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Diarrheal illness among infants and toddlers in day care centers. I. Epidemiology and pathogens
Insights
Diarrheal illness is common in day care, with enteric pathogens found in 20% of cases. Hygiene and child-handling practices significantly impact diarrhea risk in young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal illness is a significant health concern in young children, particularly in group settings like day care centers.
- Understanding the epidemiology of infectious diarrhea in this population is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the incidence and patterns of diarrheal illness in children aged 0-36 months attending day care centers.
- To identify common enteric pathogens and risk factors associated with diarrhea in this setting.
Main Methods:
- A 2-year prospective study was conducted in 22 day care centers in Maricopa County, Arizona.
- Observed 7464 child-months, identifying sporadic and outbreak-associated diarrhea cases.
- Enteric pathogens were identified, and day care center characteristics were assessed.
Main Results:
- Enteric pathogens were identified in 20% of diarrhea episodes, with Giardia lamblia, rotavirus, and Campylobacter jejuni being most common.
- Giardia was more prevalent in toddlers and asymptomatic contacts, while rotavirus was more common in infants.
- Lower scores in hygiene and child-handling practices were associated with increased diarrhea risk.
Conclusions:
- Infectious diarrhea is prevalent in diaper-aged children in day care centers.
- Disease patterns vary by pathogen and age group (infants vs. toddlers).
- Improved hygiene and child-handling practices are critical for reducing diarrhea incidence in day care settings.
Abstract:
We conducted a 2-year prospective study of diarrheal illness in children ages 0 to 36 months in 22 day care centers in Maricopa County, Arizona. In 7464 child-months of observation, 465 sporadic cases and 170 outbreak-associated cases of diarrhea were identified. Enteric pathogens were identified in 20% of diarrhea episodes. Giardia lamblia, rotavirus, and Campylobacter jejuni were the most common pathogens. Giardia was significantly more common in toddlers than in infants and was found in 19% of asymptomatic child contacts of symptomatic infected children. Rotavirus was significantly more common in infants than in toddlers. In outbreaks, shorter duration of child enrollment was associated with illness. Comparison of day care center characteristics revealed that only a lower score in standardized observations of hygiene and child-handling practices was associated with greater risk of diarrhea. Infectious diarrhea appears to be common in diaper-age children in day care centers, but the patterns of disease differ for different pathogens and for the infant and toddler age groups.