Children Attending Day Care Centers Research Articles

Trend change of nasopharyngeal colonization with Streptococcus pneumoniae and non-typeable Haemophilus influenzae in children attending daycare centres: nationwide population-based study, South Korea 2014 and 2019

Nasopharyngeal (NP) colonization with Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) is common in children, and may evolve as the source of invasive infections. In Korea, the pneumococcal conjugate vaccines (PCVs) were introduced >10 years ago, enabling the authors to study the effect of the vaccine in preventing carriage. NP swabs were taken and a household survey was conducted at daycare centres located in different regions of Korea in 2014 and 2019. Pneumococcal serotypes were identified using the Quellung method and sequencing. NTHi were identified based on pilA and bexA genes. In total, 1460 NP swabs were obtained with pneumococcal carriage rates of 36.4-42.1% and NTHi carriage rates of 36.5-26.7%. Among children carrying pneumococci, a significant increase was seen in serotype 23A between 2014 and 2019 (from 12.6% to 22.0%; P=0.005). Children who had received PCV were at lower risk of vaccine-type carriage (2.9% vs 0.8%; P=0.005). Between 2014 and 2019, the proportion of children carrying serotype 23A increased significantly, while the carriage rate of NTHi decreased. Continuous surveillance is needed to assess the long-term effects of the PCVs on carriage dynamics of pneumococcus and NTHi.

Epidemiological and Molecular Characterization of Blastocystis Infection in Children Attending Daycare Centers in Medellín, Colombia.

Simple SummaryBlastocystis infection affects more than 1000 million people globally. Its frequency varies depending on sociodemographic conditions, hygienic habits, provision of public services, and predisposing factors for contracting the infection, considering the child population as the most affected in developing countries. The lack of studies on this protozoan prevents the understanding of its transmission dynamics and its implications for the population’s health. For this protozoan, the diagnosis is based on microscopic reporting by conventional techniques; and subtype identification, which vary depending on the epidemiological distribution, host, and symptoms. In our study, we describe its epidemiological and molecular characterization in a child population. Additionally, we compare the diagnosis methods of Blastocystis; our research identified a better sensitivity with molecular methods and a great diversity of alleles and subtypes in this population.Background: The present study aims to perform an epidemiological and molecular characterization of Blastocystis infection in a child population attending daycare centers of Medellín, Colombia. Methods: A total of 265 children aged 0–5 years were enrolled in five children’s centers in urban sectors of Medellín, northwestern Colombia. Stool samples were taken to identify intestinal parasites by direct examination, Ritchie–Frick concentration, and molecular identification of Blastocystis by conventional PCR and subtype (ST) identification by PCR barcoding with subsequent phylogenetic reconstruction. Kappa index was calculated to evaluate the agreement between microscopy and PCR for the diagnosis of Blastocystis. Results: The prevalence of intestinal protozoa was 36.6% (97/265), with Blastocystis as the most frequent parasitic protozoan at 15.8% (42/265), followed by Giardia intestinalis at 15.5% (41/265) and Endolimax nana at 15.1% (40/265). The prevalence of Blastocystis by PCR was 53.2% (141/265), the subtypes identified were ST3 at 30.5% (18/59), ST2 at 23.7% (14/59), ST1 at 20.3% (12/59), and with less frequency, ST4 at 5.1% (3/59), ST6 at 1.7% (1/59) and ST16 at 15.3% (9/59) allele 162. Conclusion: This study provides the first genetic characterization of Blastocystis subtypes circulating in a population of Medellín, Colombia, and also updates the epidemiology of Blastocystis subtypes in the world with the first identification of ST16 in humans.

Paediatric antibiotic prescriptions in primary care in the Alpes-Maritimes area of southeastern France between 2008 and 2013.

France has remained among the top five European countries for ambulatory antibiotic consumption since such monitoring began in 1998. Young children are major antibiotic consumers, in spite of the viral origin of most infections in this population. Recommendations were updated in 2011 to limit prescriptions. In order to assess their impact, diagnoses and prescriptions were compared in a population of children attending daycare centres in southeastern France in 2008 and 2012. Trends in the reimbursement of paediatric antibiotic prescriptions by the national health insurance (NHI) for the whole area were also studied. Distribution of diagnoses accounting for antibiotic treatment and type of antibiotic prescribed over the previous 3months to children below 4years of age attending daycare centres in the Alpes-Maritimes area in southeastern France were compared between 2008 and 2012 prior to and following the availability of these new recommendations. Trends in reimbursed ambulatory antibiotic prescriptions by general practitioners and paediatricians in the area were studied for this age group from 2008 to 2012 and in 2013. The majority of recorded diagnoses concerned upper respiratory tract infections (URTI). Inappropriate antibiotic prescription persisted for colds and bronchitis in similar proportions during both surveys. Improvement in the choice of antibiotic with fewer prescriptions for third-generation cephalosporins was observed both in daycare centres and according to NHI data; however, this was mainly recorded among paediatricians. The management of paediatric URTI still needs improvement, pointing to the need to investigate and adequately address the reasons for inappropriate antibiotic prescription.

Giardiasis in daycare centers at Rancabali tea plantation, Bandung District, Indonesia

Background In developing countries, the prevalence of giardia-sis in daycare centers is considerably high. There had been inad-equate report of giardiasis in Indonesia.Objective To know the prevalence of giardiasis in children andthe number of children with symptomatic and asymptomatic giar-diasis who attended daycare centers at Rancabali tea plantation,Bandung district.Methods This descriptive study was conducted in daycare cen-ters between August to October 2002. Giardiasis was defined asthe occurrence of G. lamblia cyst in stool specimen independentfrom the presence or absence of symptoms. Four of 12 daycarecenters were chosen by cluster random sampling. All children aged1 to 60 months attending daycare and staying for at least 2 weekswere included in this study. Three consecutive stool specimen pre-served by 10% formalin, concentrated by formalin ether, were ex-amined microscopically to find the G. lamblia cyst.Results Giardia lamblia cysts were found in 27 (29%) of the 92children attending the daycare centers at Rancabali tea plantation(95%CI 20;38.6%). Of these children, 15 showed symptoms suchas diarrhea episodes (8 children), diarrhea (5 children), bloating (5children), abdominal cramp (5 children), and vomiting (3 children).Three children showed mild to moderate malnutrition. Ten childrenaged 13 to 36 month-old with G. lamblia-positive stool showed suchsymptoms.Conclusion The prevalence of G. lamblia infection in children at-tending daycare centers at Rancabali tea plantation was almostsimilar with other place in developing countries. More than half ofpatients had symptomatic disease

Xylitol for preventing acute otitis media in children up to 12 years of age.

Acute otitis media (AOM) is the most common bacterial infection among young children in the United States. There are limitations and concerns over its treatment with antibiotics and surgery and so effective preventative measures are attractive. A potential preventative measure is xylitol, a natural sugar substitute that reduces the risk of dental decay. Xylitol can reduce the adherence of Streptococcus pneumoniae (S pneumoniae)andHaemophilus influenzae (H influenzae) to nasopharyngeal cells in vitro. This is an update of a review first published in 2011. To assess the efficacy and safety of xylitol to prevent AOM in children aged up to 12 years. We searched CENTRAL (to Issue 12, 2015), MEDLINE (1950 to January 2016), Embase (1974 to January 2016), CINAHL (1981 to January 2016), LILACS (1982 to January 2016), Web of Science (2011 to January 2016) and International Pharmaceutical Abstracts (2000 to January 2016). Randomised controlled trials (RCTs) or quasi-RCTs of children aged 12 years or younger where xylitol supplementation was compared with placebo or no treatment to prevent AOM. Two review authors independently selected trials from search results, assessed and rated study quality and extracted relevant data for inclusion in the review. We contacted trial authors to request missing data. We noted data on any adverse events of xylitol. We extracted data on relevant outcomes and estimated the effect size by calculating risk ratio (RR), risk difference (RD) and associated 95% confidence intervals (CI). We identified five clinical trials that involved 3405 children for inclusion. For this 2016 update, we identified one new trial for inclusion. This trial was systematically reviewed but due to several sources of heterogeneity, was not included in the meta-analysis. The remaining four trials were of adequate methodological quality. In three RCTs that involved a total of 1826 healthy Finnish children attending daycare, there is moderate quality evidence that xylitol (in any form) can reduce the risk of AOM from 30% to around 22% compared with the control group (RR 0.75, 95% CI 0.65 to 0.88). Among the reasons for dropouts, there were no significant differences in abdominal discomfort and rash between the xylitol and the control groups. Xylitol was not effective in reducing AOM among healthy children during a respiratory infection (RR 1.13, 95% CI 0.83 to 1.53; moderate quality evidence) or among otitis-prone healthy children (RR 0.90, 95% CI 0.67 to 1.21; low-quality evidence). There is moderate quality evidence showing that the prophylactic administration of xylitol among healthy children attending daycare centres can reduce the occurrence of AOM. There is inconclusive evidence with regard to the efficacy of xylitol in preventing AOM among children with respiratory infection, or among otitis-prone children. The meta-analysis was limited because data came from a small number of studies, and most were from the same research group.

Improving hand hygiene compliance in child daycare centres: a randomized controlled trial.

Gastrointestinal and respiratory infections in children attending daycare centres (DCCs) are common and compliance with hand hygiene (HH) guidelines to prevent infections is generally low. An intervention was developed to increase HH compliance and reduce infections in DCCs. The objective of this paper was to evaluate the effectiveness of this intervention on HH compliance. The intervention was evaluated in a two-arm cluster randomized controlled trial in 71 DCCs in The Netherlands. Thirty-six DCCs received the intervention including: (1) HH products; (2) training about HH guidelines; (3) two team training sessions aimed at goal setting and formulating HH improvement activities; and (4) reminders and cues for action (posters/stickers). Intervention DCCs were compared to 35 control DCCs that continued usual practice. HH compliance of caregivers and children was observed at baseline and at 1, 3 and 6 months follow-up. Using multilevel logistic regression, odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for the intervention effect. Of 795 caregivers, 5042 HH opportunities for caregivers and 5606 opportunities for supervising children's HH were observed. At 1 month follow-up caregivers' compliance in intervention DCCs was 66% vs. 43% in control DCCs (OR 6·33, 95% CI 3·71-10·80), and at 6 months 59% vs. 44% (OR 4·13, 95% CI 2·33-7·32). No effect of the intervention was found on supervising children's HH (36% vs. 32%; OR 0·64, 95% CI 0·18-2·33). In conclusion, HH compliance of caregivers increased due to the intervention, therefore dissemination of the intervention can be considered.

Genotyping of Giardia duodenalis isolates in asymptomatic children attending daycare centre: evidence of high risk for anthroponotic transmission.

Giardia duodenalis is a common intestinal parasite infecting children attending daycare centres. This study aimed to verify Giardia occurrence and the genotypes of isolates infecting children aged 0-6 years and workers at a daycare centre in the state of São Paulo, Brazil. The families of children who tested positive for Giardia, were asked to provide stool samples from household members and their dogs. Samples (123 children, 14 centre employees, 44 household members, 19 children after treatment, and 20 dogs) were examined for intestinal parasites using concentration methods. DNA extracted from all samples was submitted for polymerase chain reaction (PCR) testing and the amplicons generated were used for multilocus sequence typing of beta-giardin (bg), triose phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes. Giardia was detected in 15·9% and 28·6% of the 220 samples by microscopy and PCR, respectively. Analysis of sequences retrieved from 29 isolates revealed both assemblages A (31%) and B (69%). Sub-assemblages AII, BIII and BIV were identified and the alignment of the bg, gdh and tpi sequences revealed the presence of some single nucleotide polymorphisms, especially in assemblage B sequences. The higher predominance of assemblage B and the identification of the AII type support the view that anthroponotic transmission appears to be an important route of transmission in environments that concentrate children at an age when poor hygiene practices make them more vulnerable to such infection.

Effects of Lactobacillus rhamnosus HN001 on acute respiratory infections and intestinal secretory IgA in children.

Acute respiratory infections (ARI) are one of the main health problems in children, particularly in those under 5 years of age. The aim of this study was to evaluate whether the regular intake of the probiotic Lactobacillus rhamnosus HN001 affects the frequency, severity or duration of ARI in children attending day care centers during the winter season. A double-blind, placebo-controlled trial was carried out in 398 children (1 to 5 years old) who were randomized into two groups to receive daily for 3 months either 100 mL of a product containing HN001 (1010 bacteria/day) or a control without the probiotic. ARI episodes and symptoms, absenteeism and antibiotic administration were registered. In a sub-group of children, oropharyngeal and fecal samples were obtained to detect pathogens, total Lactobacillus counts and secretory IgA, respectively. When comparing groups, neither the number nor the duration of the ARI, nor the days of absenteeism or antibiotic administration were statistically different. No differences between the groups in the detection rates of Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes in the oropharyngeal samples were observed along the study. Fecal Lactobacillus counts as well as sIgA levels increased significantly during the study in the HN001 group, compared to the control (P = 0.027 and P = 0.048, respectively). In the conditions in which this study was carried out, the regular intake of L. rhamnosus HN001 modulated the intestinal immune responses without affecting the frequency or severity of ARI in children.

A hand hygiene intervention to reduce infections in child daycare: a randomized controlled trial.

Infections are common in children attending daycare centres (DCCs). We evaluated the effect of a hand hygiene (HH) intervention for caregivers on the incidence of gastrointestinal and respiratory infections in children. The intervention was evaluated in a two-arm cluster randomized controlled trial. Thirty-six DCCs received the intervention including HH products, training sessions, and posters/stickers. Thirty-five control DCCs continued usual practice. Incidence of episodes of diarrhoea and the common cold in children was monitored by parents during 6 months. Using multilevel Poisson regression, incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were obtained. Diarrhoeal incidence was monitored in 545 children for 91 937 days. During follow-up, the incidence was 3·0 episodes per child-year in intervention DCCs vs. 3·4 in control DCCs (IRR 0·90, 95% CI 0·73-1·11). Incidence of the common cold was monitored in 541 children for 91 373 days. During follow-up, the incidence was 8·2 episodes per child-year in intervention DCCs vs. 7·4 in control DCCs (IRR 1·07, 95% CI 0·97-1·19). In this study, no evidence for an effect of the intervention was demonstrated on the incidence of episodes of diarrhoea and the common cold.

Environmental and Ventilation Assessment in Child Day Care Centers in Porto: The Envirh Project

Children attending day care centers (CDCC) have been reported to be more prone to infectious diseases when compared with those cared for at home, and are exposed to conditions that may increase the risk of allergies and asthma. Several studies revealed that consequences of poor ventilation conditions include high levels of carbon dioxide (CO2) and many other indoor pollutants commonly detected in schools. Nine child day care centers were selected randomly to participate in this study. Fifty-two classrooms were assessed for chemical, biological, physical, and allergen parameters in spring and winter seasons in these nine CDCC located in Porto, Portugal. Outdoor measurements were also conducted for comparison. Our results indicated that (i) particulate matter (PM10) median levels were above the national reference levels, both by classroom type and by season; (ii) TVOC kindergarten peak values may raise some concern; (iii) CO2 was present at high median and maximum levels during spring and winter assessment in both nurseries and kindergartens classrooms; (iv) total bacteria concentrations were 57- and 52-fold higher in the nursery and kindergarten than outdoors, respectively, for the spring season; (v) winter and spring median predicted mean vote (PMV) indices were between “neutral” (0) and “slightly cool” (≤ –1) in the thermal sensation scale for comfort situations (−2 to 2) for both types of classrooms; (vi) there were significant differences for both PMV and predicted percentage of dissatisfied (PPD) indices by season; and (vii) CO2, total bacteria, and gram-negative bacteria were associated with low airflow rates. These data will help to evaluate the effectiveness of current building operation practices in child day care centers regarding indoor air quality and respiratory health.

Pilot nutrition and physical activity intervention for preschool children attending daycare centres (JUNJI): primary and secondary outcomes.

A pilot intervention was conducted to promote physical activity and nutrition in public preschool education (near half a million children in Chile), in order to prevent obesity. To assess the primary (body fat) and secondary outcomes (physical activity and energy intake) of a nutrition and physical activity pilot intervention for preschool children, attending day care centres. A pilot intervention in six day care centres selected at random (n = 530), in 4-5 years old preschool children, Santiago, Chile intending to: provide nutritional and physical activity education to educators and health promotion activities for the family, which in turn, will affect the primary (body fat), and secondary outcomes (physical activity pattern and energy food intake) were measured in a representative subsample of 120 intervened and 145 controls children. In relation to secondary outcomes monitoring, moderate-vigorous activity was duplicated in the intervention group (+5.4% and +4.7%, respectively), in both obese and eutrophic children. Energy intake decreased in 11.7% in obese and 7.5% in eutrophic children. Dietary fat intake was reduced (-11 g in obese and -8.4 g in eutrophic children). Intervened obese children reduced body fat in 1.5%, meanwhile in control obese children, body fat increased 1.3% (p < 0.01). The pilot intervention demonstrated the feasibility to influence dietary risk factors and physical activity at the day care centres and families. Therefore, the implementation of the validated intervention program will be tested in different weather conditions, to prevent unhealthy habits in preschool children and their families.

Interventional Three-year Longitudinal Study of Melanocytic Naevus Development in Pre-school Children in Dresden, Saxony

Acquired melanocytic naevi (MN) are considered a risk factor for melanoma. Exposure to ultraviolet light (UV) is the major environmental factor for MN. UV protection is most critical in pre-school children. This 3-year interventional longitudinal study examined 395 3-year-old children attending daycare centres (DCC) in Dresden, Germany. Photo-skin type, eye and hair colour were recorded. DCC were randomly assigned to a control group and a behavioural intervention group. All children had a regular naevus check-up, including digital objective analysis with Dell'Eva-Burroni Dermoscopy Melanoma Image Processing Software (DB-MIPS) technology. Parents of children in the intervention group received additional guidance for sun-protection. The mean total MN counts of both groups at the start of the study period were 7.19 ± 4.55 (intervention) and 6.84 ± 4.63 (control), respectively. There was a significant increase in MN counts for both groups (mean 12.5 and 13.8). Subgroup analysis for skin type, eye colour, and hair colour did not demonstrate a significant influence on MN counts. The DB-MIPS integrated classifier revealed no risky lesions while analysing their patterns. Intervention did not reduce the number of newly acquired MN. MN counts in pre-school children were approximately 5 times higher than expected from previous large studies in Germany. This is the first study in pre-school children using objective digital image analysis of pigmented lesions. No atypical lesions were observed. New approaches to UV protection in pre-school children are now required.

Measuring Parental Beliefs about the Developmental Significance of Preschool Children’s Daily Activities: the Children’s Daily Activities-Parental Beliefs Scale

The study presents the Children’s Daily Activities-Parental Beliefs (CDA-PB) scale, a newly developed instrument providing parental assessment of the developmental significance of family-based, preschool children’s daily activities. These activities are considered as primary contexts for understanding children’s learning and development and parental beliefs are critical for both the organization of such activities as well as parents’ participation in them. Study informants were 383 mothers of preschool children attending daycare centres and kindergartens in the greater Athens area in Greece. Mothers completed a self-report questionnaire which included the CDA-PB and two other scales targeting at the report of the frequency of daily activities’ occurrence and mothers’ participation in them. Following a series of principal component analysis with varimax rotation the final form of the CDA-PB scale consisted of 30 items loaded on five components representing the perceived significance for certain types of activities, namely: “Household and self-care activities”, “Recurrent outings”, “Pre-academic activities”, “Play activities”, and “Home entertainment activities”. In addition, inter-correlations were revealed with the other two scales. Overall, the results are compatible with empirical evidence from different cultural settings and provide initial support for the use of this scale. Limitations of the present study and future research priorities are also addressed.

Effectiveness of Fortification of Drinking Water with Iron and Vitamin C in the Reduction of Anemia and Improvement of Nutritional Status in Children Attending Day-Care Centers in Belo Horizonte, Brazil

Because of the high prevalence of iron-deficiency anemia in Brazil, individual control measures tend to be ineffective, and fortification of foods with iron is considered the most effective method to fight anemia. To evaluate the effectiveness of fortification of drinking water with iron and vitamin C in the reduction of anemia in children in day-care centers in Belo Horizonte, Brazil. This before-and-after study evaluated 318 children aged 6 to 74 months. Identification data and data on socioeconomic variables were collected; anthropometric and biochemical measurements were performed before and after 5 months of fortification of water with 5 mg of elemental iron and 50 mg of ascorbic acid per liter. The fortified water was used for drinking and cooking at the day-care center. Wilcoxon's nonparametric test was used to evaluate the differences in continuous variables, and McNemar's test was used to compare the prevalence rates of anemia. The prevalence of anemia decreased significantly from 29.3% before fortification to 7.9% at the end of the study, with a significant increase in hemoglobin levels. Reductions in the prevalence rates of stunting and underweight were observed. Fortification of water with iron and vitamin C significantly reduced the prevalence of anemia and improved nutritional status among children attending day-care centers.

Feeding and oral hygiene habits of children attending daycare centres in Bangalore and their caretakers oral health knowledge, attitude and practices

Caretakers in day-care centers play a significant role in imparting good oral hygiene practices and also extend a working relationship with parents with regard to their children's oral health. As a result of this, caregiver's dental knowledge, attitudes, beliefs and practices affect the child's oral condition. A descriptive cross-sectional study involved caretakers working in day-care centers of Bangalore. Fifty-two day-care centers were randomly selected from the different zones of Bangalore city, from which 246 caretakers provided consent for participation. A comprehensive, closed-ended, self-administered questionnaire was employed which was designed to collect the sociodemographic details and to evaluate the oral health knowledge, attitudes, practice of caretakers. The institutional review committee approved the study. Data were entered using SPSS 13.01. Seventy-nine percent of the subjects had good knowledge of child's tooth eruption time, clinical presentation of dental caries and the role of fluoride in caries prevention. Yet, half of the subjects found routine dental examination after all the milk teeth have erupted in the oral cavity insignificant and 41% strongly agreed that dentist should be consulted only when the child has a toothache. In spite of the good knowledge, 77% preferred to use pacifier dipped in honey/sugar if the children acted troublesome. Analogous to this, 45% gave milk/juice with sugar before the child's nap time. The results of this study indicate that caretaker's attitude toward oral health care needs is far from acceptable standards to mirror any positive impact on the children.

Carriage of Haemophilus influenzae among Brazilian children attending day care centers in the era of widespread Hib vaccination

Haemophilus influenzae type b vaccine was introduced into the Immunization Program of Brazil in 1999 and no study has evaluated the impact of Hib vaccination in H. influenzae carriage so far. In June 2010, Brazil introduced the 10-valent pneumococcal nontypeable H. influenzae (NTHi) conjugate vaccine (PHiD-CV). We investigated the prevalence of encapsulated H. influenzae and NTHi isolates in nasopharyngeal samples of 1192 children attending day-care centers in Goiânia, central Brazil. H. influenzae carriage rate was 32.1% and 38.4% of them carried β-lactamase TEM-1 gene. Serotype f (4.6%) was the most frequent encapsulated isolate, type b was recovered in only 0.7% and carriage rate of NTHi was 23.3%. Recurrent acute otitis media and NTHi were independently associated with colonization by β-lactamase producing H. influenzae. Changes in frequency of H. influenzae carriage isolates should be carefully monitored to assess the impact of the PHiD-CV on NTHi carriage in young children.

Factors associated with acute respiratory illness in day care children

The aim of this study was to investigate the relationship between child characteristics, parental and environmental factors and the occurrence of acute respiratory illness (ARI) and acute otitis media (AOM) among Finnish children attending day care centres (DCCs). The study was a cross-sectional questionnaire of 594 children aged 1-6 y from 18 DCCs in Helsinki, Finland. Recurrent (> or =4 diseases/y) ARI was present in 44% of the 1-3-y-olds and 23% of the 4-6-y-olds, and recurrent AOM in 15% and 2.5%, respectively. Parent atopic disease (odds ratio (OR) 1.53, p = 0.033), mother's academic education (OR 1.77, p = 0.008) and a medium length of DCC attendance compared to a short period (OR 1.67, p = 0.049) increased, while furry pets (OR 0.44, p = 0.003) and older child age (OR 0.38, p < 0.001) reduced the risk of recurrent ARI. Recurrent ARI (OR 3.96, p = 0.008), mother's academic education (OR 5.02, p = 0.003), and a medium length of DCC attendance compared to a short period (OR 3.34, p = 0.044) increased, while partial breastfeeding > or =6 months (OR 0.20, p = 0.002) and older child age (OR 0.05, p < 0.001) reduced the risk of recurrent AOM. Parental and environmental factors had a significant impact on recurrent ARI and AOM episodes in children attending DCCs. These risk factors should be considered in future studies intending to reduce DCC infections.

The CUPDAY Study: prebiotic‐probiotic milk product in 1–3‐year‐old children attending childcare centres

The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres. The study was undertaken in a randomized controlled trial with 496 children aged 1-3 years attending 29 childcare centres in Perth, Australia. The endpoint for the study was the number of days in which children were recorded as having four or more stools. The diarrhoeal rates were analyzed by Poisson regression using 'intention to treat' (all children) and 'reduced' (children enrolled for more than 10 days) data sets. There was no difference in demographic characteristics between the case and control groups. In the 'intention to treat' analysis, a total of 41 745 child-days were included in the study. The adjusted risk ratio for those consuming the 'Cupday' milk drink was 0.82 (95% CI 0.73-0.94) for the intention to treat sample (n = 496) and 0.80 (95% CI 0.70-0.91) for the reduced sample (n = 315). The children consuming the 'Cupday' drink had a 20% reduction in the number of days experiencing four or more stools per day. A milk containing probiotics and prebiotics reduced the number of days children attending child care who had four or more stools by 20%.

O30 Carriage of quinolone-resistant Escherichia coli among healthy Israeli Arab children attending daycare centres in northern Israel

O30 Carriage of quinolone-resistant Escherichia coli among healthy Israeli Arab children attending daycare centres in northern Israel

Cytomegalovirus Excretion in Children Attending Day-Care Centers

Healthy children attending day-care centers (DCC) may excrete cytomegalovirus (CMV) frequently. Mothers of children excreting CMV are at higher risk for acquiring this infection than mothers of children not excreting CMV. Despite the increased attendance to DCC by children there is a lack of information regarding CMV infection in Mexico. Prospective determination of CMV excretion in saliva of children attending public and private DCC. Three saliva samples were collected during a 2-month follow-up period from participating children and the presence of CMV was determined by viral culture. Demographic features of children and DCC type were taken into account when comparing children with and without CMV excretion. One hundred fifty-two children participated in the study (84 from public and 68 from private DCC). Overall, 17 (11.2%) children excreted CMV during the study period. Excretion rates varied between DCC from 3.1 to 31.3%. Children from private DCC were as likely to excrete CMV as children from public DCC. There were no demographic or clinical features of children associated with viral excretion. CMV was excreted on an average of 11.2% children attending DCC. The type of DCC or other demographic features were not associated with the likelihood of CMV excretion. CMV seronegative mothers of children who attend DCC need to be aware of the possibility of CMV acquisition and transmission in DCC.