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
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Infectious Disease in Out of Home Child Care Jonathan B. Kotch, MD, MPH, FAAP, Director National Training Institute for Child Care Health Consultants The.
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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
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.