INFECTION CONTROL CHALLENGES IN CHILD-CARE CENTERS

Current social and economic factors have resulted in increasing numbers of children attending child-care facilities outside of the home. In the United States over 13 million children less than 5 years of age and 60% of children less than 13 years of age are enrolled in some form of out-of-home child care.85, 108 Children attending out-of-home care settings are at increased risk for a variety of infections.25, 62, 79, 88 The incidence of respiratory tract infections, diarrheal disease, cytomegalovirus, hepatitis A, and bacterial meningitis is higher in children cared for outside of the home.54, 88 Increased rates of infections result in increased morbidity of children attending child-care facilities and significant economic impact because of loss of work and cost of medical care. These costs have been estimated at 1.8 billion dollars per year in the United States.(47) Parents of children attending child-care facilities miss from 1 to 4 weeks of work per year caring for ill children.(28) Increased risk for infections in child-care settings is of public health significance because of potential transmission to adult contacts and dissemination into the community.(88) Infections acquired in child-care settings that are mild or asymptomatic in children may be severe in adults.(85)