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Public Health Considerations in Child Care Settings

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Children in out-of-home child care centers experience a higher ... Examples: head lice, impetigo, pinkeye, ringworm, some GI. Modes of Transmission. Indirect ... – PowerPoint PPT presentation

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Title: Public Health Considerations in Child Care Settings


1
Public Health Considerations in Child Care
Settings
  • Elizabeth Lowery, MPH
  • Epidemiologist
  • Rappahannock Area Health District

2
True or False
  • Children in out-of-home child care centers
    experience a higher incidence of common
    infectious diseases than children reared
    exclusively in their own home.

True!
  • 60 of employee absenteeism is attributable to
    unmet child care needs.

True!
  • Parents miss 1-4 weeks per year to care for sick
    children.

True!
3
On May 23…
  • RAHD received a physician report of meningococcal
    infection in a
  • toddler attending a day care center in Stafford
    County. The District
  • Director and District Epidemiologist coordinated
    with the day care center
  • director and the childs physicians to coordinate
    prophylaxis of the entire
  • class and family contacts.
  • Actions included
  • Arranging with a pharmacy close to the center to
    provide antibiotics for the students
  • Sending a letter home instructing parents how to
    pick up prescriptions
  • Following up on reports of similar illness in
    students for the next week
  • Notifying the hospital of the situation, to
    heighten their awareness of meningococcal
    infection

4
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5
Immunizations
  • Daily check for immunizations required for age
  • If not immunized
  • Letter from provider
  • Waiver signed by parents
  • Evidence of scheduled appointment
  • Will be excluded if VPD occurs in facility

6
Immunizations
  • Staff should have
  • TD boosters every 10 yrs
  • MMR
  • Polio
  • Chickenpox (or evidence of disease)
  • Hepatitis B

7
Hygiene hand washing
  • Upon arrival
  • Moving from one child care group to another
  • Before and after eating, handling food, feeding
    children, giving meds, playing in water shared by
    others

8
Hygiene hand washing
  • After
  • Diapering
  • Using bathroom
  • Handling bodily fluids
  • Handling uncooked food
  • Handling pets
  • Playing in sandbox
  • Cleaning or handling garbage

9
Infectious diseases documented in out-of-home
child care centers
  • Enteric Diseases
  • Shigellosis
  • Salmonellosis
  • E. coli
  • Norovirus
  • C. difficile
  • Other Diseases
  • RSV
  • Adenovirus
  • Group A Strep
  • Parvovirus B19
  • CMV
  • Staphylococcus aureus
  • Vaccine Preventable Diseases
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Pertussis
  • Haemophilus influenzae, Type B
  • Measles
  • Mumps
  • Rubella
  • Influenza
  • Chickenpox
  • Hepatitis A
  • Hepatitis B
  • Rotavirus

10
Patterns of disease occurrence
  • Infects children, child care staff, and family
    members (shigella)
  • Infection not apparent in children, but is
    present in staff and family members (hep A)
  • Infection in children but not adults or older
    siblings (HIB)
  • Infection mild in children, staff and family
    members, but poses risk to pregnant staff (CMV)

11
Modes of Transmission
  • Direct
  • Contact touching, biting, kissing
  • Projection droplet spray to eyes, nose, mouth
    while sneezing, coughing, spitting, singing,
    talking
  • Person to person - lesser extent person to object
    to person
  • Examples head lice, impetigo, pinkeye,
    ringworm, some GI

12
Modes of Transmission
  • Indirect
  • Vehicle-borne from an inanimate object to a
    person
  • Vector-borne insect carried
  • Examples some GI salmonella, Hepatitis A

13
Modes of Transmission
  • Airborne
  • particles that remain suspended for longer period
    droplet nuclei, dust
  • Examples cold, flu, pertussis (whooping
    cough), norovirus

14
Shigellosis
  • Bacteria
  • 14,000 cases reported/year in US
  • 470 reported cases in VA/year in the last 10
    years
  • Principle reservoir Humans

15
Shigellosis distribution by Age-2000
16
Shigellosis
  • Transmission mode direct-ingestion
  • Food/water
  • Person to person
  • 10 bacteria to infect
  • Incubation period 1-3 days
  • Fatality can range from 5-15 depending on strain

17
Shigellosis
  • Cases may continue to excrete Shigella organisms
    for 1-4 weeks after diarrhea ceases
  • Long-term carriage is rare

18
Shigellosis
  • When diarrhea stops, child may return to day
    care, but handwashing must be strictly monitored
    until stool cultures are negative.
  • 2 negative stools, 24 hours apart, at least 48
    hours after beginning antibiotics

19
Shigellosis- Public Health
  • Under normal conditions, poor hygiene is most
    common cause
  • Handwashing
  • Diapering hygiene

20
E. coli O157H7
  • 73,000 cases reported in US/yr
  • 70 cases reported in VA each year
  • Reportable since 1999

21
E. coli O157H7
  • E. coli found in intestines of all animals and
    humans
  • O157H7 is a type found in cattle that produces a
    toxin
  • Thought that 10 bacteria can infect

22
E. coli O157H7
  • Transmission mode direct-ingestion
  • Bloody diarrhea, stomach cramps
  • Lasts 1 week
  • Potential complications especially for children
    under 5
  • Hemolytic uremic syndrome (HUS-kidney failure)

23
E. coli O157H7
  • Single case in a day care?
  • Contact day care operator to determine if other
    children or staff have had diarrhea.
  • Handwashing guideline review
  • If possible, family to arrange for care of the
    child in an individualized setting

24
E. coli O157H7
  • If individual child care arrangements cannot be
    made, the child may return to the facility after
    diarrhea has ceased, but handwashing must be
    strictly monitored.

25
E. coli O157H7
  • Prefer to exclude until 2 negative stools
  • Because of the potential very serious
    complications of this infection, a more strict
    approach is taken, especially in an outbreak.

26
E. coli -Public Health
  • Avoiding cross contamination
  • Thoroughly cooking all foods
  • Handwashing
  • Diapering hygiene

27
Norovirus
  • Stomach flu
  • Not reportable in VA
  • 181,000 cases estimated to occur annually in the
    US
  • Humans only known reservoir

28
Norovirus
  • Clinical signs Vomiting
  • Nausea
  • Diarrhea
  • Usually self-limiting
  • Fatality rate lt1

29
Norovirus
  • Mode of transmission direct-ingestion
  • Incubation period 24-48 hours
  • Infective dose probably low
  • Incubation period 12-48 hours

30
Norovirus
  • More vomiting in children
  • More diarrhea in adults
  • Relatively mild, short duration

31
Norovirus
  • Highly infectious
  • (lt100 particles)
  • Spread via person-to-person and foodborne
  • droplets
  • fecal contamination

32
Norovirus Management
  • Hand hygiene
  • Exclusion of symptomatic children
  • Diapering hygiene

33
Meningococcal Meningitis
  • Transmission from asymptomatic carrier by
    respiratory tract droplets
  • ONE case must be acted upon immediately

34
Meningococcal Meningitis
  • Abrupt onset fever, malaise, headache, stiff
    neck, sometimes rash
  • Disease most often occurs in children lt5 yrs.
    (peak incidence in 3-5 mo.)

35
Management
  • Chemoprophylaxis of child care contacts
  • Determine if individual classroom or entire
    center requires antibiotic
  • No exclusion

36
Management
  • Arrange for bacterial isolates to be sent to DCLS
    for serogrouping
  • Consider vaccine if gt2 cases. Depends on age of
    children, serogroup

37
Haemophilus influenzae type b
  • Requirements for children to have HIB
  • Children not vaccinated are excluded if a case of
    invasive Hib is documented in center
  • Rifampin may be recommended if children in center
    are lt 2 yrs
  • Secondary cases are variable

38
Pertussis
  • Bacterial disease
  • Upper respiratory infection that leads to
    coughing
  • 6-10 week duration
  • Transmission via droplets
  • Contagious for 2 weeks after cough onset

39
Pertussis
  • Report to HD immediately!!
  • Exclude until MD exam/5 days of antibiotic
    therapy for case
  • Check vaccine status of children lt7
  • Contacts may receive vaccine, depending on
    status, and antibiotics
  • Monitor staff

40
Chickenpox
  • Period of Communicability
  • Usually 1-2 days before the rash and for 5 days
    after the first vesicles appear
  • Transmission
  • Contact Direct or indirect

41
Chickenpox
  • Rash characteristics
  • Lesions in various stages of evolution at any one
    time
  • Lesions have a tendency to be seen on head and
    trunk first and then spread

42
Chickenpox
  • Exclude for at least 5 days after rash first
    appears or until ALL lesions are dry.

43
Herpes simplex
  • Children with herpes simplex gingivostomatits who
    do not have control of oral secretions should be
    excluded from child care.
  • Child care providers with hs gingivostomatits
    must not nuzzle children, share food/drink,
    touch lessions, and must cover lesion.

44
CMV
  • CMV remains dormant over long period.
  • Shed in bodily fluids of any previously infected
    person, may be found in urine, saliva, blood,
    tears, semen, and breast milk.
  • Hygiene important!
  • Leading cause of congenital infection
  • Testing children and excluding those positive for
    CMV is not recommended. All infants and toddlers
    are assumed positive

45
Conjunctivitis
  • White part of eye becomes pink, tears and
    discharge
  • Direct contact
  • HANDWASHING

46
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47
Hand, foot and mouth disease
  • Viral illness
  • Common illness of children
  • Mild fever, poor appetite, sore throat and rash
  • Moderately contagious
  • More frequent in summer and fall

48
Hand, foot and mouth disease
  • No specific treatment
  • Hand and general hygiene
  • No specific guidelines, but may exclude during
    the first few days of illness

49
Fifth Disease
  • Parvovirus B19
  • Slapped cheek rash, mild fever
  • Mild illness

50
Fifth Disease
  • Contagious during early illness
  • Spread via direct contact with secretions
  • Control measures
  • Handwashing
  • Exclusion not thought to be helpful

51
Influenza
  • Symptoms fever, headache, cough, stuffy nose,
    muscle aches
  • Droplet spread
  • More virus shed earlier in illness
  • Children may be communicable for up to 7 days
    after onset

52
Influenza
  • Vaccination
  • Children staying home while ill
  • Emphasizing good respiratory etiquette
  • Washing hands frequently

53
Respiratory Etiquette
  • Cover your mouth and nose with a tissue when
    coughing or sneezing.
  • Cough into your sleeve.
  • Avoid touching your eyes, nose or mouth.
  • Washing your hands often and use alcohol based
    gels.

54
Lyme Disease
  • Tick bite
  • Tick must be attached 36-48 hours to transmit
    disease
  • Symptoms begin 7-10 days after tick bite
  • Rash looks like bullseye
  • Initial symptoms include rash, low grade fever,
    headache, fatigue

55
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56
STARI the Lone Star Tick
57
Dirty Hands...
58
References
  • www.cdc.gov
  • www.vdh.state.va.us
  • Office of Epidemiology
  • Control of Communicable Diseases Manual, James
    Chin, Editor, APHA publication
  • Red Book, American Academy of Pediatrics

59
Any Questions?
  • Addressing the spread of germs in schools is
    essential to the health of our youth, our schools
    and our nation.
  • Centers for Disease Control and Prevention (CDC)
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