BACKGROUND: The New York City (NYC) Department of Health and Mental Hygiene routinely investigates reported enteric diseases, often leading to public health action. Patients employed or engaged in activities with high risk for transmission, such as food handling, health care, or attendance at child care/preschool are excluded from high risk settings until asymptomatic or, when appropriate, until stool specimens are negative, and/or affected facilities are notified. Exclusion from work and child care can be burdensome to employees and parents.
METHODS: Reported, confirmed cases of Salmonella (including S. Typhi and S. Paratyphi), hepatitis A, Campylobacter, shiga toxin-producing Escherichia coli, and Shigella diagnosed during January 2013–December 2015 among NYC residents were analyzed. All cases are routinely investigated except for Campylobacter, for which only a sample of cases are investigated because of high volume. Patients are interviewed to collect data on employment or activities in high risk settings. Patients were summarized by demographic factors and length of exclusion.
RESULTS: During 2013–2015, 10,508 confirmed cases were reported, and 4,056 (39%) patients were interviewed. Campylobacter (5256, 50%) and Salmonella (3234, 31%) accounted for 81% of cases. Of interviewed patients, 448 (11%) worked at or attended a high-risk setting and required public health action; 193 (5%) required exclusion and 146 (4%) required negative stools. Patients were excluded for a median of 16 days, range: 2– 196 days. Among 212 patients working in high-risk settings and requiring public health action, 96 were health care workers, 93 were food handlers, 27 were child care workers, and 32 worked in other high-risk settings (the categories are not mutually exclusive). Children <5 years-old accounted for 3,175 (30%) patients. Among 1,356 (43%) children whose parents or guardians were interviewed, 236 (17%) attended a child care/preschool, and 83 (6%) required exclusion.
CONCLUSIONS: To prevent outbreaks, patients with enteric infections must be excluded from high-risk settings. In NYC, a 2014 law requires employers to provide one hour of sick leave for every 30 hours worked, with a maximum accumulation of 40 hours of sick leave. The median length of exclusion might exceed available paid sick leave for workers. Minimizing the duration of exclusion for enteric diseases such as reassigning tasks for workers and isolating or cohorting ill children in child care setting and increasing the availability of paid sick leave or other compensation could reduce the burden of exclusions on affected persons.