's office on June 28 with signs of a high fever and some diarrhea. By June 30, her tests results confirmed shigella. She has been out of day care ever since. Her mother has used vacation time and relatives' help to cover the child-care duties. She was scheduled Wednesday for her second follow-up test, but it had to be rescheduled for today because the girl's mother got stuck at work, Dr. Drasnin said.

        While the number of cases in Cincinnati is fairly high, isolated shigella outbreaks have occurred regularly in Ohio.

        Last year, officials reported 125 cases in Erie County in northeast Ohio, according to the state health department. In 1999, 149 cases popped up in Lorain County. And in 1998, 200 cases were reported in Cuyahoga County.

        In all three years, most Ohio counties saw fewer than 10 cases a year, and many saw none at all.

       



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