{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T06:25:14Z","timestamp":1791095114143,"version":"4.1.0"},"reference-count":17,"publisher":"American Public Health Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[1995,6]]},"abstract":"<jats:p> OBJECTIVES. The study's objectives were to assess (1) control of a community outbreak of shigellosis through the promotion of handwashing, (2) risk factors in day-care centers, and (3) shigellosis attributable to attendance at a day-care center. METHODS. In 1991, an outbreak of Shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared day-care centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable to attendance at day-care centers. RESULTS. The outbreak abated 3 weeks after the interventions' initiation. Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance. CONCLUSIONS. Community involvement in increasing hand washing most likely resulted in control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease. <\/jats:p>","DOI":"10.2105\/ajph.85.6.812","type":"journal-article","created":{"date-parts":[[2008,11,29]],"date-time":"2008-11-29T13:18:52Z","timestamp":1227964732000},"page":"812-816","source":"Crossref","is-referenced-by-count":65,"title":["Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers."],"prefix":"10.2105","volume":"85","author":[{"given":"J C","family":"Mohle-Boetani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Stapleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Finger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N H","family":"Bean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Poundstone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P A","family":"Blake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P M","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"p_1","first-page":"442","volume":"41","author":"Centers for Disease Control","year":"1992","journal-title":"MAWR."},{"key":"p_2","doi-asserted-by":"crossref","unstructured":"Weissman JB, Schmerler A, Wiler P, etal. The role of preschool children and daycare centers in the spread of shigellosis in urban communities.JPediatr. 1974;84:797-802.","DOI":"10.1016\/S0022-3476(74)80750-X"},{"key":"p_3","unstructured":"Dean AD, Dean JA, Burton JH, Dicker RC. Epi-Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta, Ga: Centers for Disease Control; 1990."},{"key":"p_4","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.76.6.623"},{"key":"p_5","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/145.2.255"},{"key":"p_6","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(81)80956-0"},{"key":"p_7","doi-asserted-by":"crossref","unstructured":"Wilson R, Feldman RA, Davis J, Laventure M. Family illness associated with Shigella infection: the interrelationship of age of the index patient and the age of household members in acquisition of illness.JInfectDis. 1981;143:130-132.","DOI":"10.1093\/infdis\/143.1.130"},{"key":"p_8","first-page":"509","volume":"39","author":"Centers for Disease Control","year":"1990","journal-title":"MMWR"},{"key":"p_9","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/147.4.771"},{"key":"p_10","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(82)90266-8"},{"key":"p_11","doi-asserted-by":"crossref","unstructured":"Black RE, Dykes AC, Anderson KE, etal. Handwashing to prevent diarrhea in daycarecenters.AmJEpidemiol 1981;113:445-451.","DOI":"10.1093\/oxfordjournals.aje.a113112"},{"key":"p_12","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.76.6.627"},{"key":"p_13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1974.03230470057032"},{"key":"p_14","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/136.3.458"},{"key":"p_15","unstructured":"Willer B, Hofferth SL, Kisker EE, Divine-Hawkins P, Farquhar E, Glantz FB. The demand and supply of child care in 1990. Washington, DC: National Association for the Education of Young Children; 1991. NAEYC publication 136."},{"key":"p_16","doi-asserted-by":"crossref","unstructured":"Lemp GF, Woodward WE, Pickering LK, Sullivan PS, DuPont HL. The relationship of staff to the incidence of diarrhea in day-carecenters.AmJEpidemiol. 1984;120: 750-758.","DOI":"10.1093\/oxfordjournals.aje.a113943"},{"key":"p_17","doi-asserted-by":"crossref","unstructured":"Cohen D, Slepon R, Green MS. Sociodemographic factors associated with serum anti-Shigella lipopolysaccharide antibodies and shigellosis.IntJEpidemioL 1991;20:546-550.","DOI":"10.1093\/ije\/20.2.546"}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.85.6.812","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T18:12:32Z","timestamp":1652119952000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.85.6.812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1995,6]]},"references-count":17,"journal-issue":{"issue":"6","published-print":{"date-parts":[[1995,6]]}},"alternative-id":["10.2105\/AJPH.85.6.812"],"URL":"https:\/\/doi.org\/10.2105\/ajph.85.6.812","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[1995,6]]}}}