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Salmonellosis (child care and schools)

What is salmonellosis?

Salmonella bacteria can cause an intestinal illness referred to as salmonellosis. There are approximately 2,500 different serotypes of Salmonella that have been identified. While infections occur year-round, they are most common in the summer months due to warmer weather and unrefrigerated foods creating idea conditions for bacteria to grow. Salmonella bacteria live in a very wide range of animals, including reptiles, amphibians, poultry and other birds, rodents, pets, and livestock, such as cattle. Salmonella bacteria can also live in the intestines of humans and are shed through stool (feces).

Signs and symptoms

  • Diarrhea (sometimes bloody)
  • Fever
  • Abdominal cramps

Some people may also experience

  • Nausea
  • Vomiting
  • Headache

Incubation period

The incubation period can range from six hours to ten days, but most commonly infection occurs about 12-36 hours after exposure. 

Contagious period and spread

  • Salmonella is spread through the fecal→oral route. People can become ill with salmonellosis by consuming contaminated food, including but not limited to raw or undercooked poultry, meat, and seafood; raw or undercooked eggs and egg products; contaminated produce; and unpasteurized milk or milk products. People can also become ill through eating improperly handled food, drinking contaminated water, putting contaminated objects in the mouth, or touching contaminated objects and placing their hands in their mouth. Salmonella is also spread from person-to-person (especially among household contacts and children in child care) through contaminated feces and from animals to people (especially reptiles and chicks) through their feathers, fur or skin or in their feces. 
  • People with salmonellosis are contagious as long as they have Salmonella bacteria in their stool, but they are most infectious while having diarrhea. People may continue to shed Salmonella bacteria in their stools for weeks to months after their symptoms have resolved, and although rare, symptoms can extend over a year. Treatment with antibiotics may prolong shedding. 

Public health reporting requirements

  • Staff who become aware of illness should report the infection to the facility director or school nurse, including both confirmed and suspected salmonellosis cases. 
  • The facility should report to the local or state health department within four days of diagnosis or a positive laboratory test.
  • If other children or staff are ill with diarrhea, refer them to their health care provider and contact public health as soon as possible as this could be an outbreak. Generally speaking, it is considered an outbreak if there is an increase in the number of ill children and/or staff members at the school or child care center than what is expected for a given period. This could include two or more cases from different households.
  • Suspected foodborne/enteric disease outbreaks should be reported to CDPHE or local health department immediately (within four hours), even if the causative agent is not yet known. 

Control of spread

  • Consult with local or state public health on implementation of control measures.
  • Promptly clean and sanitize/disinfect contaminated surfaces (like diaper-changing areas) and other commonly touched surfaces (like toys), and dispose of stool and soiled diapers in a sanitary manner. See Disease Prevention: The Facility Environment.
  • If food or water are thought to be the source of infection, dispose of any remaining contaminated food and promptly clean and sanitize all food contact surfaces.
  • Refer to Disease Prevention: Food Safety for information on food safety.
  • Infants, children, and elderly and immunocompromised individuals should avoid contact with reptiles, chicks, and their cages.
  • Alert possibly exposed family and staff members to watch for symptoms and provide them with prevention tips. See recommendations for caregivers and the family section below.
  • Reinforce and teach the importance of meticulous handwashing with school and child care facility staff and children especially after diaper changing and using the restroom or assisting children with toileting. If possible, this should be verified by environmental health during outbreaks. Sample signs showing when and how to wash hands are included on the department’s child care health regulations webpage under “Preventing illness” and in the hand hygiene section of this website section. Post these or similar signs with picture when possible, throughout the child care center or school to remind staff and children to wash their hands. 

Treatment

Most people with healthy immune systems will recover in four to seven days without treatment or antibiotics. Ill people should be given plenty of fluids to prevent dehydration. Ill people are usually not given antibiotics for mild Salmonella infections because antibiotics do not shorten the duration of illness and may prolong shedding of the bacteria in the stool. However, antibiotics are recommended for cases with an increased risk of invasive disease, such as:

  • Infants <12 months of age
  • People with severe illness
  • People with weakened immune systems, such as from HIV infection or chemotherapy treatment
  • Adults over 50 with certain chronic conditions such as heart disease
  • Adults age 65 or older

Exclusion

EXCLUDE all infected children and/or staff until at least 24 hours after diarrhea has resolved, without the use of anti-diarrheal medications, AND

  • Child care
    • Parents of ill children should be counseled to not take their children to another child care facility during the period of exclusion.
    • Children returning to child care are not required to provide follow-up stool tests.
    • When a case of salmonellosis is identified in a child attending child care, determine whether additional children have or have recently had diarrhea or other compatible symptoms. Other children with symptoms should be excluded, seen by their physician, and submit stool for Salmonella testing. If other cases in the center are identified, work with public health and consider sending a letter home to parents. If an outbreak is identified, obtain two consecutive negative stool tests obtained at least 24 hours apart and at least 48 hours after completion of antibiotics of each case before they return to the facility.
    • If there are concerns about the child’s hygienic practices, public health may require two negative stool tests obtained at least 24 hours apart before they child returns to the facility.  
    • If the case is the only child in the classroom or center who has been ill, no further action is indicated for other children in that classroom or center.
  • Schools
    • In general, students/children or staff with Salmonella who do not have diarrhea and are not otherwise sick may remain in school.
    • Exclude children with hygiene concerns (e.g., who wear diapers or have developmental delays resulting in fecal incontinence) until they are cleared by public health, which nmay include obtaining two consecutive negative stools samples collected 24 hours apart, and at least 48 hours after completion of antibiotics.
    • In some circumstances, public health may require additional testing before a person with infection can return to work, school, or child care. 
    • Students or staff who handle food and have a Salmonella infection must not prepare food until at least 24 hours after their diarrhea has resolved or until cleared by the state or local public health agency. 

Role of teachers, caregivers, and family

  • If your child or a child you care for is infected with Salmonella, follow the advice of the child’s health care provider. 
  • Practice good handwashing, especially after changing diapers, going to the bathroom or helping a child go to the bathroom, or handling food. 
  • Diapering, bathroom, and food preparation areas should be cleaned and sanitized/disinfected frequently.
  • Infants, children, elderly, and immunocompromised individuals should avoid contact with reptiles, chicks, and their cages as they are more likely to carry Salmonella. It is also important to wash hands after touching any pets or other animals (including after handling animal food) as they can also carry Salmonella. 
  • Keep food that will be eaten raw, such as vegetables, from becoming contaminated by animal-derived food products by properly storing food items and following proper food handling practices in accordance with environmental health and food safety regulations.
  • Thoroughly cook all food products from animals, especially poultry and eggs, and avoid consuming raw or cracked eggs, unpasteurized milk, or other unpasteurized products. Ill individuals should not prepare food for other individuals until at least 24 hours after their symptoms have resolved.

Resources

Salmonella (CDC)