Nov. 1, 2022 – Attention parents: If your child is showing signs of a stomach bug, do not send them to school or day care.
That’s the take-home message in a new CDC report, which found that nearly 90% of outbreaks of acute gastrointestinal infections in schools and child care settings result from person-to-person contact.
“Clinicians should encourage parents to keep children out of school for up to 24 hours after symptoms have subsided, as viral shedding may continue after symptoms stop,” says Janine Cory, a spokesperson for the CDC.
She also encouraged pediatricians to reinforce good hygiene habits with parents, including making sure children stay home if they are sick and that they wash their hands with warm water and soap, as most hand sanitizers are not effective against the germs most often linked to GI outbreaks in kids.
The report, published in the journal Pediatrics, was based on an analysis by CDC researchers and their colleagues of more than 4,600 outbreaks of acute gastroenteritis – what many people call a “stomach flu” – between 2009 and 2020.
Most outbreaks occurred in schools between October and March, and typically involved viral infections. Around 86% of all outbreaks in the study were linked to person-to-person contact. Roughly two-thirds of all outbreaks during the study period involved strains of norovirus or the bacteria species shigella.
Symptoms of norovirus infection include diarrhea, vomiting, and stomach pain, according to the CDC. Shigellosis, the infection caused by shigella, can cause bloody stool and diarrhea, high fever, severe stomach cramping and tenderness, and dehydration.
Schools and child care centers accounted for an average of 457 outbreaks and 15,779 cases per year during the study period. (The number of outbreaks plummeted during the COVID-19 pandemic, as kids stayed home during lockdowns, according to the researchers.)
While outbreaks in schools were significantly larger than those in child care centers, sickness in child care centers lasted longer. Outbreaks in schools lasted 9 days, on average, while child care center outbreaks lasted for an average of 15 days. Around 98% of outbreaks were to blame for at least one visit to the emergency room, the researchers report.
Bacterial outbreaks may spread more in child care facilities due to the presence of diapered children, poor hand hygiene, and the younger age of the children, the researchers say.
Tim Joos, MD, a pediatrician and internist in Seattle, says fielding calls about norovirus infections and shigellosis is a routine part of his day – particularly during the school year.
“The phrase ‘something going around the day care’ is heard daily in clinics and emergency rooms,” he says.
“As practicing clinicians, we often get caught up with not seeing the forest for the trees. We are often seeing the individual patient’s needs but not the larger trends. Thanks to this study, we now have an overview of the landscape of gastroenteritis,” Joos says.