Campylobacter—Child Care and Schools

What is Campylobacter ?

Campylobacter is a type of bacteria that can cause infection of the intestines.

What are the signs or symptoms?

• Diarrhea (often bloody)

• Fever

• Nausea and vomiting

• Abdominal cramping and pain

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

• Malaise

What are the incubation and contagious periods?

• Incubation period: 2 to 5 days but can be longer.

• Contagious period: Excretion of Campylobacter is shortened by antibiotic treatment. Without treatment, excretion of bacteria typically continues for 2 to 3 weeks (and up to 7 weeks in some cases), and relapse of symptoms may occur.

How is it spread?

• Contact with stool from infected birds, farm animals (eg, chickens, turkeys, cows, pigs), or pets (eg, dogs, cats, hamsters, birds—especially young animals).

• Contaminated water.

• Unpasteurized milk.

• Contaminated food (eg, raw or undercooked poultry).

• Person-to-person via the fecal-oral route occurs occasionally, particularly from very young children (most likely during the diarrhea phase). This generally involves an infected child contaminating their fingers and touching an object another child then touches. Children who have contact with the contaminated surface may place their fingers into their own or another person’s mouth.

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 particularly before and after contact with raw poultry or dog or cat feces and anything to do with food preparation or eating.

• 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 .

• 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.

• Ensure thorough washing of raw fruits and vegetables.

• 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 .

• Use antibiotics if prescribed; however, antibiotics are not routinely used in most cases.

• 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 Campylobacter may have bloody diarrhea, which should trigger a medical evaluation. Outbreaks are uncommon in early childhood education (ECE) settings.

• 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 Campylobacter

  • – 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, follow the directions of the local health department.

• Avoid milk that is not pasteurized and water that is not chlorinated.

Exclude from educational setting?

Yes, if

• 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 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:

• 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

Note: It is not necessary to demonstrate negative Campylobacter stool test results to be readmitted to the educational setting.