TABLE 3.1.
Association of Infectious Diseases With Group Childcare Settings
| Disease or Infection | Risk Factors and Association With Outbreaks |
|---|---|
| Enteric | Close person-to-person contact, fecal-oral contact, suboptimal hand hygiene and food preparation practices |
| Viral | |
| Rotaviruses, enteric adenoviruses, astroviruses, noroviruses, hepatitis A virus (HAV) | Commonly associated with outbreaks; HAV and rotavirus vaccine preventable |
| Bacterial | |
| Shigella spp., Escherichia coli O157:H7 | Commonly associated with outbreaks |
| Campylobacter spp., Salmonella spp., Clostridium difficile | Less commonly associated with outbreaks |
| Parasitic | |
| Giardia intestinalis | Commonly associated with outbreaks |
| Cryptosporidium parvum | |
| Respiratory tract (acute upper and lower respiratory tract infections and invasive disease) | Aerosolization and respiratory droplets, person-to-person contact, suboptimal hand hygiene |
| Bacterial | |
| Haemophilus influenzae type b (Hib) | Few outbreaks; vaccine preventable |
| Streptococcus pneumoniae | Few outbreaks; vaccine preventable; invasive S. pneumoniae caused by serotypes not in vaccine |
| Group A streptococcus | Few outbreaks and low risk of secondary cases |
| Neisseria meningitidis | Few outbreaks; some serogroups vaccine preventable |
| Bordetella pertussis | Increasingly associated with outbreaks in childcare centers and schools; vaccine preventable |
| Mycobacterium tuberculosis | Occasional outbreaks, usually as a result of contact with an infectious adult care provider |
| Kingella kingae | Outbreaks rare; oropharynx usual habitat; usually manifest as arthritis and osteomyelitis |
| Viral | |
| Rhinoviruses, parainfluenza, influenza, respiratory syncytial virus (RSV), respiratory adenoviruses, influenza, metapneumoviruses, bocavirus | Disease usually caused by same organisms circulating in the community; influenza vaccine preventable in children ≥6 months of age |
| Multiple organ systems | |
| Cytomegalovirus | Prevalent; asymptomatic excretion with transmission from children to providers |
| Parvovirus B19 | Outbreaks reported; risk to susceptible pregnant women and immunocompromised |
| Varicella-zoster virus (VZV) | Outbreaks in childcare centers occur; vaccine preventable in children ≥12 months of age; zoster lesions present low risk of infection |
| Herpes simplex virus (HSV) | Low risk of transmission from active lesions and oral secretions |
| Hepatitis B virus | Rarely occurs in childcare centers; vaccine preventable |
| Hepatitis C virus | No documented cases of transmission in the childcare setting |
| Human immunodeficiency virus (HIV) | No documented cases of transmission in the childcare setting |
| Skin | Close person-to-person contact |
| Staphylococcal and streptococcal impetigo | Transmission increased by close person-to-person contact with lesions; outbreaks less likely with decreased incidence of varicella infections; methicillin-resistant Staphylococcus aureus (MRSA) infection common |
| Scabies | Outbreaks in group childcare reported |
| Pediculosis | Common in children attending group childcare |
| Ringworm | Tinea corporis and tinea capitis outbreaks associated with childcare |
| Conjunctiva | Outbreaks in group childcare reported with both bacterial and viral causes |