Infectious Disease

Acute Infectious Diarrhea and Gastroentertis

General Description

Case Definition: Passage of 3 or more loose or liquid stools per 24 hours or more frequently than is normal for an individual person.41 A list of exposures or conditions associated with pathogens causing diarrhea is found in Appendix C.

Clinical Course: This section focuses on disease in healthy adults with intact immune systems, who experience acute watery diarrhea and acute bloody diarrhea that typically lasts less than 7 days but may be up to 2 weeks.  Acute gastroenteritis often refers to acute vomiting and/or diarrhea. Most episodes resolve with conservative care and are of viral or unknown etiology. The two most common viruses are norovirus and rotavirus. When a specific bacterial organism is identified, the most common causes of acute diarrhea in the US are Salmonella, Campylobacter, Shigella, and a Shiga toxin-producing E.coli (STEC), such as 0157-H7. Acute community acquired Clostridium difficile infection (CDI) has been reported in addition to CDI meeting the criteria for being hospital acquired. Carriers outnumber symptomatic individuals in the community at a ratio of 7:1. Although cases of CDI in healthy individuals without any discerning predisposing factors have been reported, symptomatic individuals frequently had been on antibiotics in the past 3-6 months, are in the pediatric population, female, use proton pump inhibitors, or live near farms and livestock.

Mode of Transmission: In the context of law enforcement, infectious agents may be transmitted to officers with contact with the public, in such activities as apprehending, restraining, and searching individuals, and in emergency medical response.

Viral Agents – Norovirus is usually transmitted through the fecal-oral route, through close person-to-person spread, or fecally contaminated food or water. Norovirus can also be spread by droplet route from vomitus.42 Incidence of rotavirus, a common cause of diarrhea in the pediatric population, has been reduced because of immunization. Cases in adults also are transmitted by fecal-oral route and through contact, typically a sick child.

Bacterial Agents – Most cases of bacterial infections are food- or water-borne, although transmission may be associated with person-to-person contact spread or by touching contaminated objects in environments with poor hygiene practices.

Period of Communicability: Most common causes of acute diarrheal illness and gastroenteritis can be found in Appendix D.

Effect on LEO Fitness for Duty: Symptoms of acute infectious diarrhea and acute gastroenteritis may be disruptive and temporarily disabling. The LEO should be excluded from duty until asymptomatic for 24 hours and can retain adequate liquids and nutrition. Test of cure based upon negative stool cultures is not necessary. Proper handwashing and adequate personal hygiene are important to preventing transmission of the agents of acute infectious diarrhea and gastroenteritis.

LEO-Specific Clinical Studies/Reports: Norovirus outbreak among evacuees from Hurricane Katrina. Epidemiologic investigation of law enforcement officers, medical professionals, others who contracted Norovirus, who had direct contact with patients in medical clinic supporting evacuees.43 Reactive Arthritis (Reiter’s Syndrome): Outbreak of salmonellosis in 25% of the 1608 police officers involved as security guards during papal visit. Twenty-seven of the officers developed Reiter’s Syndrome.44