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Infectious Disease in Out of Home Child Care

Infectious Disease in Out of Home Child Care. Jonathan B. Kotch, MD, MPH, FAAP, Director National Training Institute for Child Care Health Consultants The University of North Carolina at Chapel Hill. Part I: Statement of the Problem and Respiratory Transmission. Objectives for Part I.

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Infectious Disease in Out of Home Child Care

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  1. Infectious Disease in Out of Home Child Care Jonathan B. Kotch, MD, MPH, FAAP, Director National Training Institute for Child Care Health Consultants The University of North Carolina at Chapel Hill Part I: Statement of the Problem and Respiratory Transmission

  2. 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.

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

  4. 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

  5. Cost (in Millions) of Child Care-associated Illness1(Haskins, 1989) Treatment of respiratory infections ($78) Treatment of otitis ($420) Absence from work ($1,300) Treatment of HiB infections ($17.3) Long term care ($40) 1courtesy of Ralph Cordell, CDC

  6. 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

  7. 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

  8. Physical Characteristics of the Facility • Sinks and toilets • Ventilation • Food preparation areas • Over-crowding • Toys that are often mouthed

  9. Ways to Transmit Infectious Agents • Respiratory • Fecal-oral • Direct contact: Skin-to-skin • Blood, urine, saliva • Arthropod borne (via insects) • Zoonoses (from animals)

  10. Respiratory Transmission • Recurrent otitis media (ROM) • Meningitis • URI (colds, sinusitis) • Pharyngitis (sore throat) • Lower respiratory infection (pneumonia) • Uncommon

  11. 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 Respiratory Pathogens(Churchill & Pickering, 1997)

  12. 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

  13. Signs and Symptoms3 • Lethargy • Uncontrolled coughing • Inexplicable irritability or persistent crying • Difficult breathing • Wheezing • Other unusual signs for the child 3Courtesy of Steve Shuman

  14. Prevention Strategies • Immunizations • Hib • Varicella-zoster • MMR, DTaP • Pneumococcus • Rotavirus • Health benefitsof immunizations • Influenza vaccination of day care children is effective in reducing influenza-related morbidity among household contacts. (Hurwitz et al.,2000)

  15. 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

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