Infectious Disease in Out of Home Child Care
Jonathan B. Kotch, MD, MPH, FAAP, DirectorNational Training Institute for Child Care Health
ConsultantsThe University of North Carolina at Chapel Hill
Part I: Statement of the Problem and Respiratory Transmission
Objectives for Part I
At the end of this training learners will be able to:
Describe the causes and consequences of the most frequent infectious diseases in child care, and
Identify modes of transmission and prevention of infectious diseases transmitted by the respiratory route.
Infectious Disease in Child Care
Increased frequency of illness Greater severity of illness More frequent antibiotic use Increased risk for acquiring
resistant organisms May carry home illnesses and
infect family members
Cost (in Millions) of Child Care-associated Illness1(Haskins, 1989)
Absence from work ($1,300)
Treatment of otitis ($420)
Treatment of HiB infections ($17.3)
Long term care ($40)
Treatment of respiratory infections ($78)
1courtesy of Ralph Cordell, CDC
Consequences
Human suffering, adults and children Costs
Short term Medical Lost wages Additional child care costs
Long term Death Chronic sequelae
CMV and Parvovirus B19 ROM
Risk Factors
Children < 2 years of age Size of facility (number of children) Age-mixing Staff who both diaper and feed or
prepare food Staff experience, education and training Staff:child ratio Ill child in the room
Physical Characteristics of the Facility
Sinks and toilets Ventilation Food preparation
areas Over-crowding Toys that are
often mouthed
Ways to Transmit Infectious Agents
Respiratory Fecal-oral Direct contact:
Skin-to-skin Blood, urine, saliva Arthropod borne
(via insects) Zoonoses (from
animals)
Respiratory Transmission
Recurrent otitis media (ROM) Meningitis URI (colds, sinusitis) Pharyngitis (sore throat) Lower respiratory infection
(pneumonia) Uncommon
Respiratory Pathogens(Churchill & Pickering, 1997)
Bacteria Hib N. meningitidis S. pneumoniae S. pyogenes Bordetella pertussis M. tuberculosis
Viruses Adenovirus Coronavirus Enteroviruses Influenza/Parainfluenza M/M/R Parvovirus B19 RSV Varicella
Exclusion Criteria – General Principles2
Illness prevents the child from participating
Illness results in a greater need for care than staff can provide
Child is suspected by health authorities to contribute to transmission of illness.
Fever with behavior changes, or signs and symptoms of illness.
2Courtesy of Steve Shuman
Signs and Symptoms3
Lethargy Uncontrolled coughing Inexplicable irritability or persistent
crying Difficult breathing Wheezing Other unusual signs for the child
3Courtesy of Steve Shuman
Prevention Strategies
Immunizations Hib Varicella-zoster MMR, DTaP Pneumococcus Rotavirus
Health benefits of immunizations Influenza vaccination of day care children is
effective in reducing influenza-related morbidity among household contacts. (Hurwitz et al., 2000)
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