MacDonald Emily, Dalane Per Kjetil, Aavitsland Preben, Brandal Lin Thorstensen, Wester Astrid Louise, Vold Line
Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
BMC Infect Dis. 2014 Dec 18;14:673. doi: 10.1186/s12879-014-0673-2.
In Norway, it is recommended that children with Shiga-Toxin producing Escherichia coli (STEC) infections are excluded from daycare centers until up to five consecutive negative stool cultures are obtained. Children with gastrointestinal illness of unknown etiology are asked to remain home for 48 hours after symptoms subside. On 16 October 2012, two cases of STEC infection were reported from a daycare center, where other children were also symptomatic. Local health authorities temporarily closed the daycare center and all children and staff were screened for pathogenic E. coli. We present the results of the outbreak investigation in order to discuss the implications of screening and the exclusion policies for children attending daycare in Norway.
Stool specimens for all children (n = 91) and employees at the daycare center (n = 40) were tested for pathogenic E. coli. Information on demographics, symptoms and potential exposures was collected from parents through trawling interviews and a web-based questionnaire. Cases were monitored to determine the duration of shedding and the resulting exclusion period from daycare.
We identified five children with stx1- and eae-positive STEC O103:H2 infections, and one staff member and one child with STEC O91:H- infections. Three additional children who tested positive for stx1 and eae genes were considered probable STEC cases. Three cases were asymptomatic. Median length of time of exclusion from daycare for STEC cases was 53 days (range 9 days-108 days). Survey responses for 75 children revealed mild gastrointestinal symptoms among both children with STEC infections and children with negative microbiological results. There was no evidence of common exposures; person-to-person transmission was likely.
The results of screening indicate that E. coli infections can spread in daycare centres, reflected in the proportion of children with STEC and EPEC infections. While screening can identify asymptomatic cases, the implications should be carefully considered as it can produce unanticipated results and have significant socioeconomic consequences. Daycare exclusion policies should be reviewed to address the management of prolonged asymptomatic shedders.
在挪威，建议产志贺毒素大肠杆菌（STEC）感染的儿童在连续获得五次粪便培养阴性结果之前不得进入日托中心。病因不明的胃肠道疾病患儿在症状消退后需居家48小时。2012年10月16日，一家日托中心报告了两例STEC感染病例，其他儿童也出现了症状。当地卫生当局暂时关闭了该日托中心，并对所有儿童和工作人员进行了致病性大肠杆菌筛查。我们展示此次疫情调查的结果，以讨论筛查的影响以及挪威日托中心儿童的排除政策。
对日托中心所有儿童（n = 91）和员工（n = 40）的粪便标本进行致病性大肠杆菌检测。通过深入访谈和网络问卷从家长那里收集人口统计学、症状和潜在暴露信息。对病例进行监测，以确定排毒持续时间以及由此导致的日托排除期。
我们确定了5名stx1和eae阳性的STEC O103:H2感染儿童，1名工作人员和1名儿童感染了STEC O91:H-。另外3名stx1和eae基因检测呈阳性的儿童被认为可能是STEC病例。3例无症状。STEC病例日托排除的中位时间为53天（范围9天 - 108天）。对75名儿童的调查回复显示，STEC感染儿童和微生物检测结果为阴性的儿童均出现了轻微胃肠道症状。没有共同暴露的证据；可能存在人传人情况。
筛查结果表明大肠杆菌感染可在日托中心传播，这体现在STEC和EPEC感染儿童的比例上。虽然筛查可识别无症状病例，但应仔细考虑其影响，因为这可能产生意想不到的结果并带来重大社会经济后果。应审查日托排除政策，以应对长期无症状排毒者的管理问题。
