Abstract
In Reply.— In the mid-1970s, it was recognized that the secondary attack rate of HIB infections in day-care attendees is higher than in the general population. Our study has now shown that there is also a substantial increased risk of primary HIB disease among children attending day-care facilities. In our county, this increased risk was greatest for younger day-care children, especially those who were younger than 1 year of age (12.3-fold greater risk). In their letter, Osterholm et al raise questions that may be misleading about our methods of determining the denominator from which relative risk rates were calculated. We appreciate the opportunity to clarify how we arrived at our figures for day-care attendance. We defined day care as any licensed child-care site where three or more unrelated children are supervised by a nonparent for three or more hours each day. 1 This definition includes day-care centers and family day-care
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