Infectious Disease in Out of
Home Child Care
Part I: Statement of the Problem and Respiratory
Transmission
Jonathan B. Kotch, MD, MPH, FAAP, Director
National Training Institute for Child Care Health Consultants
The University of North Carolina at Chapel Hill
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


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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 Careassociated Illness1(Haskins, 1989)
Treatment of
respiratory infections
($78)
Treatment
of otitis
($420)
Absence
from work
($1,300)
1courtesy
Treatment of
HiB infections
($17.3)
Long term care
($40)
of Ralph Cordell, CDC
Consequences


Human suffering, adults and children
Costs

Short term



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Medical
Lost wages
Additional child care costs
Long term


Death
Chronic sequelae


CMV and Parvovirus B19
ROM
Risk Factors



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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



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Sinks and toilets
Ventilation
Food preparation
areas
Over-crowding
Toys that are often
mouthed
Ways to Transmit
Infectious Agents



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

Respiratory
Fecal-oral
Direct contact: Skinto-skin
Blood, urine, saliva
Arthropod borne (via
insects)
Zoonoses (from
animals)
Respiratory Transmission



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Recurrent otitis media (ROM)
Meningitis
URI (colds, sinusitis)
Pharyngitis (sore throat)
Lower respiratory infection
(pneumonia)

Uncommon
Respiratory Pathogens
(Churchill & Pickering, 1997)
Bacteria

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Hib
N. meningitidis
S. pneumoniae
S. pyogenes
Bordetella pertussis
M. tuberculosis
Viruses

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Adenovirus
Coronavirus
Enteroviruses
Influenza/Parainfluenza
M/M/R
Parvovirus B19
RSV
Varicella
Exclusion Criteria –
2
General Principles




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
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Lethargy
Uncontrolled coughing
Inexplicable irritability or persistent crying
Difficult breathing
Wheezing
Other unusual signs for the child
3Courtesy
of Steve Shuman
Prevention Strategies

Immunizations

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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