Asymptomatic salmonellosis among children in day-care centers in Mérida, Yucatan, Mexico.

BACKGROUND: Child day-care centers (DCC) have become common in many lower and middle income countries, presenting new problems that may differ from those of DCC in more developed countries. Diarrhea is a common problem in DCC in the United States, but information on the prevalence of diarrhea or specific enteropathogens among children in DCC in tropical and developing countries is limited.
METHODS: Because of preliminary data from newborns and DCC attendees in Mérida, Mexico, with high rates of Salmonella infection, we conducted a 12-month longitudinal surveillance study of enteropathogens in two Mérida DCC. Seventy-eight children ages 2 months to 4 years were evaluated with demographic and clinical data, and stools were cultured monthly.
RESULTS: Salmonella sp. was the most common enteropathogen detected (46 of 683 specimens, 6.7%), with higher rates in children younger than 18 months (P < 0.02), but it was found in only 1 of 10 diarrhea episodes that coincided with sampling. Other common organisms identified included Giardia lamblia (21 of 683, 3.0%) and LT-producing enterotoxigenic Escherichia coli (16 of 683, 2.3%). Salmonella was recovered from as many as 19% of children in a single month, but the large multiplicity of serotypes recovered suggested multiple sources rather than a common source outbreak. Children with Salmonella tended to have more liquid stools during the preceding 2 weeks. Salmonella was also isolated from the stool of teachers in 1 of the 2 DCC in 10 of 94 specimens (10.6%), and again multiple serotypes were represented.
CONCLUSION: These data indicate the presence of multiple sources of Salmonella infection in the DCC, posing a complex situation for infection control.