Recognition, Investigation, and Control of Communicable-Disease Outbreaks in Child Day-Care Settings

As increasing numbers of young children attend day-care centers in the US, the elevated risk of acquiring infectious diseases in this setting has emerged as an important public health issue.1 Outbreaks of infectious diseases occur frequently within the daycare setting,2 and enteric and respiratory pathogens may be readily transmitted to household members and others in the community.1,2 The economic burden of these outbreaks is considerable; for example, parents of children in day care miss an average of I to 4 weeks of work each year to care for their sick children.1 Investigations of communicable-disease outbreaks in day-care centers have provided a wealth of information useful in developing and implementing infection-control policies and guidelines. While documented experiences with outbreaks in day-care settings have been relatively recent, they have rapidly expanded our understanding of reservoirs of infectious agents, routes of transmission, clinical characteristics of illness, risk factors for infection, the effectiveness of interventions, and recognition of pathogens previously not reportable or thought to be unimportant. Outbreak investigations in day-care centers reported in the literature have focused primarily on the etiologic agents listed in the Table. The purpose of this paper is to provide a brief overview of methodologic issues pertinent to such investigations