1. DAY CARE INFECTIONS

2. 13 million children under 5 years of age use child care services.
National Center for Health Statistics, 2010

3. 90 percent of families with preschool children use child care services.
National Commission on Children, 2010

4. TYPES OF DAY CARE SETTINGS
Small family child-care home
6 children
licensing not required
Large family child-care home
7-12 children
variable licensing requirements
Centers
13 children
Licensed
Facilities for ill children
Facilities for children with special needs
APHA/AAP Out-of-Home Child Care Guidelines, 1992.

5. HIGH RISK PERSONNEL Susceptible to childhood infections
(measles, mumps, chickenpox, etc.)
Immunocompromised
asplenia
cancer
transplantation
HIV
Pregnant women
Grossman Ed 8, Infection Control in the Child Care Center,
Demos Medical Publisher, 2012

6. HIGH RISK CHILDREN Infancy Immunocompromised Chronic lung disease
Risk Factors:
Infancy
Immunocompromised
Chronic lung disease
Cardiac disease
Physical handicaps
Chronic skin disease
Grossman, Ed 8, Infection Control in the Child Care Center,
Demos Medical Publisher, 2012.

7. HIGH RISK CHILDREN FOR SPREADING INFECTION
Children living in impoverished conditions
multiple care givers
transient “family” or shelter
poor sanitary conditions
untreated infections in the home
Children from developing nations
Children with immune deficiencies
Children with chronic infections

8. DAY CARE FACTORS THAT INCREASE TRANSMISSION OF PATHOGENS
Large numbers of children in close contact
Infants and toddlers have
no independent personal hygiene
are incontinent
put everything in their mouths
Children are susceptible to most infectious agents
Infected children may be contagious before symptomatic
Parvovirus B19
Varicella
Infected children may be asymptomatic
Giardia
Hepatitis A

9. RESPIRATORY TRANSMISSION
Bacteria Bordetella pertussis Haemophilus influenzae type B Mycobacterium tuberculosis Neisseria meningitidis Streptococcus pneumoniae
Viruses Adenovirus Influenza Measles Parainfluenza Parvovirus B19 Respiratory syncytial virus Rhinovirus Rubella Varicella

10. FECAL-ORAL TRANSMISSION

11. TRANSMISSION BY SKIN OR MUCOUS MEMBRANE CONTACT

12. TRANSMISSION BY INOCULATION OR SPLATTERING OF BLOOD
Cytomegalovirus
Hepatitis B
Hepatitis C
Human immunodeficiency virus

13. ILLNESSES AND ABSENTEESIM IN DAY CARE CHILDREN (2 YEAR SURVEILLANCE PERIOD)

14. ANTIBIOTIC USE IN DAY CARE CHILDREN (2 MONTH SURVEILLANCE PERIOD)

15. ENVIRONMENTAL COLIFORM CONTAMINATION (2946 SAMPLES)
Number Contaminated (%) Inanimate objects 307 (15) Toy balls 73 (46) Hands 131 (17)
Van et al, JAMA, 1991.

16. HEPATITIS A

23. HEPATITIS A
Child care attendees or employees account for 14% of all cases of Hepatitis A in the United States.

24. Small non-enveloped RNA virus
ETIOLOGIC AGENT
Small non-enveloped RNA virus

25. EPIDEMIOLOGY Source infected human High risk child care centers
large numbers of children
longer hours
diapered children
Mode of spread
fecal-oral

27. CLINICAL MANIFESTATIONS
Most children are asymptomatic
80% of adults are symptomatic
Rash
Fatigue
Jaundice
Anorexia
Dark urine
Light stools
Vomiting

29. INCUBATION PERIOD INFECTIOUS PERIOD 15 to 50 days
Among symptomatic persons, infectivity has waned by the time the individual seeks medical care.

30. DIAGNOSIS
Hepatitis A serology
THERAPY
Supportive

31. PREVENTION
Standard precautions
Vaccine
Immune serum globulin

32. CHILD CARE EXCLUSION
Infected children can return 10 days after onset of symptoms
During an outbreak, return to day care will be governed by the public health department

33. RECOMMENDATIONS FOR OTHER CHILDREN
Hepatitis A vaccine
Immune serum globulin, if exposed
Children should be taught how to minimize risks of transmission by handwashing

34. RECOMMENDATIONS FOR PERSONNEL
Hepatitis A vaccine
Significant risks of infection in the day care setting

35. Pre-attendance Hepatitis A vaccine
PARENTAL ADVICE
Pre-attendance Hepatitis A vaccine

37. VARICELLA

38. BEFORE 1995 INTRODUCTION OF THE VARICELLA VACCINE IN THE UNITED STATES
4 million cases per year
11,000 hospitalizations per year
100 varicella associated deaths
Meyer PA et al, J Infect Dis, 2000

39. AFTER INTRODUCTION OF VARICELLA VACCINE IN THE UNITED STATES 1995-2000
New Cases:
 California % 
 Texas % 
 Pennsylvania % 

40. ETIOLOGIC AGENT
DNA virus

41. EPIDEMIOLOGY
 Source  infected human: -respiratory tract -infected lesions  Mode of spread  airborne  direct contact

42. CLINICAL MANIFESTATIONS
Pruritic vesicular rash
Fever
Systemic symptoms

43. Until lesions are crusted
INCUBATION PERIOD
10 to 21 days
INFECTIOUS PERIOD
Until lesions are crusted

44. Acyclovir for high risk individuals
DIAGNOSIS
 Clinical
 Viral culture
 Serology
THERAPY
Acyclovir for high risk individuals

45. PREVENTION
 Vaccine  Airborne and Contact precautions  VZIG in high risk exposed children  Post-exposure vaccination of susceptible children and adults

46. CHILD CARE EXCLUSION
Infected children can return when lesions are crusted (approximately 5 to 7 days)

47. RECOMMENDATIONS FOR OTHER CHILDREN
 VZIG for high risk exposed children
 Varicella vaccine
RECOMMENDATIONS FOR PERSONNEL
 Varicella vaccine for susceptible adults

48. THEORETIC CONCERNS
Increased Varicella in Older Children and Adults who have:  Never received the vaccine  Have waning immunity  Have less booster exposures to VZV  later varicella disease   herpes zoster

49. INFLUENZA

50. ETIOLOGIC AGENT
Enveloped RNA virus

51. EPIDEMIOLOGY Source • infected human Mode of spread
• large droplet aerosol
• small droplet aerosol
• direct and indirect contact with infected secretions

52. INFLUENZAE ATTRIBUTABLE MORBIDITY IN NORMAL CHILDREN LESS THAN 1YEAR OF AGE
Increased Hospitalization
Increased Outpatient Visits
Increased Antibiotic Use
Neuzil KM et al, NEJM, 2000
Izurieta HS et al, NEJM, 2000

53.  High risk children  Chronic lung disease  Congenital heart disease  Immunocompromised  Sickle cell disease  Diabetes  Chronic renal failure  Metabolic disease  Under 2 years of age

54. CLINICAL MANIFESTATIONS
 Fever  Headache  Myalgias/Arthralgias  Chills  Pharyngitis  Rhinorrhea  Cough/Croup/Bronchitis

55. INCUBATION PERIOD 1 to 3 days
INFECTIOUS PERIOD
Influenza A days prior to 7 days
after symptoms
Influenza B - 6 days prior to 14 days

56. DIAGNOSIS THERAPY Viral Culture Rapid tests (immunofluorescent or
enzyme immunoassay)
THERAPY
Influenza A -Amantadine
-Rimantadine
-Zamamivir (inhaled)
-Oseltamivir
Influenza B -Zamamivir (inhaled)

57. PREVENTION  Annual influenza vaccine
• high risk children - recommended*
• healthy children 6 to 23 months - encouraged*
Prophylactic antiviral therapy for high risk children
*Recommendations of the ACIP, MMWR, 2002

58. CHILD CARE EXCLUSION
Until child is able to participate in child care center activities

59. RECOMMENDATIONS FOR PERSONNEL
OTHER CHILDREN
 Avoid aspirin during influenza season
 Annual influenza vaccine
RECOMMENDATIONS FOR PERSONNEL

60. MOLLUSCUM CONTAGIOSUM

61. ETIOLOGIC AGENT
DNA virus

62. EPIDEMIOLOGY Source • infected human Mode of spread
• direct skin to skin contact
• contaminated formites

63. CLINICAL MANIFESTATIONS
 Small painless skin lesions notable for a central dimple  Lesions are usually on face, trunk and limbs  Lesions spontaneously disappear within 6-12 months

64. INCUBATION PERIOD 2-24 weeks
INFECTIOUS PERIOD
As long as child has visible lesions

65.  Clinical  Biopsy  Usually unnecessary  Cryotherapy  Curettage  Laser  Cimetidine  Topical therapies  Acyclovir for high risk individuals
DIAGNOSIS
THERAPY

66. PREVENTION  No vaccine available Handwashing
Cover lesions with clothing

67. CHILD CARE EXCLUSION
None recommended

68. PREVENTIVE STRATEGIES

69. ENTRANCE REQUIREMENTS FOR CHILDREN
Medical history
Immunizations
Diphtheria-Pertussis-Tetanus
Hemophilus influenza B
Hepatitis A
Hepatitis B
Influenza
Mumps
Polio
Rubella
Rubeola
Varicella
Pneumococcus

70. ENTRANCE REQUIREMENTS FOR STAFF
Medical history
Immunizations
Diphtheria-Tetanus
Hepatitis A
Hepatitis B
Influenza
Mumps
Polio
Rubella
Rubeola
Varicella
(Pertussis)

71. EXCLUSION FROM CHILD CARE