Governor Asa Hutchinson [Nathaniel Smith, MD, MPH, Director and State Health Officer ph & rkansas Department of Health June 12, 2017 Dear Parent of child in Ascent Daycare, ‘The Arkansas Department of Health (ADH) has been responding to cases of diarrhea caused by Shigella bacteria in your part of the state, We have confirmed that several of the children with Shigella attend Ascent Daycare where your child also attends, Ascent staff have followed all recommendations to control the spread of Shigella. Despite these efforts, we are still seeing illness spread to other children. Therefore, the management at Ascent has decided to close the daycare on Wednesday, June 14 and reopen on Monday, June 19 in an effort to stop further spread and better protect the children, While they are closed, the staff will intensively clean and sanitize the facility. This decision was made according to recommendations from the ADH. igella bacteria cause diarrhea, fever and stomach cramps, The illness is called shigellosis, and it is very contagious. It can easily spread from person to person through infected stool while people have diarrhea and for up to 2 weeks after the diarthea has ended, Infected stool can contaminate the environment and be very difficult to remove. Even a tiny amount of contaminated stool can cause infection. Most people who are infected will develop symptoms 1 to 2 days after they are exposed to the bacteria. Symptoms last for an average of 5 to 7 days. Shigellosis can be treated with an antibiotic medication, which requires a prescription from a doctor. Childcare centers where there are young children in diapers are most likely to have problems with Shigella. Therefore, ADH recommends that you keep your child at home until Ascent Daycare reopens on June 19, 2017. Do not take your child to another daycare, as this may further spread Shigella. If your child develops diarthea, please report that to the daycare and take your child (and this letter) to the doctor to get a stool culture test. The stool culture can also be done by the ADH. you request it, For this outbreak, we consider anyone with diarrhea or poorly-formed stool that is new to be a suspected case of shigellosis unless itis proven otherwise. If your child is found to have shigellosis, they must remain out of the daycare until they are without diarrhea and have either taken 5 days of antibiotics or had 2 stool culture tests that are clear of Shigella bacteria. ‘You will need to keep your child out of daycare until the ADH informs you that you can return. ‘This is to prevent the spread of illness to other children.The recommended treatment is with azithromycin, but trimethoprim-sulfamethoxazole may also be used. If the child does not receive treatment, then they would need to be excluded from daycare until they have had 2 stool cultures free of Shigella, Shigella can remain in the stool for 2 ‘weeks or longer. Therefore, we recommend treatment rather than waiting, because this will allow your child to retum to daycare more quickly. We have attached a fact sheet to answer questions to give you more information about Shigella. Thank you for your cooperation. Please don’t hesitate to call us at 501-537-8969, if we can be of further assistance. Yours sincerely, Ou Alo Dirk Haselow, MD, PhD, FAAP State Epidemiologist and Medical Director for Outbreak Response Arkansas Department of Health