Shigella

Shigellosis is a very contagious diarrheal disease caused by bacteria called Shigella. Shigella causes about 500,000 cases of diarrhea in the United States annually.

What Are the Symptoms of Shigella Infection?

Symptoms of the Shigella infection typically start one to two days after exposure and include:

  • Diarrhea (sometimes bloody)
  • Fever
  • Abdominal pain
  • A painful sensation of needing to pass stools even when bowels are empty

What Head Start or Child Care Programs Should Know About Shigella

See PDF version: What Head Start Programs Should Know About Shigella

How Does Shigella Spread?

Shigella spreads when people put something in their mouths or swallow something that has come into contact with stool of a person infected with Shigella. This can happen when:

  • Contaminated hands touch your food or mouth.
  • Hands can become contaminated through a variety of activities, such as touching surfaces that have been contaminated by stool from an infected person (e.g., toys, bathroom fixtures, changing tables, diaper pails).
  • Hands can also become contaminated with Shigella while changing the diaper of an infected child or caring for an infected person.
  • Eating food contaminated with Shigella. Food may become contaminated if those who are preparing food have Shigella infection.
  • Drinking water that was contaminated by infected fecal matter, and using recreational water, such as wading pools and sensory tables that is contaminated.
  • Shigella germs are present in the stools of infected persons for up to two weeks after the diarrhea has gone away.

Who Is at Risk?

Young children are the most likely to get Shigella infections, but people from all age groups are affected. Many outbreaks are related to child care settings and schools. Shigella spreads from young children to their family members and others because it is so contagious.

Implications for Head Start and Child Care Programs

Programs should review their emergency plans and staff availability to ensure adequate coverage, if needed.

Should a Child Infected with Shigella be Excluded from Head Start or Child Care?

  • Diarrhea is defined by watery or loose stools that are not associated with changes of diet.
  • Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing soiled clothing.
  • In addition, diapered children with diarrhea should be excluded, if the stool frequency exceeds two or more stools above normal for that child.
  • Readmission after diarrhea can occur when diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children are continent.
  • State and local health departments may require additional conditions to be met before children infected with Shigella are permitted to return to child care (e.g., they may require a note from a health provider, and/or one or more laboratory tests to show that the infection has passed).

How Can Providers Limit the Spread of Shigella Infection?

  • Follow diapering procedures that will minimize exposure to germs that cause diarrhea
  • Make sure to clean and disinfect toys.
  • Make sure all children and adults use good hand washing techniques—including scrubbing with soap for 20 seconds. Soap and water is preferred.
  • Children who have recently recovered from Shigella infection can be grouped together in one classroom to minimize exposing uninfected children and staff.
  • Assign separate staff to diapering versus food prep.
  • Reassign adults with diarrhea to jobs that minimize opportunities for spreading infection, such as desk work and not food preparation. State and local health regulations may require adults with shigellosis to refrain from working in childcare while ill.
  • During Shigella outbreak, stop water play.

How to Talk to Children about Shigella?

  • If children have questions, take time to listen and answer their questions.
  • Be honest. Answer questions based on the facts and as age-appropriate.
  • Speak in a calm tone of voice, using reassuring words.
  • Emphasize hand washing and toilet hygiene.

Where Can I Learn More?

What Parents Should Know About Shigella

See PDF version: What Head Start Parents Should Know About Shigella

How Does Shigella Spread?

Shigella germs can be present in the stools of infected people for up to two weeks after the diarrhea has gone away. Shigella spreads when people put something in their mouths or swallow something that has come into contact with stool of a person infected with Shigella. This can happen when:

  • Contaminated hands touch your food or mouth.
  • Hands can become contaminated through a variety of activities, such as touching surfaces that have been contaminated by stool from an infected person. (e.g., toys, bathroom fixtures, changing tables, diaper pails).
  • Hands can also become contaminated with Shigella while changing the diaper of an infected child or caring for an infected person.
  • Eating food contaminated with Shigella.
  • Food may become contaminated if the person preparing food has Shigella.
  • Drinking water that was contaminated by infected fecal matter, and using recreational water, such as wading pools and sensory tables, that is contaminated. Shigella germs are present in the stools of infected persons for up two weeks after the diarrhea has gone away.

Who Is at Risk?

Young children are the most likely to get Shigella infections, but people from all age groups are affected. Many outbreaks are related to childcare settings and schools. Shigella commonly spreads from young children to their family members and others in their communities because it is so contagious.

How Is Shigella Infection Diagnosed?

Many different kinds of germs can cause diarrhea, so establishing the cause will help guide treatment. Healthcare providers can order laboratory tests to identify Shigella in the stools of an infected person. The laboratory can also do special tests to determine which antibiotics, if any, would be best to treat the infection.

Should a Child Infected with Shigella be Excluded from Head Start or Child Care?

  • Diarrhea is defined by watery or loose stools that are not associated with changes of diet.
  • Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing soiled pants or clothing.
  • In addition, diapered children with diarrhea should be excluded if the stool frequency exceeds two or more stools above normal for that child.
  • Children may return to the program if diapered children have their stool contained within the diaper (even if the stools remain loose) or toilet-trained children are able to use the toilet on their own, without having an accident.

How to Stop the Spread of Shigella Infection?

  • Carefully wash your hands with soap during key times: Before eating and after changing a diaper or helping to clean another person who has used the toilet. Make sure all children and adults use good hand washing techniques—including scrubbing with soap for 20 seconds. Soap and water is preferred.
  • Supervise hand washing of children after they use the toilet and before they eat.
  • Wash infants' hands with soap and water after diaper changes.
  • Dispose of soiled diapers properly, and clean diaper changing areas after using them.
  • Make sure to clean and disinfect toys.

How to Talk to Children about Shigella?

  • If children have questions, make time to listen and answer their questions.
  • Speak in a calm tone of voice. Use reassuring words.
  • Keep all explanations easy for your child to understand.
  • Emphasize hand washing and toilet hygiene.

Where Can I Learn More?

Shigella. HHS/ACF/OHS. 2016. English.

Last Reviewed: April 2016

Last Updated: April 12, 2016