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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 55
(Also see disease-specific chapters in Section 3.)
Enteric DiseasesRespiratory Tract Diseases
Other Conditions
Bloodborne Virus Infections
Immunizations
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ENTERIC DISEASES
The close personal contact and suboptimal 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 intestinalis, Cryptosporidium species, and hepatitis A virus (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.
Human-animal contact involving family and classroom pets, animal displays, and petting zoos expose children to pathogens harbored by these animals. Most reptiles and many rodents (eg, hamsters, mice, rats) are colonized with Salmonella organisms, lymphocytic choriomeningitis virus, and other viruses that may be transmitted to children via contact (see Diseases Transmitted by Animals [Zoonoses]: Household Pets, Including Nontraditional Pets, and Exposure to Animals in Public Settings, p 198). Optimal hand hygiene is essential to prevent transmission of zoonoses in the child care setting.
Young children who are not toilet trained have an increased frequency of diarrhea and of HAV infection. Fecal contamination of the environment is common in child care programs and is highest in infant and toddler areas, especially among partially toilet trained attendees. 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 assist with toilet use and diaper-changing activities also prepare or serve food. Several enteric pathogens, including rotaviruses, HAV, G intestinalis
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