Infectious diseases in early education and child care programs

An Examination of Employee Immunization Policies Among Colorado Child Care Providers

BACKGROUND

Child care employee vaccination policies can protect children and adults from vaccine-preventable diseases (VPDs) in child care programs. We aimed to understand the prevalence and characteristics of employee immunization policies at child care facilities and support among child care administrators for statewide employee vaccination regulations.

METHODS

A postal mail survey was distributed to a cross-sectional sample of 300 center-based and 300 home-based child care programs in Colorado. Programs were asked to report whether they had any type of policy requiring employee immunizations and if they would support statewide regulations mandating employee immunizations for influenza, pertussis, and measles.

RESULTS

The response rate was 48% (288/600). About 55% of child care programs reported having an employee immunization policy. Child care centers (73%) were more likely than home-based child care programs (30%, P < .001) to report having a policy. Overall, 62% of respondents reported that they would support one or more statewide regulations requiring child care employees to be vaccinated. Home-based programs (71%) were more likely than center-based programs (53%, P = .001) to support one or more statewide child care employee immunization regulations.

CONCLUSIONS

Our findings demonstrate the variability of employee immunization policies at child care programs across Colorado. These results may be used to inform strategies to increase employee immunization uptake and reduce the incidence of VPDs, including developing comprehensive employee immunization policies at the facility and state level. Future research is needed to understand vaccination knowledge, attitudes, and behaviors among child care employees including their perspectives on employee vaccination policies and regulations.

A comparison of child development, growth and illness in home-care and day-care center settings

Purpose

Childcare is an essential part of early life environment that has a significant influence on lifelong physical and mental health. This study aimed to examine the relationship between development, growth and frequency of illness in different types of care.

Design/methodology/approach

This cross-sectional study recruited 177 children aged 30–36 months and their caregivers. Of these 66 were being cared for at home and 111 were attending out-of-home day-care facilities. An interview form, growth measurement and the Denver Developmental Screening Test II were collected. The association between child developmental, growth and illness variables was analyzed with Chi-square, Fisher's exact and Mann–Whitney U tests.

Findings

This study found that the development and growth results did not show statistically significant differences between the home-care and day-care groups. The number of minor illnesses was significantly lower in home-care children than in day-care children (OR = 0.33, 95% CI = 0.15-0.72).

Research limitations/implications

This study indicated that the risk of infection is increased in the children attending day care. Provision of a healthy and safe childcare environment needs to be an essential health promotion strategy to improve family and child well-being.

Originality/value

As the number of women's participation in the labor market has increased rapidly over the past decades, so did the number of children in nonparental care. The study findings reflect that the development of a day-care center for children was unclear, whereas the risk of infection was increased. Therefore, provision of a healthy and safe childcare environment needs to be an essential health promotion strategy to improve family and child well-being.

Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms

OBJECTIVE

To investigate the occurrence of infectious morbidities according to day care attendance during the first year of life.

METHODS

This was a cross-sectional analysis of data from the 12-month follow-up of a medium-sized city birth cohort from children born in 2015, in the Southern Brazil. Main exposure variables were day care attendance from 0 to 11 months of age, type of day care center (public or private), and age at entering day care. Health outcomes were classified as follows: "non-specific respiratory symptoms," "upper respiratory tract infection," "lower respiratory tract infection," "flu/cold," "diarrhea," or "no health problem," considering the two weeks prior to the interview administered at 12 months of life. Associations were assessed using Poisson regression adjusted by demographic, behavioral, and socioeconomic variables.

RESULTS

The sample included 4018 children. Day care attendance was associated with all classifications of health outcomes mentioned above, except for flu/cold. These were stronger among children who entered day care at an age closer to the outcome time-point. An example are the results for lower respiratory tract infection and diarrhea, with adjusted prevalence ratios of 2.79 (95% CI: 1.67-4.64) and 2.04 (95% CI: 1.48-2.82), respectively, for those who entered day care after 8 months of age when compared with those who never attended day care.

CONCLUSIONS

The present study consistently demonstrated the association between day care attendance and higher occurrence of infectious morbidities and symptoms at 12 months of life. Hence, measures to prevent infectious diseases should give special attention to children attending day care centers.

Communicable Disease Outbreaks in Michigan Child Care Centers Compared With State and Regional Epidemics, 2014-2017

The Michigan Child Care Related Infections Surveillance Program (MCRISP) is a novel, online illness surveillance system used by a collection of southeast Michigan child care centers. Recently established, MCRISP has not been assessed epidemiologically. We created MCRISP epidemic curves for both respiratory and gastrointestinal disease over three seasons, comparing these to data from an established statewide surveillance system. Results suggest that online child care center-based disease surveillance is timely, functional, and has potential as an early sentinel system for community epidemics.

Variation in surface decontamination practices among Michigan child care centers compared to state and national guidelines

BACKGROUND

Environmental decontamination is one of the most effective methods to prevent transmission of infectious pathogens in child care centers (CCCs). Alongside state recommendations, national organizations-including the American Academy of Pediatrics (AAP)-offer best-practice policies. In Michigan, these sets of guidelines differ, and the extent to which CCC practices agree with either set of protocols is unknown.

METHODS

A survey of environmental decontamination practices was administered at a professional meeting of CCC directors (N = 24) in a single Michigan county. CCC practices (eg, products, locations, frequencies) were compared to state and AAP guidelines. Bivariate analyses investigated CCC characteristics as predictors of decontamination policy agreement.

RESULTS

CCC agreement with established policy was slightly higher for national AAP guidelines (66%) than Michigan standards (59%). The use of an outside child care health consultant was strongly associated with a significantly higher level of agreement with state decontamination policy (P = .01).

CONCLUSION

We noted substantial disagreement between county CCC practices and state/national guidelines, regardless of CCC size or director experience. Results highlight opportunities to improve CCC director familiarity with current state and nationally advised protocols, to consolidate state licensing and AAP guidelines, and to promote the use of child care health consultants.

Gastrointestinal and respiratory illness in children that do and do not attend child day care centers: a cost-of-illness study

Background

Gastrointestinal and respiratory diseases are major causes of morbidity for young children, particularly for those children attending child day care centers (DCCs). Although both diseases are presumed to cause considerable societal costs for care and treatment of illness, the extent of these costs, and the difference of these costs between children that do and do not attend such centers, is largely unknown.

Objective

Estimate the societal costs for care and treatment of episodes of gastroenteritis (GE) and influenza-like illness (ILI) experienced by Dutch children that attend a DCC, compared to children that do not attend a DCC.

Methods

A web-based monthly survey was conducted among households with children aged 0–48 months from October 2012 to October 2013. Households filled-in a questionnaire on the incidence of GE and ILI episodes experienced by their child during the past 4 weeks, on the costs related to care and treatment of these episodes, and on DCC arrangements. Costs and incidence were adjusted for socioeconomic characteristics including education level, nationality and monthly income of parents, number of children in the household, gender and age of the child and month of survey conduct.

Results

Children attending a DCC experienced higher rates of GE (aIRR 1.4 [95%CI: 1.2–1.9]) and ILI (aIRR: 1.4 [95%CI: 1.2–1.6]) compared to children not attending a DCC. The societal costs for care and treatment of an episode of GE and ILI experienced by a DCC-attending child were estimated at €215.45 [€115.69–€315.02] and €196.32 [€161.58–€232.74] respectively, twice as high as for a non-DCC-attending child. The DCC-attributable economic burden of GE and ILI for the Netherlands was estimated at €25 million and €72 million per year.

Conclusions

Although children attending a DCC experience only slightly higher rates of GE and ILI compared to children not attending a DCC, the costs involved per episode are substantially higher.