Acute respiratory infections in day care

Incidence of acute respiratory infections in preschool children in an outpatient setting before and during Covid-19 pandemic in Lombardy Region, Italy

Introduction

The incidence of acute respiratory tract infections (ARTIs) in children is difficult to estimate because they are typically treated in outpatient settings and the majority of epidemiological data originate from hospital settings and refer to the most severe illnesses. Therefore, the incidence of ARTIs in a real-world setting remains largely unexplored. Therefore, this study aims to estimate the incidence of ARTIs, upper respiratory tract infections (URTIs), and lower respiratory tract infections (LRTIs) in children aged 0–5 years in an outpatient setting.

Methods

This prospective cohort study was conducted in Lombardy, Italy, from October 1st, 2019, to March 31st, 2021, before and during the COVID-19 pandemic that began in March 2020. Caucasian healthy children aged 0–5 years were recruited from 69 Family Pediatricians (FP) and followed-up in an outpatient setting. Data were collected whenever a child was referred to FP and ARTI was diagnosed (Covid-19 related ARTI were excluded). The primary outcome was an estimate of the incidence of ARTIs. The incidence of ARTIs in different age groups and the effect of the COVID-19 pandemic on the incidence of ARTIs were secondary outcomes.

Results

We enrolled 484 children, 249 male (51.8%), mean age of 2.39 ± 1.68 years. The mean estimated incidence of ARTIs was 12.1/100 children × 30 days (95% CIs: 9.5–12.9), with the highest value observed in infants aged 1–12 months (24.9/100 children × 30 days; 95% CIs: 17.6–28.9). The mean estimated incidence of URTIs was higher than that of LRTIs (8.3 – CIs: 7.6–8.9 vs 3.8/100 children × 30 days – CIs: 6.4–4.3, respectively). The comparison of ARTIs, which occurred in the pre-pandemic winter, to those measured during the COVID-19 pandemic, revealed an impressive 82.1% drop in the incidence rate (CIs: 77.8–85.7).

Conclusions

This study showed that infants aged 1–12 months are more likely to develop ARTIs than older children and that COVID-19 pandemic has dramatically altered the epidemiology of ARTIs in children aged 0–5 years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-022-01221-w.

Variables Associated With Shunt Failure in Children With Cerebrospinal Fluid Diverting Shunts

OBJECTIVES

We sought to identify clinical characteristics that would negatively predict shunt failure, thus potentially obviating the need for further diagnostic workup or extended periods of observation. We hypothesized that viral symptoms and a patient history of epilepsy or chronic headaches would be negative predictors of shunt failure.

METHODS

Data were retrospectively collected for children 19 years or younger with a cerebrospinal fluid diverting shunt in their medical history or problem list who underwent neuroimaging during an ED visit from March 2008 to September 2016. Patients were defined as having shunt failure if they required surgical exploration for shunt revision within 7 days of the ED visit. Descriptive statistics were used for patient demographics, current symptoms, and historical features. We conducted a logistic regression analysis to determine which characteristics were associated with the odds of shunt failure and used binary recursive partitioning to determine if there were features or a combination of features that were able to accurately classify patients without shunt failure.

RESULTS

There were 606 visits by 277 patients during this interval, 34% of whom were experiencing shunt failure. Variables found to be significantly predictive of shunt failure were revision within the prior 6 months, vomiting, personality changes, family opinion of shunt failure, and cranial nerve palsies. Viral symptoms and a history of epilepsy or chronic headaches were not predictive of shunt failure. Binary recursive partitioning identified family opinion and personality changes as predictive of shunt failure, with a sensitivity of 72.2% (95% confidence interval, 65.5%-78.2%) and specificity of 46.6% (95% confidence interval, 41.7%-51.7%).

CONCLUSIONS

Although certain clinical and historical features have modest predictive value in children with shunted hydrocephalus, these factors are insufficiently sensitive to exclude shunt failure, arguing for liberal neuroimaging and extended observation.

La prévention et le contrôle des infections au cabinet du pédiatre

La transmission d’infections au cabinet du pédiatre est une source de préoccupation croissante. Le présent document traite des voies de transmission des infections et des principes de contrôle des infections actuellement en vigueur. La prévention englobe un aménagement du cabinet et des politiques administratives appropriés, le triage, les pratiques de soins habituelles pour tous les patients (p. ex., hygiène des mains; port de gants, de masques, d’un dispositif de protection oculaire et de blouses pour certaines interventions; nettoyage, désinfection et stérilisation des surfaces et de l’équipement, y compris les jouets; technique d’asepsie pour les interventions invasives), ainsi que les précautions additionnelles en cas d’infections particulières. Les membres du personnel doivent avoir reçu les vaccins nécessaires, et ceux qui sont atteints d’une infection doivent respecter les politiques de restriction au travail.

Heterotypic Infection and Spread of Rhinovirus A, B, and C among Childcare Attendees

Background

Despite the frequency of human rhinovirus (HRV), data describing the molecular epidemiology of HRV in the community are limited. Childcare centers are optimal settings to characterize heterotypic HRV cocirculation.

Methods

HRV specimens were prospectively obtained from a cohort of childcare attendees at enrollment and weekly during respiratory illness. The 5' noncoding region sequences were used to determine HRV species (A, B, C) and genotypes.

Results

Among 225 children followed, sequence data were available for 92 HRV infections: HRV-A (n = 80; 59%) was most common, followed by HRV-C (n = 52, 39%), and HRV-B (n = 3, 2%). Forty-one genotypes were identified and cocirculation was common. Frequent spread between classrooms occurred with 2 HRV-A genotypes. Repeated detections within single illnesses were a combination of persistent (n = 7) and distinct (n = 7) genotypes. Prevalence of HRV among asymptomatic children was 41%. HRV-C was clinically similar to HRV-A and HRV-B.

Conclusions

HRV epidemiology in childcare consists of heterotypic cocirculation of genotypes with periodic spread within and among classrooms. Based on our finding of multiple genotypes evident during the course of single illnesses, the use of sequence-based HRV type determination is critical in longitudinal studies of HRV epidemiology and transmission.

Effect of Higher vs Standard Dosage of Vitamin D3 Supplementation on Bone Strength and Infection in Healthy Infants: A Randomized Clinical Trial

IMPORTANCE

Although guidelines for vitamin D supplementation in infants have been widely implemented, they are mostly based on studies focusing on prevention of rickets. The optimal dose for bone strength and infection prevention in healthy infants remains unclear.

OBJECTIVE

To determine whether daily supplementation with 1200 IU of vitamin D3 increases bone strength or decreases incidence of infections in the first 2 years of life compared with a dosage of 400 IU/d.

DESIGN, SETTING, AND PARTICIPANTS

A randomized clinical trial involving a random sample of 975 healthy term infants at a maternity hospital in Helsinki, Finland. Study recruitment occurred between January 14, 2013, and June 9, 2014, and the last follow-up was May 30, 2016. Data analysis was by the intention-to-treat principle.

INTERVENTIONS

Randomization of 489 infants to daily oral vitamin D3 supplementation of 400 IU and 486 infants to 1200 IU from age 2 weeks to 24 months.

MAIN OUTCOMES AND MEASURES

Primary outcomes were bone strength and incidence of parent-reported infections at 24 months.

RESULTS

Of the 975 infants who were randomized, 485 (49.7%) were girls and all were of Northern European ethnicity. Eight hundred twenty-three (84.4%) completed the 24-month follow-up. We found no differences between groups in bone strength measures, including bone mineral content (mean difference, 0.4 mg/mm; 95% CI, -0.8 to 1.6), mineral density (mean difference, 2.9 mg/cm3; 95% CI, -8.3 to 14.2), cross-sectional area (mean difference, -0.9 mm2; 95% CI, -5.0 to 3.2), or polar moment of inertia (mean difference, -66.0 mm4, 95% CI, -274.3 to 142.3). Incidence rates of parent-reported infections did not differ between groups (incidence rate ratio, 1.00; 95% CI, 0.93-1.06). At birth, 914 of 955 infants (95.7%) were vitamin D sufficient (ie, 25-hydroxyvitamin D [25(OH)D] concentration ≥20.03 ng/mL). At 24 months, mean 25(OH)D concentration was higher in the 1200-IU group than in the 400-IU group (mean difference, 12.50 ng/mL; 95% CI, 11.22-13.78).

CONCLUSIONS AND RELEVANCE

A vitamin D3 supplemental dose of up to 1200 IU in infants did not lead to increased bone strength or to decreased infection incidence. Daily supplementation with 400 IU vitamin D3 seems adequate in maintaining vitamin D sufficiency in children younger than 2 years.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01723852.

Towards evidence-based vitamin D supplementation in infants: vitamin D intervention in infants (VIDI) - study design and methods of a randomised controlled double-blinded intervention study

BACKGROUND

Vitamin D is important for bone mass accrual during growth. Additionally, it is considered a requirement for a multitude of processes associated with, for example, the development of immunity. Many countries apply vitamin D supplementation strategies in infants, but the guidelines are not based on scientific evidence and aim at prevention of rickets. It remains unclear whether the recommended doses are sufficient for the wide array of other effects of vitamin D. The VIDI trial performed in Finland is the first large randomised controlled study for evaluation of the effects of different vitamin D supplemental doses in infancy on: 1. bone strength 2. infections and immunity 3. allergy, atopy and asthma 4. cognitive development 5. genetic regulation of mineral homeostasis METHODS/DESIGN: VIDI, a randomised controlled double-blinded single-centre intervention study is conducted in infants from the age of 2 weeks to 24 months. Participants, recruited at Helsinki Maternity Hospital, are randomised to receive daily either 10 μg (400 IU) or 30 μg (1 200 IU) of vitamin D3 supplementation. Both groups are assessed at 6 months of age for calcium homeostasis, and at 12 and 24 months of age for parameters associated with bone strength, growth, developmental milestones, infections, immunity, atopy-related diseases, and genetic factors involved in these functions.

DISCUSSION

The study enables evaluation of short and long term effects of supplemental vitamin D on growth, immune functions and skeletal and developmental parameters in infants, and the effects of genetic factors therein. The results enable institution of evidence-based guidelines for vitamin D supplementation in infancy.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01723852 , registration date 6.11.2012.

Effect of cleaning and disinfection of toys on infectious diseases and micro-organisms in daycare nurseries

Background

The rising number of children in daycare nurseries increases opportunities for the transmission of infectious diseases. Pathogens may be transmitted directly from child to child via sneezing, coughing and touching, or indirectly via the environment. Toys are among the fomites with the highest pathogen load, but their role in disease transmission is unknown.

Aim

To determine if washing and disinfection of toys can reduce sickness absence and microbial pathogen load in the nursery environment.

Methods

Twelve nurseries (caring for 587 children) were randomized to intervention and control groups. The intervention consisted of washing and disinfection of toys and linen every two weeks for three months by a commercial cleaning company. The extent and causes of sickness absence among the children were recorded in both groups before and after introduction of the intervention. Ten sampling points in each nursery were examined for bacteria and respiratory viruses.

Results

The presence of respiratory virus DNA/RNA was widespread, but very few pathogenic bacteria were found in the environment. The intervention reduced the presence of adenovirus [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1–5.0], rhinovirus (OR 5.3, 95% CI 2.3–12.4) and respiratory syncytial virus (OR 4.1, 95% CI 1.5–11.2) compared with the control group, but the intervention had no effect on sickness absence or disease patterns in the nurseries.

Conclusion

Although cleaning and disinfection of toys every two weeks can decrease the microbial load in nurseries, it does not appear to reduce sickness absence among nursery children.

Risk factors for acute respiratory infection in the Australian community

OBJECTIVES

The objective of this study was to identify the risk factors for ARI in the Australian community.

METHODS

We used a national survey of 7578 randomly selected respondents in 2008-2009 to identify the risk factors of ARI. A case was defined as a person experiencing cold or flu with one or more symptoms of: fever, chills, sore throat, runny nose, or cough in the previous four weeks.

RESULTS

There were 19.8% (1505/7578) of respondents who reported ARI in the four weeks prior to the survey. Age was an independent risk factor for ARI, with the risk of acquiring ARI decreasing as age increased. Respondents reporting asthma (OR 1.4, 95%CI: 1.2-1.7) or having someone in their house attending childcare (OR 1.6, 95%CI: 1.2-2.1) were more likely to report ARI.

CONCLUSIONS

It is important to identify ways of interrupting transmission of ARI amongst children. Improving identification of risk factors will enable targeted interventions for this exceedingly common syndrome.

[Day-care centers: Sites of viral contact]

La répétition des épisodes infectieux chez les nourrissons placés précocement en collectivités est une évidence. Leur tropisme sur la sphère respiratoire et l’appareil digestif l’est également. Leur probable retentissement au long cours est difficile à évaluer par la rareté des études prospectives. Le risque infectieux est lié en partie au type de structure de garde, ce risque est important dans les premiers mois de fréquentation et conditionne les récidives ultérieures. Les liens de causalité entre infection virale et asthme sont complexes. Les infections virales augmentent le risque d’asthme mais le statut asthmatique augmente aussi le risque de réponses sévères à une infection virale. Alors que les infections acquises dans cet environnement sont majoritairement virales, leur répétition conduit à une utilisation excessive des antibiotiques d’où une pression de sélection microbienne et un retentissement sur le microbiome digestif voire respiratoire.

Risk factors for community-based reports of gastrointestinal, respiratory, and dermal symptoms: findings from a cohort study in Australia

Background

Although gastrointestinal (GI), respiratory, and dermal symptoms are common, few studies have conducted concurrent and comparative prospective analyses of risk factors for these 3 morbidity outcomes.

Methods

We used data from a community-based randomized controlled trial among 277 South Australian families to analyze GI (diarrhea, vomiting), respiratory (sore throat, runny nose, cough) and dermal (rash, generalized itch, dermal infection) symptoms.

Results

Log-binomial regression analysis revealed similar risks of GI (adjusted risk ratio [RR], 1.65; 95% CI, 1.05–2.58) and respiratory (RR, 1.68; 95% CI, 1.31–2.15) symptoms among childcare/kindergarten attendees. Swimming in public pools/spas in the current or previous week was associated with all 3 symptom complexes, conferring similar risk for each (RR for GI: 1.33; 95% CI, 0.99–1.77; respiratory: 1.20; 95% CI, 1.04–1.38; dermal: 1.41; 95% CI, 1.08–1.85). Pet ownership was not associated with symptoms. Household clustering of GI and respiratory symptoms was common, and clustering of respiratory symptoms correlated with number of individuals per household.

Conclusions

This simultaneous examination of risk factors for 3 health outcomes yielded new comparative data that are useful for developing prevention strategies.

Prolonged and recurrent fevers in children

Some children referred for prolonged fever are actually not having elevated temperatures; the approach here requires dissection of the history and correction of health misperceptions. Others have well-documented fevers associated with clinical, laboratory, or epidemiologic findings that should point to a specific diagnosis. "Fever-of-Unknown-Origin" (FUO) is the clinical scenario of daily fever for ≥ 14 days that defies explanation after a careful history, physical examination, and basic laboratory tests. The diagnostic approach requires a meticulous fever diary, serial clinical and laboratory evaluations, vigilance for the appearance of new signs and symptoms, and targeted investigations; the pace of the work-up is determined by the severity of the illness. Approximately half of children with FUO will have a self-limited illness and will never have a specific diagnosis made; the other half will ultimately be found to have, in order, infectious, inflammatory, or neoplastic conditions. Irregular, intermittent, recurrent fevers in the well-appearing child are likely to be sequential viral illnesses. Monogenic autoinflammatory diseases should be considered in those who do not fit the picture of recurrent infections and who do not have hallmarks of immune deficiency. Stereotypical febrile illnesses that recur with clockwork periodicity should raise the possibilities of cyclic neutropenia, if the cycle is approximately 21 days, or periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, the most common periodic fever in childhood.

The use of the probiotic Lactobacillus rhamnosus GG and viral findings in the nasopharynx of children attending day care

Limited data are available on the effects of probiotics on the nasopharyngeal presence of respiratory viruses in children attending day care. In this substudy of a randomized, double-blinded, placebo-controlled 28-week intervention study, nasopharyngeal swab samples were collected, on visits to a physician due to symptoms of infection, from children receiving control milk (N = 97) and children receiving the same milk supplemented with probiotic Lactobacillus rhamnosus GG (N = 97). The presence of 14 respiratory viruses was assessed by PCR methods, and viral findings were compared with symptom prevalences in the intervention groups. Rhinovirus was identified in 28.6% of 315 swab samples, followed by respiratory syncytial virus (12.4%), parainfluenza virus 1 (12.1%), enterovirus (8.9%), influenza A(H1N1)pdm09 (7.9%), human bocavirus 1 (3.8%), parainfluenza virus 2 (3.2%), adenovirus (2.9%), and influenza A(H3N2) (0.6%). The children in the probiotic group had less days with respiratory symptoms per month than the children in the control group (6.48 [95% CI 6.28-6.68] vs. 7.19 [95% CI 6.98-7.41], P < 0.001). Probiotic intervention did not reduce significantly the occurrence of the examined respiratory viruses, or have an effect on the number of respiratory symptoms observed at the time of a viral finding. Rhinovirus, respiratory syncytial virus, and parainfluenza virus 1 were the most common respiratory viruses in symptomatic children. Children receiving Lactobacillus rhamnosus GG had fewer days with respiratory symptoms than children in the control group, although probiotic intervention was not effective in reducing the amount of viral findings or the respiratory symptoms associated with viral findings.

Infection control in paediatric office settings

Transmission of infection in the paediatric office is of increasing concern. The present document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (eg, hand hygiene; use of gloves, masks, eye protection and gowns for specific procedures; adequate cleaning, disinfection and sterilization of surfaces and equipment including toys, and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies.

Effect of day care attendance on sensitization and atopic wheezing differs by Toll-like receptor 2 genotype in 2 population-based birth cohort studies

BACKGROUND

Variation in the Toll-like receptor 2 gene (TLR2/-16934) is associated with allergic diseases among farmers' children but not among children not living on farms.

OBJECTIVE

To test the hypothesis that the same genetic variant conferring protection in the farming environment is associated with reduced risk of developing allergic phenotypes among urban children attending day care in early life.

METHODS

In 2 population-based birth cohorts (Manchester, United Kingdom, Manchester Asthma and Allergy Study [MAAS]; Tucson, Ariz, Tucson Infant Immune Study [IIS]), participants were recruited prenatally and followed prospectively (MAAS: 3, 5, 8 and 11 years; IIS: 1, 2, 3 and 5 years). We assessed allergic sensitization and atopic wheezing at each follow-up.

RESULTS

A total of 727 children participated in Manchester and 263 in Tucson. We found no significant associations between TLR2/-16934 and sensitization and atopic wheeze in either cohort. However, a different pattern emerged when we explored the interaction between TLR2/-16934 and day care attendance on these outcomes. We found a significant interaction between day care and TLR2/-16934 on the development of sensitization in the longitudinal model in MAAS in that children carrying the T allele who attended day care were less likely to be sensitized than those who did not attend day care, whereas among AA homozygotes, the association tended to be in the opposite direction. In a longitudinal model in IIS, we found a significant interaction between day care attendance and TLR2/-16934 on the development atopic wheezing. Significant interactions between TLR2/-16934 and day care were maintained when adjusting for socioeconomic status.

CONCLUSION

The effect of day care on sensitization and atopic wheezing may differ among children with different variants of the TLR2 gene.

Epidemiology of viral respiratory tract infections in a prospective cohort of infants and toddlers attending daycare

BACKGROUND

The epidemiology of respiratory tract infections (RTIs) in a daycare cohort has not been explored using molecular techniques.

OBJECTIVES

(1) Determine the overall incidence of RTIs in a daycare cohort using real-time reverse transcriptase polymerase chain reaction (RT-PCR). (2) Determine the relative incidence and impact of specific respiratory viruses, and characterize and compare clinical features associated with these pathogens.

STUDY DESIGN

In this prospective cohort study conducted from February 2006 to April 2008, nasal swabs were obtained from symptomatic children ages 0-30 months enrolled in fulltime daycare. RT-PCR was performed to detect respiratory syncytial virus (RSV), human metapneumovirus (MPV), influenza (Flu) viruses A and B, parainfluenza (PIV), adenovirus (AdV), human coronaviruses (CoV) and rhinovirus (RhV). Symptom diaries were completed for each illness.

RESULTS

We followed 119 children (mean age 10 months; range 2-24 months) for 115 child years. The mean annual incidence of RTI per child was 4.2 the first year and 1.2 the second year of the study. At least 1 virus was identified in 67% RTIs. Co-infections were common (27% RTIs), with RhV, CoV, and AdV the most common co-pathogens. PIV was identified in 12% of RTIs with a high incidence of PIV4. The viruses with the greatest impact on our population were RSV, RhV and AdV.

CONCLUSIONS

Using molecular techniques, viruses were identified in approximately twice as many RTIs as previously reported in a daycare cohort. Infections with newly identified viruses, such as HMPV and CoV subtypes were less frequent and severe than infections with RSV, AdV and RhV.

Diarrhea and colds in child day care centers: impact of various numerator and denominator definitions of illness episodes

BACKGROUND

Numerators and denominators used to estimate infections' incidence rates (IRs), incidence rate ratios (IRRs), and differences (IRDs) vary. Our objective is to quantify the impact of various common definitions for illness episodes (numerators) and person-time at risk (denominators) in estimating these measures.

METHODS

Data were from a cohort study in which daily occurrence of illness and children's attendance in day care centers were recorded. We compared 4 IR estimates using various definitions of episode and at-risk time units.

RESULTS

IRs for diarrhea and colds were highest using child-days, lowest for diarrhea using child-weeks, and lowest for colds using child-months. The 4 methods led to similar IRRs but considerably different IRDs.

CONCLUSION

Incidence rate differences and ratios for infectious diseases can vary by the definition of episode and person-time at risk. This limits the value of the evidence base on which public health recommendations are formulated. Development of a more standard approach to measurement and reporting of IRs is recommended.

Day-care attendance, position in sibship, and early childhood wheezing: a population-based birth cohort study

BACKGROUND

There are conflicting data on the effect of day-care attendance and position in sibship on the development of wheezing.

OBJECTIVE

To investigate the relationship between day-care attendance and position in sibship with early childhood wheeze.

METHODS

Prospective population-based birth cohort. At age 5 years, we collected information on parentally reported symptoms (n = 922); lung function was ascertained using plethysmography (n = 745) and allergic sensitization by skin testing (n = 815). Participants were assigned into categories according to the age of entry to day-care (0-6, 6-12, >12 mo) and number of older siblings (0, 1, 2, >2).

RESULTS

Current wheeze was reported by 203 participants (22%); 224 (28%) were sensitized. In the multivariate model, sensitization (odds ratio, 2.47; 95% CI, 1.66-3.67), male sex (1.49, 1.01-2.20), maternal asthma (1.72, 1.10-2.68), and maternal smoking during pregnancy (2.15, 1.26-3.66) significantly increased the risk of wheezing. Entering day-care between 6 and 12 or after 12 months of age was significantly and inversely associated with current wheeze (0.25, 0.11-0.60; and 0.65, 0.44-0.98, respectively). Entry into nursery between 6 and 12 months reduced the risk of persistent wheezing (P = .04). We found no association between day-care attendance and lung function. Entering nursery in the first 6 months of life was associated with increased risk of atopy (2.47, 1.23-4.95). Having older siblings was associated only with rhinoconjunctivitis (0.72, 0.54-0.97).

CONCLUSION

Day-care attendance was associated with a reduced risk of current wheezing in 5-year-old children. The protective effect appeared strongest for children who entered day-care between the ages of 6 and 12 months.

Immunostimulants for preventing respiratory tract infection in children

BACKGROUND

Acute respiratory tract infections (ARTIs) are a major cause of childhood morbidity and mortality. Immunostimulants (IS) may reduce the incidence of ARTIs.

OBJECTIVES

To determine the efficacy and safety of IS in preventing ARTIs in children.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2005); MEDLINE (January 1966 to January 2006); and EMBASE (January 1990 to January 2006); PASCAL (up to January 2006); SciSearch (up to January 2006); and IPA (up to January 2006) for reports of trials. Investigators in the field were also contacted. Ongoing studies were searched in the trial registration web site, metaRegister of Controlled Trials.

SELECTION CRITERIA

All comparative trials which enrolled patients less than 18 years of age were included. The intervention of interest was the use of an IS medication administered by any method for preventing ARTIs. Clinical trials using random or quasi-random allocation and comparing IS medication or medications to placebo were included.

DATA COLLECTION AND ANALYSIS

The outcome on ARTIs was analyzed both as the mean number of ARTIs by group and as a percent change in the rate of ARTIs. Meta-analysis was undertaken using a random-effects model and results were presented as weighted mean differences (WMD) with 95% confidence intervals (CI). The trials search, quality assessment and data extraction were undertaken independently by two authors. A funnel plot suggested there may be publication bias in the trials identified.

MAIN RESULTS

Thirty-four placebo controlled trials (3877 participants) provided data in a form suitable for inclusion in the meta-analysis. When compared with placebo, the use of IS was shown to reduce ARTIs measured as the total numbers of ARTIs (WMD -1.27; 95% CI -1.58 to -0.97) and the difference in ARTIs rates (WMD -39.68%; 95% CI -47.27% to -32.09%). The trial quality was generally poor and a high level of statistical heterogeneity was evident. The subgroup analysis of bacterial IS studies produced similar results, with lower heterogeneity. No difference in adverse events was evident between the placebo and IS groups

AUTHORS' CONCLUSIONS

This review showed that IS reduces the incidence of ARTIs in children, by 40% on average. However, due to significant heterogeneity and the poor quality of the trials this positive result should be interpreted with caution. The safety profile of IS appears to be good. Further high-quality trials are needed and we encourage national health authorities to conduct large, multicenter, double-blind, placebo-controlled trials on the role of IS in the prevention of ARTIs.

Outbreak of Kingella kingae skeletal system infections in children in daycare

OBJECTIVE

The objective of this study is to describe the investigation of an outbreak of one culture-proven and two presumptive cases of Kingella kingae osteomyelitis detected within a 15-day period in a daycare center in Israel.

METHODS

Surveillance pharyngeal cultures were obtained from all attendees at the index daycare center and from two neighboring facilities. Combined amoxicillin-rifampin prophylaxis was administered to all children aged 6 to 30 months living in the community. K. kingae isolates were typed by pulsed field gel electrophoresis, random amplified polymorphic DNA analysis and sequencing of the rRNA genes.

RESULTS

Surveillance cultures showed that four of 11 attendees at the index facility as well as five of 12 and one of 15 attendees at neighboring daycare centers carried K. kingae. Typing of isolates showed that the isolate from a child with osteomyelitis was identical to all other isolates from the same daycare center and different from organisms derived from the other facilities. Administration of prophylactic antibiotics resulted in partial eradication of the organism.

CONCLUSIONS

Dissemination of K. kingae in a susceptible pediatric population may result in an outbreak of invasive disease. Our experience suggests the need for increased alertness for clusters of K. kingae infections among children in daycare.

Effectiveness of inactivated influenza vaccine for prevention of otitis media in children

OBJECTIVE

The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care.

STUDY DESIGN

This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004.

RESULT

The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05).

CONCLUSION

Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.

Infection prevention at day-care centres: feasibility and possible effects of intervention

OBJECTIVE

To study the effect of an educationally oriented intervention programme, with the recommendations from the National Board of Health and Welfare as a base.

DESIGN

A prospective intervention study.

SETTING

Six day-care centres in Växjö, Sweden. Three centres comprised the intervention group and three constituted the control group.

SUBJECTS AND MAIN OUTCOME MEASURES

The parents and personnel completed a questionnaire on their views concerning information about infectious diseases. During a nine-month period, parents of all children reported every episode of absence, the number of days absent, the cause of absence, and any contact with doctors or prescription of antibiotics.

RESULTS

The guidelines were implementable in routine child day-care. Parents found regular information valuable and felt better informed about infectious diseases. Multilevel analyses showed no statistically significant results of the intervention. "Infection-prone" children had more sickness absence, doctor's consultations, and antibiotic prescriptions than those not "infection-prone".

CONCLUSION

It is possible to implement an educationally oriented intervention programme directed against infectious diseases in child day-care. No significant effect of the intervention was found, which is why a larger intervention study is needed.

Infectious disease in pediatric out-of-home child care

Provision of some form of child care outside of the home is certainly not a new phenomenon. In the past, most out-of-home care was provided by a relative, a friend, or someone who had a specific relationship with the family of the child. The frequency of utilization of child care centers for out-of-home care and the different formats of out-of-home care services has increased within recent decades and will vary by geographic location. Also, there is an increased utilization of temporary child care such as "mother's day out" or baby-sitting services provided at churches, grocery stores, and other places. Child care centers represent special risks for transmission of infectious agents because young children exhibit high susceptibility to many community-acquired viruses and bacteria; they lack developmental understanding required for good hygiene; and they frequently receive antibiotics (appropriately and inappropriately). Infections acquired in child care centers can significantly impact the health of the children who acquire the infection and also result in significant economic impacts on the child's family, particularly if 1 or more of the parents has to lose time from work. In the United States, it is estimated that families who have children in child care lose 13 days of work per year for all types of infections. Interventions that have proven valuable for reducing infections within child care centers include the following: (1) formal written policies for infection control within the child care center, (2) formal education of child care center staff concerning infection control practices (needs to be repeated; preferably on a recurring basis), (3) good hand hygiene by both staff and children, (4) appropriate cleaning of contaminated surfaces, (5) separation of food preparation and diaper changing, (6) exclusion of certain ill children, (7) cohorting ill children when exclusion is not possible, (8) ensuring adequate age-appropriate immunization of child care attendees and staff, and (9) optimal ratios of children to staff.

Absence from childcare for respiratory illness

BACKGROUND

This population-based study investigated prospectively collected absence for respiratory illness data in two types of formal childcare (centre day care and family day care) in Perth, Western Australia, and factors associated with such absence.

METHODS

All centres (n = 11) and 95% of family day care caregivers (n = 130) selected at random from licensing lists agreed to participate. Demographic details were obtained from a parental questionnaire and absences were recorded prospectively. Characteristics of the child and family were described using univariate odds ratios (OR) with 95% confidence intervals (CI). Multivariable analysis including generalized estimating equations was used to investigate having at least one absence for respiratory illness, having two or more absences, and having six or more absences.

RESULTS

No statistically significant difference between care types for having had at least one absence episode for respiratory illness (OR 1.37, 95% CI 0.92-2.04) was found. Children who attended care for more days per week (OR 1.40, 95% CI 1.26-1.56) and those in the study for more weeks (OR 1.03, 95% CI 1.01-1.05) were more likely to be absent for respiratory illness. Those children in care for a greater number of hours per day were less likely to be absent (OR 0.88, 95% CI 0.80-0.97). Family history of bronchitis was also associated with absence for respiratory illness (OR 1.86, 95% CI 1.32-2.63).

CONCLUSIONS

Statistically significant factors which had an impact on absence for respiratory illness were primarily those relating to the time spent in childcare and to family history of bronchitis.

Effect of a nonavalent conjugate vaccine on carriage of antibiotic-resistant Streptococcus pneumoniae in day-care centers

BACKGROUND

In the developed societies, day-care centers (DCCs) play an important role in the spread of antibiotic-resistant pneumococci both within the facility and from the facility to the community. This study was conducted to determine the effect of a nonavalent pneumococcal conjugate vaccine (PCV-9) on the carriage of antibiotic-resistant pneumococci in the DCC.

SUBJECTS AND METHODS

Healthy DCC attendees ages 12 to 35 months were randomized to receive either PCV-9 or a control vaccine (conjugate meningococcus C vaccine) in a double blinded manner. Nasopharyngeal Streptococcus pneumoniae cultures were obtained from each subject before vaccination, monthly during the first year of follow-up and every 2 to 3 months during the second year of follow-up. For each isolate the serotype and antibiotic susceptibility were determined.

RESULTS

A total of 132 and 130 evaluable toddlers received either PCV-9 or the control vaccine, respectively. In total 3748 cultures were obtained, of which 2450 (65%) were positive for S. pneumoniae. The resistance rates to penicillin, trimethoprim-sulfamethoxazole and erythromycin were 36, 35 and 16%, respectively. Resistance rates to > or =1 and > or =3 antibiotic categories were 52 and 9%, respectively. Antibiotic resistance was found mainly in the 5 serotypes included in the pneumococcal conjugate vaccines (6B, 9V, 14, 19F and 23F) and in 2 related serotypes (6A and 19A). In the vaccinated group a clear and significant reduction of the carriage rate of the serotypes included in the vaccine and the related serotype 6A as well as an increase in the carriage rate of the serotypes not included in the vaccine were observed. In parallel a significant decrease in carriage rate of antibiotic-resistant pneumococci was observed. The reduction of carriage of antibiotic-resistant pneumococci was seen in all age windows but was greater in the age window <36 months.

CONCLUSIONS

The carriage rate of antibiotic-resistant S. pneumoniae, including multiply resistant S. pneumoniae, in DCC attendees is high. Pneumococcal conjugate vaccines seem to be an important tool for reducing the carriage rate of antibiotic-resistant pneumonia in DCCs.

Is there a common cold constitution?

OBJECTIVE

Constitutional factors might play a role in the susceptibility to clinical illness during the common cold. This study seeks to determine if the likelihood of developing frequent common colds persists during childhood.

DESIGN

The Tucson Children's Respiratory Study involves 1246 children enrolled at birth and followed prospectively since 1980 and 1984. Parents reported the occurrence of frequent (> or =4) colds during the past year by questionnaire at 2, 3, 6, 8, 11, and 13 years of age. Blood for ex vivo interferon-gamma responses was obtained at 9 months and 11 years of age.

RESULTS

After adjustment for potential confounding variables, children with frequent colds at year 2 or 3 were twice as likely to experience frequent colds at year 6 (relative risk [RR], 2.8; 95% confidence interval [CI], 2.1-3.9), year 8 (RR, 2.6; 95% CI, 2.1-3.3), year 11 (RR, 2.4; 95% CI, 1.8-3.1), and year 13 (RR, 2.1; 95% CI, 1.4-3.3) compared with children who had infrequent colds at years 2 and 3. At 9 months of age, children who ultimately experienced persistent frequent colds had lower interferon-gamma titers than children without persistent frequent colds (3.05 +/- 1.61 vs 3.74 +/- 1.39, P =.016); this finding persisted at 11 years of age.

CONCLUSION

These data suggest the existence of a common cold constitution, whereby some children are more susceptible to infection and/or the expression of clinical symptoms when infected than are other children.

Experience of respiratory and allergic illness in children attending childcare

OBJECTIVES

To describe previous illness for children attending two types of formal childcare (130 family daycare homes and 11 child daycare centres).

DESIGN

A questionnaire was completed by the parents of 846 children, which provided information about previous illness and associated factors. The questionnaire was conducted in Perth, Western Australia.

RESULTS

Of all children, 39% had experienced otitis media, 11% glue ear and 26% allergies; 18% had been diagnosed with asthma; 10% had been admitted to hospital with respiratory illness, and 9% had experienced more than six respiratory conditions in the previous year. Attending centre daycare compared with family daycare was more likely to be associated with some of the previous illness outcomes (more than six respiratory illnesses in the past year, asthma, otitis media and glue ear) but, for all children, the major predisposing factors associated with these illnesses were a family history of atopy or bronchitis.

CONCLUSIONS

Children with a history of respiratory illness or otitis media are more likely to be attending centre than family daycare, but family history of respiratory illness is an important risk factor for all children in childcare.

Effect of a conjugate pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees

BACKGROUND

Incidence and severity of respiratory infections are increased in day-care center attendees. Streptococcus pneumoniae is an important contributor to these infections.

OBJECTIVE

To examine whether the use of a pneumococcal conjugate vaccine could reduce the occurrence of respiratory infections and the ensuing antibiotic drug use in the day care.

METHOD

In this double blind, randomized, controlled study performed in 8 day-care centers located in Beer-Sheva, Israel, 264 toddlers ages 12 to 35 months at enrollment were randomized to receive either a 9-valent conjugate pneumococcal vaccine (conjugated to CRM197) or a control vaccine [conjugate meningococcus C vaccine (conjugated to CRM197)] and were followed for an average of 22 months. The main outcome measures were respiratory morbidity and antibiotic use.

RESULTS

An overall reduction of 7% in child months with > or = 1 reported illness episodes was observed among vaccinees (P = 0.008), and 85% of all episodes were related to the respiratory tract. Reductions of 15, 16 and 17% were observed in upper respiratory infections, lower respiratory problems and otitis media, respectively. An overall reduction of 17% in antibiotic days was observed [10% for upper respiratory infections, 20% for otitis and 47% for lower respiratory problems (P < or = 0.005 for each entity)]. The reduction in episodes and antibiotic use was greater for those <36 months of age than for the older children.

CONCLUSION

The reduction of respiratory problems, including those not traditionally considered of pneumococcal origin and the ensuing lowered antibiotic use in day-care center attendees by pneumococcal conjugate vaccination suggest a broader benefit from the vaccine than preventing invasive disease only.

The public health problem of acute respiratory illness in childcare

Acute respiratory illness continues to be a significant problem for children attending childcare. The problems for the child are in terms of prevalence, incidence, and quality of life. Additional costs relate to parental absence from work and loss of earnings. This paper reports on the literature, and notes that little research has been undertaken to determine whether there are long-term risks or benefits to experiencing acute respiratory illness in early childhood. Research to date is presented, and the role of public health nurses is discussed in relation to how they might assist in reducing the incidence/prevalence of acute respiratory illness in children attending childcare.

Comparison between two common methods for reporting cold and diarrhoea symptoms of children in daycare centre research

BACKGROUND

The increasing number of children attending day care centres (DCCs) in industrialized countries has refocused attention on the occurrence of infections and infectious diseases in these settings.

OBJECTIVE

To evaluate the agreement between two methods (parent method vs. educator method) for reporting the occurrence of respiratory and diarrhoeal infections.

METHODS

Fifty-two DCCs in Quebec, Canada, participated. Both educators and parents were invited to fill in calendars on which they would indicate the occurrence of colds and diarrhoea. For the parents' method, parents were telephoned biweekly to record their calendar information. For the educators' method, educators returned their calendar pages monthly (following prompting by phone, when necessary).

RESULTS

Three hundred and thirty-three parents of toddlers participated in the 15-month reporting period between September 1996 and November 1997. The average agreement between the two methods was low (13.5% for colds and 9.8% for diarrhoea). Overall estimates of the incidence rates of respiratory and diarrhoeal infections based on parents' method were higher than those based on educators' method.

CONCLUSIONS

Parents' data lead to larger estimations of incidence rates and are probably more valid than educators' data.

Acute lower respiratory infections in hospitalized children over a 6 year period in Tokyo

BACKGROUND

Acute lower respiratory infections are major causes of hospitalization in children and are mainly caused by respiratory viruses. In the present study, we investigated the etiologic agents responsible for acute lower respiratory infections from the period November 1986 to October 1992 in order to determine the seasonal pattern and different characteristics of age distribution of respiratory infectious agents, mainly virus infections.

METHODS

A total of 1521 patients with lower respiratory infections was hospitalized in Saiseikai Central Hospital, Tokyo, Japan. Nasopharyngeal secretions were obtained for virus isolation and paired sera in the acute and convalescent phases were obtained for serological examination.

RESULTS

Etiological agents were identified in 668 of 1521 patients (43.9%) by serological antibody responses, virus isolation and/or detection of virus antigen: 240 (15.8%) with respiratory syncytial (RS) virus; 62 (4.1%) with influenza virus type A; 26 (1.7%) with influenza virus type B; 86 (5.7%) with adenovirus; 81 (5.3%) with parainfluenza virus; 32 (2.1%) with measles virus; 20 (1.3%) with enteroviruses or Herpes virus other than respiratory viruses; 75 (4.9%) with Mycoplasma pneumoniae; 10 (0.7%) with pertussis; and 36 (2.4%) with mixed infections. In the remaining 853 patients (56.1%), etiologic agents were not identified. Respiratory syncytial (RS) virus was a main causative agent of respiratory infections in patients younger than 3 years of age. Influenza virus and M. pneumoniae were two main causative agents in patients with acute respiratory illness over 5 years of age. Parainfluenza virus type 3 was frequently observed in infants from 9 to 12 months of age. A distinct seasonal pattern of viral infections was consistently observed in each year during the study period; RS and influenza viruses were prevalent in winter, parainfluenza virus was prevalent in spring and M. pneumoniae was prevalent in summer and autumn. However, adenovirus infections were observed in all seasons. Serological responses were poor in patients younger than 1 year of age and they were mainly diagnosed by virus isolation or detection of virus antigen.

CONCLUSIONS

Virological epidemiology provides useful information in daily clinical practice for the prediction of etiological agents based on patient age and the seasonal distribution of agents. We should examine virus isolation and the detection of virus antigen, along with serological examinations in patients with respiratory infections, especially in infants younger than 1 year of age because of poor serological responses.

The impact of day care on ventilation tube insertion

OBJECTIVE

To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion.

DESIGN

A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance.

SETTING

Private practice in a mid-sized, southeastern university town.

PATIENTS AND CONTROLS

This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were age five or less at entry into the study.

INTERVENTIONS

Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications.

MAIN OUTCOME MEASURES

The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded.

RESULTS

Day care and younger age were both identified as risk factors associated with initial ventilation tube insertion. Only 11% (seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes (P = 0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone (P = 0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance.

New prospects in the prevention of otitis media

Otitis media is the most common bacterial infection in children, accounting for a substantial economic burden to the health care system. Together with concern for long-term developmental sequelae, prevention of otitis media has become a high priority area of research. A wide range of factors has been associated with an increased risk of acute otitis media. Most of these factors, however, predispose to upper respiratory tract infection which, in turn, can be considered the most important risk factor for acute otitis media. Conventionally, antimicrobial prophylaxis, tympanostomy tubes and adenoidectomy have been used for prevention of otitis media. At present, the vaccine approach seems to hold the greatest promise for ultimate prevention of otitis media. In addition to the bacterial vaccines, vaccines against the most common viruses predisposing to acute otitis media may also prove valuable in the prevention of otitis media.

Acute respiratory illness in the first year of primary school related to previous attendance at child care

The aim of this study was to assess the relationship between previous child care outside the home (day care or family care) and acute respiratory illness in the first year at primary school. Participants were 445 Adelaide school children (mean age 5 years 2 months), 73 per cent of those eligible. Information about early childhood, family, child care arrangements and illness history was obtained from a questionnaire completed by parents. A respiratory illness score was calculated from the parental reports of respiratory illness experience in the winter months of the second school term in 1992. Absences from school owing to respiratory illness were counted from school records. Children who had attended child care before commencing school had fewer episodes of acute respiratory illness and had fewer absences from school than children with no child care experience. Children who had attended child care prior to commencing school experienced half as many episodes of asthma as those children who had never attended child care. Children who attend day care before age five tend to experience less acute respiratory illness than their peers on school entry. Possible explanations include selection of illness-prone children into home care, protection against respiratory illness as a result of early exposure, and a shift in the age-related peak of illness.

The clinical impact of human respiratory virus infections

Acute respiratory infections are the most frequent illnesses of the human host. Most infections are caused by viruses and bacteria; the proportion caused by viruses is much greater. The viruses most frequently involved are adenoviruses, influenza viruses, parainfluenza viruses, respiratory syncytial viruses, and rhinoviruses. Acute respiratory infections are more common in young children, have rather specific seasonal occurrences, and some agents are associated with specific respiratory syndromes. Risk factors associated with increased incidence or severity of respiratory infections are occurrence in the very young or the elderly; crowding; being male; inhaled pollutants; anatomic, metabolic, genetic or immunologic disorders; and malnutrition, including vitamin or micronutrient deficiency. Respiratory infections are a much greater problem in developing countries than in developed countries and are the leading causes of death in children under 5 yr of age. The same agents cause infections, and the incidence of total respiratory infections is the same as in the developed countries. The precise causes of increased morbidity and mortality in the developing world are unclear, but crowding, inhaled pollutants, and malnutrition are likely candidates. The interactive role of viruses and bacteria is not clear but may play a role in increased severity of respiratory infections.

Carriage of Streptococcus pyogenes among infants and toddlers attending day-care facilities in closed communities in southern Israel

Infants and toddlers attending ten day-care facilities in closed communities in southern Israel were tested monthly for pharyngeal carriage of Streptococcus pyogenes and associated respiratory morbidity. Overall, the prevalence of Streptococcus pyogenes was 2.7% in infants and 8.4% in toddlers, reaching 8.5% and 17.8% in the two groups, respectively by midwinter. In 4 of 61 (6.6%) infants and 15 of 67 (22.4%) toddlers, the organism was recovered in more than one month (range 2 to 5 months). Streptococcus pyogenes in the pharynx was only associated with rhinitis during the spring and summer but not with other respiratory symptoms. During the study period, a mean of 0.9 strains were isolated in day-care facilities attended by infants, while a mean of 2.1 strains were found in toddlers. Young children attending day-care facilities show early acquisition of Streptococcus pyogenes in the pharynx.

Child care and infectious respiratory disease during the first two years of life in a rural Kenyan community

Recent research in the U.S. has demonstrated the health risks accompanying the increase in use of day care centers for infants and young children, a trend that reflects large-scale social and economic changes. The present study reports increased risk of respiratory disease in rural Kenyan children, resulting from increased exposure to unrelated young children. The shift in risk patterns accompanies sociocultural and economic trends during the 1970s: maternal participation in work groups for cash cropping and increased school attendance by other family members. Thus as in the American case, participation in modern patterns of household economics significantly influences the pattern of illness for infants and young children.

Acute illnesses in children. A description and analysis of the cumulative incidence proportion

OBJECTIVES

To describe parent-reported morbidity in relation to the psycho-social conditions of the families and to characterize families whose children are frequently ill.

DESIGN

The parent-reported morbidity in a two-month prospective period, and the psychosocial conditions of the families were registered by means of a questionnaire. The conditioned probability of parents' reporting an episode of illness was estimated by means of logistic regression analysis, taking the psycho-social conditions into consideration.

SETTING

18,949 families with at least one child under the age of 8 years, resident in the County of Ringkjøbing in western Denmark at 1 March 1988.

SUBJECTS

An age-stratified random sample of 1982 families was entered in the study. 1588 (82%) families returned the questionnaire.

RESULTS

The parents reported considerable morbidity in their children. The cumulative incidence proportion (CIP) for the period was 48%. The multivariate analysis of the parent-reported morbidity led to the following main results: 1) the morbidity was greatest for children aged 6 to 18 months, after which it decreased with age, 2) there was interaction between the care conditions and the child's age--CIP for children up to two years was largest for the children who were cared for in daycare, while the CIP for the older children was largest for the children who were cared for at home, 3) if the parents reported that the child's siblings suffered from chronic or frequently recurring morbidity, the child's morbidity rate was significantly increased, 4) mothers with higher education reported more morbidity in their children than mothers without this education, and 5) parents with a high perception of the general health threat ("worried" parents) reported more morbidity than did parents with a low perception.

CONCLUSIONS

The results made it possible to characterize families whose children were frequently reported ill.

Chemical disinfection to interrupt transfer of rhinovirus type 14 from environmental surfaces to hands

Rhinoviruses can survive on environmental surfaces for several hours under ambient conditions. Hands can readily become contaminated after contact with such surfaces, and self-inoculation may lead to infection. Whereas hand washing is crucial in preventing the spread of rhinovirus colds, proper disinfection of environmental surfaces may further reduce rhinovirus transmission. In this study, the capacities of Lysol Disinfectant Spray (0.1% o-phenylphenol and 79% ethanol), a domestic bleach (6% sodium hypochlorite diluted to give 800 ppm of free chlorine), a quaternary ammonium-based product (7.05% quaternary ammonium diluted 1:128 in tap water), and a phenol-based product (14.7% phenol diluted 1:256 in tap water) were compared in interrupting the transfer of rhinovirus type 14 from stainless steel disks to fingerpads of human volunteers upon a 10-s contact at a pressure of 1 kg/cm2. Ten microliters of the virus, suspended in bovine mucin (5 mg/ml), was placed on each disk, and the inoculum was dried under ambient conditions; the input number on each disk ranged from 0.5 x 10(5) to 2.1 x 10(6) PFU. The dried virus was exposed to 20 microliters of the test disinfectant. The Lysol spray was able to reduce virus infectivity by > 99.99% after a contact of either 1 or 10 min, and no detectable virus was transferred to fingerpads from Lysol-treated disks. The bleach (800 ppm of free chlorine) reduced the virus titer by 99.7% after a contact time of 10 min, and again no virus was transferred from the disks treated with it.(ABSTRACT TRUNCATED AT 250 WORDS)