Infectious diseases in schools and child care facilities.

Abstract

1. Joan Robinson, MD* 1. 2. *Clinical Associate Professor, Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Objectives After completing this article, readers should be able to: 1. Compare the incidence of infections between preschool children who attend child care centers and those who are cared for in their own homes. 2. Delineate illness exclusion criteria for children attending a child care facility. 3. Describe the potential relationship between cytomegalovirus infection among children cared for in a child care facility and congenital cytomegalovirus infection. 4. Determine when transmission of human immunodeficiency virus or hepatitis C may be a problem in child care facilities or schools. Management of infectious diseases in schools and child care centers is becoming increasingly complex. The emergence of penicillin-resistant pneumococci (PRP) means that oral antibiotic treatment of common bacterial infections acquired in schools or child care facilities may be less successful in the future. The etiology of many rashes, fevers, and respiratory tract diseases now can be determined with relatively noninvasive procedures. If other children attending the same school or child care center have the same diagnosis, it is evident that a child probably acquired an infection such as parvovirus, influenza, or respiratory syncytial virus (RSV) in these facilities. Accordingly, issues related to infection control in these settings are of greater interest to parents and staff than in the past. Furthermore, because of immunization programs, serious infections are now less common in children, which has made parents less tolerant of their children acquiring these infections outside the home. Until the 1960s, the vast majority of preschool children were cared for in their own homes, initially entering a group setting at age 5 or 6 years, when they started school. Now, most preschoolers are exposed to large numbers of other children in a closed setting several days per week when they enter a child care facility. Child care facilities for preschoolers can be: