Hepatitis A in day care centre

A focal outbreak of hepatitis was detected in a day-care centre for children centrally located in Pune. The source of infection was suspected to be an 11-year-old child who probably got the infection from his school. Seven out of 15 children from day-care centre developed clinical hepatitis. Two cases of secondary infection were identified among the family contacts of infected children. Sera from all the nine sick children were positive for anti-hepatitis A virus-IgM antibodies. A stool sample from a case of secondary infection showed presence of HAV-RNA by RT-nested PCR. These findings proved that the outbreak was caused by hepatitis A virus.     

Use of medical care and antibiotics among preschool children in different day care settings

The use of medical care among 880 1-5 year olds in different day care settings was studied using register information on physician visits, purchases of antibiotics and municipal day care in 1984. The unit of analysis was months in the different day care settings and not children. The rates of physician visits were 1.4 to 1.8 times higher for acute upper respiratory tract infections and all acute infections and 2 to 3 times higher for secretory otitis media during day care centre months and family day care months as compared to home care months. The rate of visits for bronchial asthma was 5 times higher during day care centre months than during home care months. No differences were found between day care centre months and family day care months with respect to the rates of physician visits for acute upper respiratory tract infections, acute otitis media and all acute infections. Among children in family day care, the daily number of hours in day care, and size, average age and age homogeneity of the groups were not significantly associated with rates of visits for all acute infections or purchases of antibiotics.     

Transmission of invasive Haemophilus influenzae type b disease in day care settings

We prospectively studied the risk of secondary transmission of invasive Haemophilus influenzae type b (Hib) disease among children in day care in Oklahoma. We established a statewide surveillance system for the reporting of all forms of invasive Hib disease from physicians, clinical laboratories, county health departments, and infection control practitioners from all hospitals in and bordering Oklahoma. For the 2-year period March 15, 1984, to March 15, 1986, there were 409 culture-confirmed cases of invasive Hib disease in children 12 years of age or younger; 147 (37%) case-patients attended day care. When a case-patient attended day care during the week before illness, we prospectively identified and observed all classroom contacts (n = 2147) for the next 60 days. Of 1253 classroom contacts younger than 4 years of age, seven (0.6%) secondary cases were identified. Isolates from all paired index and secondary cases had identical outer membrane protein (OMP) patterns. Strains causing primary disease were indistinguishable by OMP distribution from those causing secondary disease. Of 685 classroom contacts younger than 2 years of age from whom rifampin use was ascertained, five (1.7%) of 292 who did not receive rifampin became secondary cases, compared with one (0.3%) of 393 who received rifampin (rate ratio 6.7; 95% confidence limits 1.1, 42.5; P less than 0.05). Of 495 classroom contacts 24 to 47 months of age for whom rifampin use was ascertained, one (0.5%) of 194 who did not receive rifampin became a secondary case, compared with none of 301 who received rifampin. This experience indicates that secondary transmission of invasive Hib disease can be appreciable in day care settings, particularly in children younger than 2 years of age, and that rifampin prophylaxis reduces this risk.     

Risk of injury to children less than 5 years of age in day care versus home care settings

Recent studies have suggested that day care may be a relatively unsafe environment. In this population-based study, the incidence of injuries in day care and home care were evaluated based on the number of hours children were exposed to each environment. In this population, 43.6% of children less than 5 years of age spent part of the year in day care. The rate of injuries in day care was 2.50 per 100,000 child-hours of exposure compared with a rate of 4.88 per 100,000 child-hours of exposure in the home environment. There were no differences in overall severity of injuries in the two groups. It was concluded that children are at no greater risk of injury in day-care settings than in the home environment.     

Allergy in day care children: prevalence and environmental risk factors

Aim: To investigate the prevalence of atopic disease among Finnish day care children and the relationship between atopy and environmental factors.
Methods: A cross-sectional study of 594 day care children aged 1–6 years from Helsinki, Finland. Each child's history of atopic diseases and environmental exposure was collected in a questionnaire completed by the parents.
Results: The prevalence of diagnosed asthma was 0.9% for the 1–3-year olds and 5.5% for the 4–6-year olds, atopic eczema/dermatis was 16% in both groups, and allergic rhinitis 5% in the younger group, 9% in the older group. According to multivariable logistic regression models, breastfeeding (exclusive ≥4 months or partial ≥6 months) reduced the risk of atopic diseases (OR = 0.60; CI₉₅ 0.39–0.93, p = 0.021). Atopic diseases were more common in the oldest age group, 5–6-year olds, compared to the youngest, 1–2-year olds (OR = 2.18; CI₉₅ 1.14–4.15, p = 0.018). One parent with atopic disease increased the child's risk (OR = 1.89; CI₉₅ 1.20–2.97, p = 0.006), more so if both parents had a history (OR = 3.17; CI₉₅ 1.48–6.78, p = 0.003).
Conclusion: Our results support the hypothesis that breastfeeding for at least six months may protect against atopic diseases. The child's greater age (5–6 years) and parental history of atopic diseases increased the risk of atopy.     

Management of HIV-infected children in the home and institutional settings. Care of children and infections control in schools, day care, hospital settings, home, foster care, and adoption

The likelihood of high-risk pediatric exposure to HIV infection, other than perinatal exposure, has been shown to be low in most cases, and HIV PEP should be considered on a case-by-case basis. Generic considerations in the management of children who have become HIV infected emphasizes the principles of inclusion, maintaining confidentiality of a child's HIV status, and notifying those who need to know about the HIV status to care properly for the child or adolescent. Although appropriate infection-control precautions are applicable for all children and for many pathogens, children especially HIV-infected children, exposed to such pathogens, must be managed in a timely fashion. In many cases, recommendations that are applicable in one setting are applicable in others. Some exceptions apply, including infection-control precautions in hospitals versus other settings. A few additional considerations have been made for special settings and activities, including adoption, foster care, athletics, summer camp, and other recreational activities.     

Longitudinal study of Giardia lamblia infection in a day care center population

An enzyme-linked immunosorbent assay was used to detect Giardia lamblia in stool specimens collected during a 15-month longitudinal study of diarrhea in 82 children 1 to 24 months old attending a day care center (DCC) in Houston. A total of 2727 stool specimens were collected on a weekly basis from the DCC children and were evaluated for rotavirus and Giardia. For DCC children who developed diarrhea stool specimens were also cultured for bacterial enteropathogens. During the 15-month study period, 48 episodes of Giardia infection were detected in 27 of 82 (33%) DCC children, compared with 57 episodes of rotavirus detected in 37 (45%) of these same DCC children. The duration of Giardia excretion was 2.0 +/- 1.5 weeks (mean +/- SD). Only 6 (7%) of the 82 DCC children, or 6 of the 27 (22%) with infection, developed symptoms attributable to Giardia. Ten of the 27 (37%) DCC children infected with Giardia had 2 or more episodes of infection. Giardia was identified in the DCC in all months except June. Two Giardia outbreaks occurred in 1 of the 6 DCC rooms under study. One outbreak was associated with overcrowding. Neither outbreak was associated with the introduction of a new Giardia-positive child into the involved room. In this study Giardia infection occurred commonly in the DCC throughout the year, was rarely associated with illness and was not associated with introduction of asymptomatic carriers into the DCC rooms.     

Communicable disease outbreaks in long day care centres in western Sydney: Occurrence and risk factors

We surveyed the directors of all 92 long day care centres in western Sydney to document the occurrence of communicable disease outbreaks during 1992 and to identify risk factors for the occurrence of these outbreaks. A total of 6092 children were enrolled at the centres, of whom 530 (8.7%) were less than 3 years old. Most centres (80.4%) reported at least one outbreak of communicable disease. Diarrhoea was the most commonly reported outbreak type (60 outbreaks), followed by conjunctivitis, head louse infestation and chicken pox (46, 44 and 24 outbreaks, respectively). Chicken pox outbreaks had the largest mean number of cases per outbreak (9.6) and the longest mean outbreak duration (4.4 weeks). Centres with a large total enrolment (50 or more children), those that were open for 12 or more hours each day and those which had commenced operating in 1990 or more recently were generally more likely to report outbreaks, particularly of diarrhoea. The vast majority of communicable disease outbreaks (92.1%) were handled by day-care staff without seeking outside assistance. Day-care centre directors may be unaware of the health services that could help them. We need to work more closely with long day care centres, and to focus preventative efforts on large centres, those open for long hours, and newly opened centres.     

Sudden infant death syndrome in child care settings in the Netherlands

Background: In the Netherlands, there is a very low incidence of sudden infant death syndrome (SIDS) due to effective preventive campaigns. Methods: During the period September 1996 to August 2002, nationwide 161 deaths from SIDS (about 85% of all cases of SIDS during that time) were investigated by the Cot Death Committee of the Dutch Paediatric Association. Results and Discussion: Over 10% of cases of SIDS took place during some type of child care. From a national survey carried out in 2000/01 information was available on the child care attendance of 2000 Dutch infants aged 3–6 months. Based on the hours usually spent in child care by these infants, the number of similarly aged infants that died from SIDS while attending child care was 4.2 times higher than expected. Remarkably, the prevalence of known risk factors for SIDS, such as sleeping position and parental smoking, was favourable in the SIDS cases in child care settings. The adherence of child care facilities to the safe sleeping recommendations is high in the Netherlands, and no explanation as to why child care settings may be associated with an increased risk of SIDS is apparent. The possibility of other explanations, such as stress and change in routine care, is hypothesised.