13 million children under 5 years of age use child care services. National Center for Health Statistics, 2010
90 percent of families with preschool children use child care services. National Commission on Children, 2010
TYPES OF DAY CARE SETTINGS Small family child-care home 6 children licensing not required Large family child-care home 7-12 children variable licensing requirements Centers 13 children Licensed Facilities for ill children Facilities for children with special needs APHA/AAP Out-of-Home Child Care Guidelines, 1992.
HIGH RISK PERSONNEL Susceptible to childhood infections (measles, mumps, chickenpox, etc.) Immunocompromised asplenia cancer transplantation HIV Pregnant women Grossman Ed 8, Infection Control in the Child Care Center, Demos Medical Publisher, 2012
HIGH RISK CHILDREN Risk Factors: Infancy Immunocompromised Chronic lung disease Cardiac disease Physical handicaps Chronic skin disease Grossman, Ed 8, Infection Control in the Child Care Center, Demos Medical Publisher, 2012.
HIGH RISK CHILDREN FOR SPREADING INFECTION Children living in impoverished conditions multiple care givers transient “family” or shelter poor sanitary conditions untreated infections in the home Children from developing nations Children with immune deficiencies Children with chronic infections
DAY CARE FACTORS THAT INCREASE TRANSMISSION OF PATHOGENS Large numbers of children in close contact Infants and toddlers have no independent personal hygiene are incontinent put everything in their mouths Children are susceptible to most infectious agents Infected children may be contagious before symptomatic Parvovirus B19 Varicella Infected children may be asymptomatic Giardia Hepatitis A
INCUBATION PERIOD 10 to 21 days INFECTIOUS PERIOD Until lesions are crusted
DIAGNOSIS Clinical Viral culture Serology THERAPY Acyclovir for high risk individuals
PREVENTION Vaccine Airborne and Contact precautions VZIG in high risk exposed children Post-exposure vaccination of susceptible children and adults
CHILD CARE EXCLUSION Infected children can return when lesions are crusted (approximately 5 to 7 days)
RECOMMENDATIONS FOR OTHER CHILDREN VZIG for high risk exposed children Varicella vaccine RECOMMENDATIONS FOR PERSONNEL Varicella vaccine for susceptible adults
THEORETIC CONCERNS Increased Varicella in Older Children and Adults who have: Never received the vaccine Have waning immunity Have less booster exposures to VZV later varicella disease herpes zoster
EPIDEMIOLOGY Source infected human Mode of spread large droplet aerosol small droplet aerosol direct and indirect contact with infected secretions
INFLUENZAE ATTRIBUTABLE MORBIDITY IN NORMAL CHILDREN LESS THAN 1YEAR OF AGE Increased Hospitalization Increased Outpatient Visits Increased Antibiotic Use Neuzil KM et al, NEJM, 2000 Izurieta HS et al, NEJM, 2000
High risk children Chronic lung disease Congenital heart disease Immunocompromised Sickle cell disease Diabetes Chronic renal failure Metabolic disease Under 2 years of age
PREVENTION Annual influenza vaccine high risk children - recommended* healthy children 6 to 23 months - encouraged* Prophylactic antiviral therapy for high risk children *Recommendations of the ACIP, MMWR, 2002
CHILD CARE EXCLUSION Until child is able to participate in child care center activities
RECOMMENDATIONS FOR OTHER CHILDREN Avoid aspirin during influenza season Annual influenza vaccine RECOMMENDATIONS FOR PERSONNEL Annual influenza vaccine
ENTRANCE REQUIREMENTS FOR CHILDREN Medical history Immunizations Diphtheria-Pertussis-Tetanus Hemophilus influenza B Hepatitis A Hepatitis B Influenza Mumps Polio Rubella Rubeola Varicella Pneumococcus
ENTRANCE REQUIREMENTS FOR STAFF Medical history Immunizations Diphtheria-Tetanus Hepatitis A Hepatitis B Influenza Mumps Polio Rubella Rubeola Varicella (Pertussis)
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