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Diarrheal Outbreaks in Schools and Daycares

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Since March 2019 pediatricians have been on the forefront of responding to a global outbreak of COVID-19. And while all the attention in the world has been focused on the novel coronavirus, we seem to have forgotten about one of the original school outbreaks – diarrhea. Fortunately, Mattis et al, in this month’s Pediatrics, analyze 4,756 school and childcare acute gastroenteritis outbreaks in the US reported through the National Outbreak Reporting System (NORS) during 2009–2020 (10.1542/peds.2021-056002). First, while this seems like a large number of outbreaks, it only represents those reported to NORS, so potentially undercounts the true number of diarrheal outbreaks in school settings. The most common etiologies of the outbreaks are norovirus and Shigella spp. Not surprisingly, the daycare outbreaks tended to last longer than the school-based outbreaks. Not surprisingly, in 2020 the rate of outbreaks declined.

So what can we learn from this study? First, we need to be vigilant about outbreaks in school and daycare settings as they can lead to a substantial number of children out with illness and a large loss of time before containment – 9 days in schools and 15 days in daycares. Second, and least surprisingly, the same measures that mitigate the spread of COVID-19 mitigate the spread of diarrheal outbreaks. Hand washing, staying home when sick, and environmental disinfection all can reduce the risk of widespread outbreaks. While those measures can be relatively easy to implement, what is missing is the support needed for families to actually keep children home from school or daycare. Many families in the US do not have access to sick leave or family leave or alternate caregivers who can care for sick children while the parent has to work. We all have to remember that to implement public health mitigation measures, we have to advocate for policies and incentives that help family members   stay home when their child is sick. If the pandemic has taught us anything, it’s that inequities and a lack of family support lead to worse outcomes for everyone, but especially the most disadvantaged in our society.

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