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Risk factors for gastroenteritis in child day care

  • R. ENSERINK (a1) (a2), L. MUGHINI-GRAS (a1) (a3), E. DUIZER (a1), T. KORTBEEK (a1) and W. VAN PELT (a1)...


The child day-care centre (DCC) is often considered as one risk factor for gastroenteritis (GE) rather than a complex setting in which the interplay of many factors may influence the epidemiology of GE. This study aimed to identify DCC-level risk factors for GE and major enteropathogen occurrence. A dynamic network of 100 and 43 DCCs participated in a syndromic and microbiological surveillance during 2010–2013. The weekly incidence of GE events and weekly prevalence of five major enteropathogens (rotavirus, norovirus, astrovirus, Giardia lamblia, Cryptosporidium hominis/parvum) were modelled per DCC using mixed-effects negative binomial/Poisson regression models. Sixteen hundred children were surveyed up to 3 years, during which 1829 GE episodes were reported and 5197 faecal samples were analysed. Identified risk factors were: large DCC capacity, crowding, having animals, nappy changing areas, sandpits, paddling pools, cleaning potties in normal sinks, cleaning vomit with paper towels (but without cleaner), mixing of staff between child groups, and staff members with multiple daily duties. Protective factors were: disinfecting fomites with chlorine, cleaning vomit with paper towels (and cleaner), daily cleaning of bed linen/toys, cohorting and exclusion policies for ill children and staff. Targeting these factors may reduce the burden of DCC-related GE.

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Corresponding author

* Author for correspondence: Dr R. Enserink, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands. (Email:


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1. Enserink, R, et al. Infectious disease burden related to child day care in the Netherlands. Pediatric Infectious Disease Journal 2013; 32: e334340.
2. Friesema, IH, et al. Costs of gastroenteritis in the Netherlands, with special attention for severe cases. European Journal of Clinical Microbiology & Infectious Diseases 2012; 31: 18951900.
3. Davis, JP, Pfeiffer, JA. Surveillance of communicable diseases in child day care settings. Reviews of Infectious Diseases 1986; 8: 613617.
4. Ferguson, JK, et al. Prospective study of diarrhoeal outbreaks in child long-daycare centres in western Sydney. Medical Journal of Australia 1995; 163: 137140.
5. Gudnason, T, et al. Does hygiene intervention at day care centres reduce infectious illnesses in children? An intervention cohort study. Scandinavian Journal of Infectious Diseases 2013; 45: 397403.
6. Janssen, A. Prevention of norovirus infection in schools and childcare facilities. Stockholm: European Centre for Disease Control (ECDC), 2012.
7. Enserink, R, et al. Gastroenteritis attributable to 16 enteropathogens in children attending day care. significant effects of rotavirus, norovirus, astrovirus, Cryptosporidium and Giardia. Pediatric Infectious Disease Journal (in press).
8. Meulders, D, et al. The provision of childcare services – a comparative review of 30 European countries. Brussels: European Commission, 2009.
9. Enserink, R, et al. The KIzSS network, a sentinel surveillance system for infectious diseases in day care centers: study protocol. BMC Infectious Diseases 2012; 12: 259.
10. Ward, M, et al. Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, 2003. Eurosurveillance 2005; 10: 2730.
11. Härdle, W, Simar, L. Applied Multivariate Statistical Analysis. Berlin, Heidelberg, Dordrecht and New York: Springer, 2007.
12. Augustine, JM, Crosnoe, RL, Gordon, R. Early child care and illness among preschoolers. Journal of Health and Social Behavior 2013; 54: 315334.
13. Boone, SA, Gerba, CP. The occurrence of influenza A virus on household and day care center fomites. Journal of Infection 2005; 51: 103109.
14. Mitchell, DK, et al. Virologic features of an astrovirus diarrhea outbreak in a day care center revealed by reverse transcriptase-polymerase chain reaction. Journal of Infectious Diseases 1995; 172: 14371444.
15. Chadwick, PR, et al. Management of hospital outbreaks of gastro-enteritis due to small roundstructured viruses. Journal of Hospital Infection 2000; 45: 110.
16. de Wit, MA, Koopmans, MP, van Duynhoven, YT. Risk factors for norovirus, Sapporo-like virus, and group A rotavirus gastroenteritis. Emerging Infectious Diseases 2003; 9: 15631570.
17. Enserink, R, et al. Absence of influenza A(H1N1) during seasonal and pandemic seasons in a sentinel nursing home surveillance network in the Netherlands. Journal of the American Geriatrics Society 2011; 59: 23012305.
18. Taylor, M, Adams, CL, Ellis, A. Gatekeepers of health: a qualitative assessment of child care centre staff's perspectives, practices and challenges to enteric illness prevention and management in child care centres. BMC Public Health 2008; 8: 212.
19. Sagebiel, D, et al. Giardiasis in kindergartens: prevalence study in Berlin, Germany, 2006. Parasitology Research 2009; 105: 681687.
20. Overgaauw, PA, et al. Zoonotic parasites in fecal samples and fur from dogs and cats in The Netherlands. Veterinary Parasitology 2009; 163: 115122.
21. Matsuo, J, Nakashio, S. Prevalence of fecal contamination in sandpits in public parks in Sapporo City, Japan. Veterinary Parasitology 2005; 128: 115119.
22. Mughini-Gras, L, et al. Risk factors for human salmonellosis originating from pigs, cattle, broiler chickens and egg laying hens: a combined case-control and source attribution analysis. PLoS ONE 2014; 9: e87933.
23. Paludo, ML, et al. Frequency of Toxocara infection in children attended by the health public service of Maringa, south Brazil. Revista do Instituto de Medicina Tropical de Sao Paulo 2007; 49: 343348.
24. Carabin, H, et al. Effectiveness of a training program in reducing infections in toddlers attending day care centers. Epidemiology 1999; 10: 219227.
25. Podewils, LJ, et al. Outbreak of norovirus illness associated with a swimming pool. Epidemiology and Infection 2007; 135: 827833.
26. Hilfman, MM. Giardia in Leningrad [in Dutch]. Nederlands Tijdschrift voor Geneeskunde 1975; 119: 1872.
27. Fournet, N, et al. Simultaneous increase of Cryptosporidium infections in the Netherlands, the United Kingdom and Germany in late summer season, 2012. Eurosurveillance 2013; 18: 37.
28. Weniger, BG, et al. Fecal coliforms on environmental surfaces in two day care centers. Applied and Environmental Microbiology 1983; 45: 733735.
29. Cody, MM, Sottnek, HM, O'Leary, VS. Recovery of Giardia lamblia cysts from chairs and tables in child day-care centers. Pediatrics 1994; 94: 10061008.
30. Lyman, WH, et al. Prospective study of etiologic agents of acute gastroenteritis outbreaks in child care centers. Journal of Pediatrics 2009; 154: 253257.
31. Tuladhar, E, et al. Residual viral and bacterial contamination of surfaces after cleaning and disinfection. Applied and Environmental Microbiology 2012; 78: 77697775.
32. Richardson, M, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatric Infectious Disease Journal 2001; 20: 380391.
33. Barros, AJ, et al. Preventing acute respiratory infections and diarrhoea in child care centres. Acta Paediatrica 1999; 88: 11131118.
34. Brady, MT. Infectious disease in pediatric out-of-home child care. American Journal of Infection Control 2005; 33: 276285.
35. Zomer, TP, et al. Sociocognitive determinants of observed and self-reported compliance to hand hygiene guidelines in child day care centers. American Journal of Infection Control 2013; 41: 862867.
36. Pickering, LK, et al. Asymptomatic excretion of rotavirus before and after rotavirus diarrhea in children in day care centers. Journal of Pediatrics 1988; 112: 361365.
37. Sukhrie, FH, et al. Nosocomial transmission of norovirus is mainly caused by symptomatic cases. Clinical Infectious Diseases 2012; 54: 931937.
38. Hiebert, R, Nordin, M. Methodological aspects of outcomes research. European Spine Journal 2006; 15 (Suppl. 1): S416.
39. O'Boyle, CA, Henly, SJ, Larson, E. Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American Journal of Infection Control 2001; 29: 352360.



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