Risk factors for gastroenteritis in child day care

Area of Science:

• Epidemiology
• Public Health
• Infectious Disease Control

Background:

• Child day-care centres (DCCs) are recognized settings for gastroenteritis (GE) transmission.
• The complex interplay of factors within DCCs influences GE epidemiology.
• Previous research has not fully elucidated DCC-level risk factors for GE and enteropathogen prevalence.

Purpose of the Study:

• To identify specific risk factors at the DCC level that contribute to gastroenteritis (GE) incidence.
• To determine DCC-level factors associated with the occurrence of major enteropathogens.
• To inform targeted interventions for reducing GE burden in child day-care settings.

Main Methods:

• Syndromic and microbiological surveillance in 100 and 43 DCCs from 2010-2013.
• Mixed-effects negative binomial/Poisson regression models to analyze weekly GE incidence and enteropathogen prevalence.
• Analysis of 1829 GE episodes and 5197 faecal samples from 1600 children.

Main Results:

• Identified risk factors: large DCC capacity, crowding, presence of animals, nappy changing areas, sandpits, paddling pools, improper cleaning of potties and vomit, staff mixing between groups, and multiple staff duties.
• Protective factors: chlorine disinfection, proper vomit cleaning, daily cleaning of linens/toys, and exclusion policies for ill individuals.
• Significant association between specific environmental and operational factors and GE/enteropathogen occurrence.

Conclusions:

• DCC environmental and operational factors significantly influence GE and enteropathogen epidemiology.
• Targeting identified risk factors, such as improving hygiene and implementing exclusion policies, can reduce GE burden.
• This study provides evidence-based recommendations for enhancing infection control in DCCs.