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Salmonella

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What is Salmonella?

  • An intestinal infection caused by Salmonella bacteria.

  • Typhoid fever is caused by a type of Salmonella infection that is more serious and can cause outbreaks but is uncommon in the United States.

What are the signs or symptoms?

  • Diarrhea

  • Fever

  • Abdominal cramps and tenderness

  • Nausea or vomiting

  • Sometimes blood or mucus in stool

What are the incubation and contagious periods?

  • Incubation period: 12 to 36 hours (for non-Salmonella serotype Typhi strains, those strains responsible for diarrheal strains in the United States).

  • Contagious period: About half of children younger than 5 years still have Salmonella in stool 12 weeks after having this infection.

How is it spread?

  • Fecal-oral route: Contact with feces of infected children and animals, especially reptiles and poultry. This generally involves an infected child contaminating his own fingers, and then touching an object that another child touches. The child who touched the contaminated surface then puts her fingers into her own mouth or another person’s mouth.

  • Ingestion of contaminated food, water, meats, eggs, and unpasteurized milk.

  • Contact with fecal material from or objects contaminated by children and animals who carry Salmonella.

How do you control it?

  • Use good hand-hygiene technique at all the times listed in Chapter 2, especially after toilet use or handling soiled diapers and before anything to do with food preparation or eating.

  • Ensure proper surface disinfection that includes cleaning and rinsing of surfaces that may have become contaminated with stool (feces) with detergent and water and application of a US Environmental Protection Agency– registered disinfectant according to the instructions on the product label.

  • No animals that are known to carry Salmonella should be allowed in child care facilities or schools. Salmonella is a normal bacterial inhabitant of the intestinal tract of many animals. Cages and all surfaces involved in the care of these animals should be considered contaminated with this organism and a source that spreads infection to children in group care settings. The animals known to commonly spread Salmonella to humans include reptiles (turtles, lizards, and snakes), amphibians (frogs and toads), poultry (chicks, chickens, ducklings, ducks, geese, and turkeys), other birds (parakeets, parrots, and wild birds), rodents (mice, rats, hamsters, and guinea pigs), other small mammals (hedgehogs), and farm animals (goats, calves, cows, sheep, pigs, and horses). Even dogs and cats can spread Salmonella to humans if they themselves become infected.

  • Proper sanitation methods for food processing, preparation, and service. Special attention is necessary to avoid contamination by raw poultry of surfaces such as cutting boards and utensils.

  • Eggs and other foods of animal origin, especially poultry, should be cooked thoroughly.

  • Exclusion of infected staff members who handle food.

  • Exclusion for specific types of symptoms (see Exclude from group setting?).

What are the roles of the teacher/caregiver and the family?

  • A child or staff member with Salmonella may have bloody diarrhea, which should trigger a medical evaluation.

  • There are multiple causes of bloody diarrhea. Until the cause of the diarrhea is identified, apply the recommendations for a child or staff member with diarrhea from any cause (see Diarrhea Quick Reference Sheet). In addition

    • Report the condition to the staff member designated by the early education/child care program or school for decision-making and action related to care of ill children or staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms and notifies the health consultant.

    • Ensure staff members follow the control measures listed under How do you control it?

    • Report outbreaks of diarrhea (more than 2 children and/or staff members in the group) to the health consultant, who may report to the local health department.

  • If you know a child has Salmonella in the program

    • Follow advice from the child’s health care provider and care for the ill child.

    • Report the infection to the local health department, as the health professional who makes the diagnosis may not report that the infected child is a participant in an early education/child care program or school, and this could delay controlling the spread of the disease.

    • Reeducate staff members to ensure strict and frequent hand-washing, diapering, toileting, food handling, and cleaning and disinfection procedures.

    • In an outbreak (rare), follow the directions of the local health department.

  • Prevent contact of young children with animals known to spread Salmonella to humans and the habitat of these animals. (See list under How do you control it?) Pet dogs and cats should be tested to be sure they are not carriers of Salmonella before allowing these animals into the early education/child care facility. (Ensure immediate hand hygiene if there has been any contact with any of these animals.)

Exclude from group setting?

Yes, if

  • The local health department determines exclusion is needed to control an outbreak.

  • Stool is not contained in the diaper for diapered children.

  • Diarrhea is causing “accidents” for toilet-trained children.

  • Stool frequency exceeds 2 stools above normal during the time the child is in the program because this may cause too much work for teachers/caregivers and make it difficult for them to maintain sanitary conditions.

  • There is blood or mucus in stool.

  • The stool is all black.

  • The child has a dry mouth, no tears, or no urine output in 8 hours (suggesting the child’s diarrhea may be causing dehydration).

  • The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

  • The child meets other exclusion criteria.

Readmit to group setting?

Yes, when all the following criteria have been met:

  • Most types of Salmonella (exception is serotype Typhi) do not require negative test results from stool cultures.

  • Three negative test results from stool cultures are needed for children with S Typhi.

  • Once diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children do not have toileting accidents.

  • Once stool frequency is no more than 2 stools above normal during the time the child is in the program, even if the stools remain loose.

  • When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

Comments

  • Despite the presence of Salmonella in the stool for prolonged periods after infection, outbreaks in group care settings are rare.

  • Antibiotics usually are not indicated because they do not shorten duration of diarrheal disease and may prolong the time Salmonella is in the stool after the symptoms of infection have resolved.

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Quick Reference Sheet from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.

© 2017 American Academy of Pediatrics. All rights reserved.

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