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.

Percent of Children 1-6, By Type of Care, 2001 (America’s Children 2003)

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)

Acknowledgement

Supported by Grant #U93-MC00003 from the Maternal and Child Health Bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services.

END OF PART I