Skip to main content

Table 1 Main scenarios evaluated: shigellosis exclusion policies assessed and patient treatment scenarios

From: Evaluation of the impact of shigellosis exclusion policies in childcare settings upon detection of a shigellosis outbreak

Main scenarios for evaluation

Definition

I. Shigellosis exclusion policiesa

The patient can return to childcare if in compliance with the following requirements:

Two consecutive tests: Culture

Two consecutive laboratory culture analyses of convalescentb stool samples yield negative results for Shigella

Two consecutive tests: PCRc

Two consecutive laboratory PCR analyses of convalescentb stool samples yield negative results for Shigella

One test: Culture

One laboratory culture analysis of convalescentb stool samples yields negative results for Shigella

One test: PCR

One laboratory PCR analysis of convalescentb stool samples yields no Shigella

14 days after onset

14 days after symptom onset, with no tests performed during convalescence

7 days after beginning treatment

Seven days after beginning antimicrobial treatment, with no tests performed during convalescence

24 h symptom-free

24 h symptom-free, with no tests performed during convalescence

II. Treatment scenarios for each exclusion policyd

 A. Immediate, effective treatment

Child visits healthcare provider and starts effective antimicrobial treatment without requiring any further diagnosis or test on the second day of illness

 B. Effective treatment after diagnosis

Child visits healthcare provider on the second day of illness, gets a stool culture with antimicrobial susceptibility testing, and starts effective treatment after results are availablee

 C. Ineffective treatment

Child visits healthcare provider and starts ineffective antimicrobial treatment on second to fourth day of illness

 D. No treatment

Child receives no antimicrobial treatmentf

  1. Notes
  2. aIn all scenarios, the patient would get an initial diagnostic test to confirm Shigella infection
  3. bDefinition of convalescent stool samples: samples collected at least 24 h after completing antimicrobial therapy and/or diarrhea resolution; if performing more than 1 test, the samples should be collected at an interval of ≥24 h
  4. cPCR: polymerase chain reaction
  5. dThe exclusion policy “7 days after beginning treatment” was not evaluated for the treatment scenario “D. No Treatment” given that they are mutually exclusive
  6. eWe assumed that the interval between starting treatment between patients receiving Treatment A and patients receiving Treatment B was two days. This includes the time necessary to do an additional test, receive the results, and have the doctor do a prescription for treatment after the first medical encounter
  7. fFor example, if the patient does not follow up after the initial diagnostic visit, or no antimicrobials are prescribed