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Section 2. Recommendations for Care of Children in Special Circumstances
CHILDREN IN OUT-OF-HOME CHILD CARE
Infectious Diseases—Epidemiology and Control 1
(See also disease-specific chapters in Section 3.)
ENTERIC DISEASESThe close personal contact and poor hygiene of young children provide ready opportunities for spread of enteric bacteria, viruses, and parasites in child care settings. Enteric pathogens transmitted by the person-to-person route, such as rotaviruses, enteric adenoviruses, astroviruses, noroviruses, Shigella species, E coli O157:H7, Giardia lamblia, Cryptosporidium parvum, and HAV have been the principal organisms implicated in outbreaks. Salmonella species, Clostridium difficile, and Campylobacter species infrequently have been associated with outbreaks of disease in children in child care. Most reptiles and rodents carry Salmonella organisms, and small reptiles and rodents (eg, hampsters, mice, rats) that could be handled by children can transmit Salmonella organisms (or other bacteria) or lymphocytic choriomeningitis (or other viruses) to children.
There is an increased frequency of diarrhea and of HAV infection in young children who are not toilet trained. Fecal contamination of the environment is common in child care programs and is highest in infant and toddler areas. Enteropathogens are spread by the fecal-oral route, either directly by person-to-person transmission or indirectly via fomites, environmental surfaces, and food. The risk of food contamination can be increased when staff members who care for diapered children also prepare or serve food. Several enteric pathogens, including rotaviruses, HAV, G lamblia cysts, and C parvum oocysts, survive on environmental surfaces for periods ranging from hours to weeks.
Child care programs can be a major source of HAV spread within the community. Hepatitis A virus infection differs from most other diseases in child care centers, because symptomatic illness occurs primarily among adult contacts of infected asymptomatic children. To recognize outbreaks and initiate
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