1
|
Rostgaard K, Stensballe LG, Søegaard SH, Kamper-Jørgensen M, Hjalgrim H. Childcare attendance and risk of infectious mononucleosis: A population-based Danish cohort study. PLoS One 2021; 16:e0261665. [PMID: 34937060 PMCID: PMC8694440 DOI: 10.1371/journal.pone.0261665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/07/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The risk of infectious mononucleosis (IM) is affected both by crowding and by sibship structure, i.e., number and signed age differential between an index child and a sibling. Siblings provide protection against IM by pre-empting delayed primary Epstein-Barr virus infection with its associated high risk of IM. The association between childcare attendance and risk of IM, on the other hand, has never been studied in a large, well-characterized cohort. METHODS Danish children born in July 1992 through 2016 with a completely known simple childcare attendance history before age 1.5 years (n = 908,866) were followed up for a hospital contact with an IM diagnosis at ages 1.5-26 years. Hazard ratios (HRs) of IM for an additional year of exposure were obtained from stratified Cox regression analyses, stratified by sex and year of birth, with age as the underlying time scale, adjusted for sibship structure, and sociodemographic variables including parental ethnicity and maternal age. RESULTS An additional year of exclusively attending a daycare home (max 5 children) yielded HR = 0.90 (95% confidence interval 0.81-1.00), and similarly, each year of exclusively attending a childcare institution (e.g., crèche) yielded HR = 0.94 (0.84-1.06). CONCLUSIONS Forwarding enrollment in childcare by a year lowers the risk of IM later in life much less than having an additional sibling of comparable age and has no practical public health implications. We find our results suggestive of a random threshold for successful Epstein-Barr virus infection that is more easily reached by a sibling than the collective of playmates in daycare homes or childcare institutions.
Collapse
Affiliation(s)
- Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Lone Graff Stensballe
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Holst Søegaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.,Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
2
|
Heusinkveld M, Mughini-Gras L, Pijnacker R, Vennema H, Scholts R, van Huisstede-Vlaanderen KW, Kortbeek T, Kooistra-Smid M, van Pelt W. Potential causative agents of acute gastroenteritis in households with preschool children: prevalence, risk factors, clinical relevance and household transmission. Eur J Clin Microbiol Infect Dis 2016; 35:1691-700. [PMID: 27372926 DOI: 10.1007/s10096-016-2714-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/20/2016] [Indexed: 01/05/2023]
Abstract
Acute gastroenteritis (AGE) morbidity remains high amongst preschool children, posing a significant societal burden. Empirical data on AGE-causing agents is needed to gauge their clinical relevance and identify agent-specific targets for control. We assessed the prevalence, risk factors and association with symptoms for enteropathogens in households with preschool children. A monthly-repeated cross-sectional survey of enteropathogens in households with preschool children was performed. A parent-child pair per household (n = 907 households) provided faecal samples and reported their symptoms and potential risk exposures. Samples were tested by multiplex reverse transcription polymerase chain reaction (RT-PCR) for 19 enteropathogens. Associations were assessed using logistic regression. 28.3 % of children (n = 981) and 15.6 % of parents (n = 971) carried pathogenic bacteria and/or Escherichia coli-associated pathogenicity genes, and 6.5 % and 3.3 % carried viruses, respectively. Giardia lamblia (4.6 % of children, 2.5 % of parents) and Dientamoeba fragilis (36 %, 39 %, respectively) were the main parasites, and were associated with pet exposure. Living in rural areas was associated with carriage of pathogenic E. coli, norovirus I and D. fragilis. Pathogenic E. coli was associated with summertime and livestock exposure. Attending day-care centres increased the risk of carrying norovirus, sapovirus and G. lamblia. Viruses occurred mainly in winter and were associated with AGE symptoms. Child-parent associations were found for bacterial pathogenicity genes, viruses, G. lamblia and D. fragilis. Enteropathogens spread widely in households with preschool children, particularly viruses, which more often cause symptoms. While bacteria predominate during summer and in those exposed to livestock, viruses predominate in wintertime and, like G. lamblia, are widespread amongst day-care centre attendees.
Collapse
Affiliation(s)
- M Heusinkveld
- Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - L Mughini-Gras
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. .,Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, The Netherlands.
| | - R Pijnacker
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - H Vennema
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - R Scholts
- Certe Laboratory for Infectious Diseases, Groningen, The Netherlands
| | | | - T Kortbeek
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - M Kooistra-Smid
- Certe Laboratory for Infectious Diseases, Groningen, The Netherlands.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W van Pelt
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| |
Collapse
|
3
|
Gabor-Harosa FM, Stan OP, Daina L, Mocean F. Proposed model for a Romanian register of chronic diseases in children. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 130:198-204. [PMID: 27208534 DOI: 10.1016/j.cmpb.2016.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/06/2016] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of chronic diseases at children is increasing due to the progress made in medicine, which radically changed the evolution and the prognostics. Disease registers became important tools to register and monitor the chronic patients in order to asses their needs and improve their care. Disease registers are also very important for adjusting to population needs the actions in the public health field. The main objective for this research is to develop a model for a chronic disease register of children in Romania, taking into account the current situation of chronic diseases' registration and reporting, the specific requirements for such medical database and the particularities of the information systems in the Romanian healthcare system. METHODS Our study was based on interviews with specialists and Health Ministry representatives, field observations, and analysis of published and unpublished data). RESULTS We developed a platform for a chronic diseases register of children based on open EHR specifications and architecture, which respects the requirements for data security and the particularities of Romania's healthcare system. The model created is functioning on two levels. The first one is local and corresponds to a medical unit, while the second one represents the connection and the communication method within the entire national medical system. In order to achieve the highest level of interoperability at the semantic level, we used, for the communication module of a National Disease Register system, only EN 13606 or HL7 v3 and / or HL7 v3 CDA. CONCLUSIONS This model is functional and can be applied initially at a clinical level for medical and administrative purposes. Its design allows a future development, integrated with the current informational systems and implemented at regional and national level. This will significantly improve the knowledge that may support good medical practice in this field, will enhance the coherence of data collection and, as a consequence, will impact positevely on the health of children diagnosed with chronic diseases.
Collapse
Affiliation(s)
- Florina Maria Gabor-Harosa
- University of Medicine and Pharmacy "Iuliu Hatieganu", Community Medicine Department, Public Health Discipline, Avram Iancu no. 31, Cluj-Napoca, Romania.
| | - Ovidiu Petru Stan
- Technical University, Faculty of Automation and Computer Science, Department of Automation, George Baritiu no. 26-28, Cluj-Napoca, Romania.
| | - Lucia Daina
- Oradea University, Faculty of Medicine and Pharmacy, 1 Decembrie Square no. 10, Oradea, Romania.
| | - Floarea Mocean
- University of Medicine and Pharmacy "Iuliu Hatieganu", Community Medicine Department, Public Health Discipline, Avram Iancu no. 31, Cluj-Napoca, Romania.
| |
Collapse
|
4
|
Rudant J, Lightfoot T, Urayama KY, Petridou E, Dockerty JD, Magnani C, Milne E, Spector LG, Ashton LJ, Dessypris N, Kang AY, Miller M, Rondelli R, Simpson J, Stiakaki E, Orsi L, Roman E, Metayer C, Infante-Rivard C, Clavel J. Childhood acute lymphoblastic leukemia and indicators of early immune stimulation: a Childhood Leukemia International Consortium study. Am J Epidemiol 2015; 181:549-62. [PMID: 25731888 DOI: 10.1093/aje/kwu298] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/29/2014] [Indexed: 01/04/2023] Open
Abstract
The associations between childhood acute lymphoblastic leukemia (ALL) and several proxies of early stimulation of the immune system, that is, day-care center attendance, birth order, maternally reported common infections in infancy, and breastfeeding, were investigated by using data from 11 case-control studies participating in the Childhood Leukemia International Consortium (enrollment period: 1980-2010). The sample included 7,399 ALL cases and 11,181 controls aged 2-14 years. The data were collected by questionnaires administered to the parents. Pooled odds ratios and 95% confidence intervals were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Day-care center attendance in the first year of life was associated with a reduced risk of ALL (odds ratio = 0.77, 95% confidence interval: 0.71, 0.84), with a marked inverse trend with earlier age at start (P < 0.0001). An inverse association was also observed with breastfeeding duration of 6 months or more (odds ratio = 0.86, 95% confidence interval: 0.79, 0.94). No significant relationship with a history of common infections in infancy was observed even though the odds ratio was less than 1 for more than 3 infections. The findings of this large pooled analysis reinforce the hypothesis that day-care center attendance in infancy and prolonged breastfeeding are associated with a decreased risk of ALL.
Collapse
|
5
|
Ajrouche R, Rudant J, Orsi L, Petit A, Baruchel A, Lambilliotte A, Gambart M, Michel G, Bertrand Y, Ducassou S, Gandemer V, Paillard C, Saumet L, Blin N, Hémon D, Clavel J. Childhood acute lymphoblastic leukaemia and indicators of early immune stimulation: the Estelle study (SFCE). Br J Cancer 2015; 112:1017-26. [PMID: 25675150 PMCID: PMC4366894 DOI: 10.1038/bjc.2015.53] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/04/2015] [Accepted: 01/12/2015] [Indexed: 11/29/2022] Open
Abstract
Background: Factors related to early stimulation of the immune system (breastfeeding, proxies for exposure to infectious agents, normal delivery, and exposure to animals in early life) have been suggested to decrease the risk of childhood acute lymphoblastic leukaemia (ALL). Methods: The national registry-based case–control study, ESTELLE, was carried out in France in 2010–2011. Population controls were frequency matched with cases on age and gender. The participation rates were 93% for cases and 86% for controls. Data were obtained from structured telephone questionnaires administered to mothers. Odds ratios (OR) were estimated using unconditional regression models adjusted for age, gender, and potential confounders. Results: In all, 617 ALL and 1225 controls aged ⩾1 year were included. Inverse associations between ALL and early common infections (OR=0.8, 95% confidence interval (CI): 0.6, 1.0), non-first born (⩾3 vs 1; OR=0.7, 95% CI: 0.5, 1.0), attendance of a day-care centre before age 1 year (OR=0.7, 95% CI: 0.5, 1.0), breastfeeding (OR=0.8, 95% CI: 0.7, 1.0), and regular contact with pets (OR=0.8, 95% CI: 0.7, 1.0) in infancy were observed. Conclusions: The results support the hypothesis that conditions promoting the maturation of the immune system in infancy have a protective role with respect to ALL.
Collapse
Affiliation(s)
- R Ajrouche
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Sud University, Le Kremlin Bicêtre, France
| | - J Rudant
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France [3] RNHE-National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| | - L Orsi
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France
| | - A Petit
- 1] AP-HP, Hôpital Armand Trousseau, Paris, France [2] Université Paris 6 Pierre et Marie Curie, Paris, France
| | - A Baruchel
- 1] AP-HP, Hôpital Robert Debré, Paris, France [2] Université Paris 7, Paris, France
| | | | - M Gambart
- Hôpital des Enfants, Toulouse, France
| | - G Michel
- AP-HM, Hôpital la Timone, Marseille, France
| | - Y Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - S Ducassou
- Hôpital Pellegrin Tripode, Bordeaux, France
| | | | - C Paillard
- Hôpital de Hautepierre, Strasbourg, France
| | - L Saumet
- Hôpital Arnaud de Villeneuve, Montpellier, France
| | - N Blin
- Hôpital Mère-Enfant, CHU-Nantes, Nantes, France
| | - D Hémon
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France
| | - J Clavel
- 1] Epidemiology of childhood and adolescent cancers, CRESS, INSERM U1153, Villejuif, France [2] Paris-Descartes University, Paris, France [3] RNHE-National Registry of Childhood Hematopoietic Malignancies, Villejuif, France
| |
Collapse
|
6
|
af Sandeberg M, Wettergren L, Björk O, Arvidson J, Johansson E. Does school attendance during initial cancer treatment in childhood increase the risk of infection? Pediatr Blood Cancer 2013; 60:1307-12. [PMID: 23596132 DOI: 10.1002/pbc.24510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 02/04/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study aimed to investigate the relationship between school attendance and infection requiring antimicrobial treatment in children undergoing treatment for cancer. PROCEDURE A national cohort of children aged 7-16 years undergoing cancer treatment was assessed during two observation periods of 19 days each, 1 month (n = 89) and 2.5 months (n = 89) poststart of treatment. Children free from infection at start of each observation period were included. Multivariable logistic regression analyses were performed including factors potentially associated with start of antimicrobial treatment. RESULTS Twenty-seven (30%) children started antimicrobial treatment during the first observation period. Factors associated with an increased risk of starting antimicrobial treatment were diagnosed with sarcoma (OR = 24.37, P = 0.002) or non-Hodgkin lymphoma (OR = 17.57, P = 0.025), having neutropenia (OR = 5.92, P = 0.020) and age less than 13 years (OR = 8.54, P = 0.014). During the second observation period, when 20 (22%) children started antimicrobial treatment, the probability of starting treatment was increased in children with neutropenia (OR = 4.25, P = 0.007). There was no statistically significant association between starting treatment for infection and school attendance. CONCLUSIONS In this study, children attending school while undergoing cancer treatment did not run a higher risk of starting antimicrobial treatment than children absent from school. However, there is a need for further studies evaluating risk of infections in children with ongoing cancer treatment.
Collapse
Affiliation(s)
- Margareta af Sandeberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
7
|
Enserink R, Noel H, Friesema IHM, de Jager CM, Kooistra-Smid AMD, Kortbeek LM, Duizer E, van der Sande MAB, Smit HA, Pelt WV. The KIzSS network, a sentinel surveillance system for infectious diseases in day care centers: study protocol. BMC Infect Dis 2012; 12:259. [PMID: 23066727 PMCID: PMC3561242 DOI: 10.1186/1471-2334-12-259] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/02/2012] [Indexed: 11/17/2022] Open
Abstract
Background Day care-associated infectious diseases are widely recognized as a public health problem but rarely studied. Insights into their dynamics and their association with the day care setting are important for effective decision making in management of infectious disease control. This paper describes the purpose, design and potential of our national multi-center, day care-based sentinel surveillance network for infectious diseases (the KIzSS network). The aim of the KIzSS network is to acquire a long-term insight into the syndromic and microbiological aspects of day care-related infectious diseases and associated disease burden and to model these aspects with day care setting characteristics. Methods/design The KIzSS network applies a prospective cohort design, following day care centers rather than individual children or staff members over time. Data on infectious disease symptoms and related morbidity (children and staff), medical consumption, absenteeism and circulating enteric pathogens (children) are collected on a daily, weekly or monthly basis. Every two years, a survey is performed to assess the characteristics of participating day care centers. Discussion The KIzSS network offers a unique potential to study infectious disease dynamics in the day care setting over a sustained period of time. The created (bio)databases will help us to assess day care-related disease burden of infectious diseases among attending children and staff and their relation with the day care setting. This will support the much needed development of evidence-based and pragmatic guidelines for infectious disease control in day care centers.
Collapse
Affiliation(s)
- Remko Enserink
- Center for Infectious Disease Control Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment RIVM, Bilthoven, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|