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Infectious diarrhoea in children: controlling transmission in the child care setting
1Epidemiology and International Health Unit, Macfarlane Burnet Centre for Medical Research, Fairfield, Victoria, Australia.
Insights
Preschoolers in group child care are at high risk for gastrointestinal diseases due to enteric pathogens. Poor hygiene and close contact in centers increase transmission, necessitating strict prevention measures.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Increased female workforce participation has led to a rise in group child care for preschoolers.
- Preschoolers are vulnerable to enteric pathogens, with group settings amplifying transmission risks.
- Diarrheal illness is a significant concern in child care environments.
Purpose of the Study:
- To review enteric pathogens causing diarrheal illness in children.
- To identify risk factors for pathogen transmission in formal day care settings.
- To discuss diagnostic limitations and prevention strategies for diarrheal diseases in child care.
Main Methods:
- Literature review of enteric pathogens and diarrheal illness in child care.
- Analysis of risk factors contributing to disease transmission.
- Evaluation of diagnostic testing limitations during outbreaks.
Main Results:
- Key risk factors include non-toilet-trained children, combined nappy/food duties, large enrollment, low staff ratios, and poor hygiene.
- Limited diagnostic testing often identifies only bacterial and protozoal agents, requiring cautious interpretation.
- Pathogens with prolonged carriage are frequently implicated in outbreak investigations.
Conclusions:
- Effective prevention requires robust hygiene education, emphasizing handwashing.
- Separating hygiene areas (nappy changing) from food preparation is crucial.
- Environmental disinfection and exclusion of ill individuals are vital control measures.
Abstract:
An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.