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What is Salmonella ?

• Salmonella is a type of bacteria that can infect the intestines.

• Typhoid fever is caused by a type of Salmonella Typhi or Paratyphi 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

• Nausea or vomiting

• Signs of dehydration, including dry mouth, no tears, or no urine for 8 hours

• Sometimes blood or mucus in stool

What are the incubation and contagious periods?

• Incubation period: 6 to 48 hours (for nontyphoidal Salmonella strains, those strains most commonly responsible for diarrhea in the United States).

• Contagious period: About half of children younger than 5 years still have Salmonella in their feces/stool 12 weeks after having this infection, but testing for or treating this condition is not recommended.

How is it spread?

• Fecal-oral route: Contact with feces of infected children and animals, especially reptiles, amphibians, and poultry, but also birds, rodents, other small mammals, farm animals, and even dogs and cats (see the specific list of animals in the section How do you control it?). This generally occurs when children touch a contaminated surface and then put their contaminated fingers in their own mouth and/or touch an object or put their contaminated fingers in the mouth of another person.

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

• Contact with fecal material transferred to food preparation or other surfaces or objects contaminated by children or animals with Salmonella .

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition , especially after toilet use or handling soiled diapers and before anything to do with food preparation or eating, particularly before and after contact with raw poultry or handling animals known to carry Salmonella (see bullet point later in this section).

• 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. For guidance on disinfectants, refer to Selection and Use of a Cleaning, Sanitizing, or Disinfecting Product in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Animals that are known to carry Salmonella (reptiles [turtles, lizards, and snakes], amphibians [frogs and toads], and poultry [chicks, chickens, ducklings, ducks, geese, and turkeys]) should not be allowed in an early childhood education (ECE) program or school facility. Salmonella is a normal bacterial inhabitant of the intestinal tract of many animals without making them sick. Cages and all surfaces involved in the care of these animals should be considered contaminated with Salmonella . These objects are a common source of spread of Salmonella infection to children in educational settings.

• Use 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.

• Ensure thorough washing of raw fruits and vegetables.

• Ensure proper cooking, handling, and storage of food. Avoid using the same cutting boards or utensils for raw and cooked foods without proper cleaning in between.

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

• Exclude infected staff members who handle food. See Safe Food Preparation and Service: Food Handlers in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Special clearance from the local or state department of public health is warranted for Salmonella Typhi strains.

• Exclude for specific types of symptoms (see the section Exclude from educational setting?).

What are the roles of the educator 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).

  • – Report the condition to the staff member designated by the ECE program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms and notifies the Child Care Health Consultant.

  • – Ensure staff members follow the control measures listed in the section How do you control it?

  • – Do not allow a staff member with diarrhea to be involved with food handling or feeding of children.

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

• If you know a child or staff member in the program has Salmonella

  • – Follow the advice of the child’s or staff member’s health professional.

  • – Report the infection to the local health department. The health professional who makes the diagnosis may not report that the infected child is a participant in an ECE program or school, and this could lead to delay in controlling the spread.

  • – Reeducate staff members about strict and frequent handwashing, 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 the section 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 ECE program or school facility. Ensure immediate hand hygiene if there has been any contact with any of these animals.

Exclude from educational setting?

Yes, if

• The infection is from Salmonella Typhi or Paratyphi strains.

• 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 is more watery and frequency exceeds 2 stools above normal for that child during the time the child is in the program because this may cause too much work for EC educators 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 (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

Readmit to educational setting?

Yes, when all the following criteria are met:

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

  • – For Salmonella Typi or Paratyphi strains

    • ❖ Three negative test results from stool cultures at least 48 hours after stopping antibiotic treatment are needed for children with S Typhi.

    • ❖ For staff members infected with Salmonella Typhi, the health department should be consulted to determine length of exclusion and testing, which can vary by location.

• 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 for that child during the time the child is in the program, even if the stools remain loose.

• When exclusion criteria are resolved, 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.