By Barbara Isaacs
HERALD-LEADER STAFF WRITER
Fayette Countyís ongoing shigellosis outbreak is no longer just related to kids sickened in day care, the countyís health commissioner said today.
ìThis is a community-wide outbreak going on,î said Dr. Melinda Rowe, commissioner of the Lexington-Fayette County Health Department. ìItís probably going to get worse before it gets better.î
The number of confirmed shigellosis cases has doubled during the past month, bringing the total since May to 111. Shigellosis is a form of dysentery that causes diarrhea, fever and vomiting.
A month ago, the vast majority of shigella infections ó 49 of 55 cases ó were among children 4 and under who attend day care.
But the outbreak is expanding. Most troubling to Rowe and other public health officials is that seven recent cases have sprung up among adults who havenít had contact with infected children or day care centers.
ìAnother concern is that school is starting back,î Rowe said.
As of yesterday, of the 111 cases, 58 are small children ranging from infants to age 4, all of whom attend some type of day care. The remaining 53 cases are among people ages 5 and up. Twenty four are ages 5 to 9, 14 are ages 10-18 and 15 are adults.
Among the youngest age group, the illnesses are centered around 10 commercial day care centers; 57 of the infected children ages 4 and under attend such day care centers. The other sick child in that age group attends a small, private in-home day care, said Jim Wilkins, the health departmentís spokesman.
Symptoms of shigella infection include diarrhea, sometimes bloody diarrhea, fever, nausea, vomiting and abdominal cramps. Anyone with these symptoms should seek medical care and have their stool tested for the shigella bacteria. Even diarrhea with no other symptoms should be evaluated among kids attending day care, said T.J. Sugg, Fayette Countyís regional epidemiologist.
Four of the infected people have been hospitalized for dehydration, Sugg said. Those hospitalized include two three year olds, a seven year old and a person in their 20s, Sugg said.
Severe shigella infection is usually treated with antibiotics, but most people with mild illness do not need antibiotics. Rowe said that the health department also is alerting doctors that this strain of shigella is resistant to ampicillin and Bactrim, two common antibiotics, so another type of antibiotic should be prescribed when antibiotics are needed.
The illness usually begins a day or two after exposure and lasts five to seven days. Shigella bacteria remain in the stool for up to two weeks after the illness and can infect others during that time.
The best way to avoid shigella infection is frequent and careful handwashing for at least 15 seconds with soap and warm water. Shigellosis is caused by fecal bacteria that enters the mouth. Children with diarrhea should be kept home from day care; people with diarrhea should also avoid preparing food for others.
Rowe said that itís also best for people with young children to frequently sanitize diaper-changing surfaces and toys.
Nationally, there are about 18,000 cases of shigellosis reported each year in the United States, according to the federal Centers for Disease Control and Prevention. But because many milder cases are not reported, itís estimated the number is actually closer to 360,000 a year.
Children ages 2 to 4 are most likely to get shigellosis and the disease is more common in the summer.
In 1991, Fayette County also experienced a major shigellosis outbreak centered around day care centers. Some 186 cases of the disease were confirmed between January and July that year.