Rotavirus is a good example of the kind of disease that is easily transmitted in child care settings.
There are others as well, most of them considerably less serious in their effects than rotavirus, but nevertheless things to watch out for. Among them is hepatitis A (HAV).
Although there is a vaccine for it, hepatitis A remains a threat in day care centers. Hepatitis A is a very tough virus, and the usual route of transmission is fecal-oral. It can last on environmental surfaces for more than a month, and to kill it with heat, you have to cook food to 185°F for at least a minute. Surfaces can be disinfected with a 1-to-100 solution of household bleach.
No one is quite sure why, but the highest rates of HAV occur in western and southwestern states. Eleven states in the United States constitute 22 percent of the country’s population: California, Alaska, Washington, Oregon, New Mexico, Utah, Arizona, Oklahoma, South Dakota, Idaho, and Nevada. But those same states are home to 50 percent of the HAV cases.
Interestingly, though, the threat is not that great for the kids themselves. Most kids who get hepatitis A have symptoms so mild that no one pays much attention to them, or they have no symptoms at all.
The problem is that it is transmitted by toddlers to adults and older children, and it can make these older people very sick indeed. The very young kids serve as what epidemiologists call the reservoir of disease. The results of this transmission are serious: between 11 and 22 percent of people with the illness wind up in the hospital, and about 100 people a year die from liver complications of HAV. The fatality rates among people over 50 are the highest.
Since hepatitis A is caused mainly by contact with the feces of an infected person, most people would probably guess that being a sewage worker would put you at much higher risk for HAV than being a day care worker. But in fact, no work-related instances of HAV transmission have ever been reported among sewage workers in the United States, while outbreaks traced to day care centers have been recognized for at least the past 30 years.
The cause is just what you’re thinking: poor hygiene among little kids and poor handling of dirty diapers. In day care centers that have toilet training as an admission requirement, HAV outbreaks are rare. Because HAV has few symptoms in kids, the way the outbreak is usually noticed is that a bunch of adults, usually parents, get ill. For some reason, staff at day care centers don’t get ill at the same high rates as parents do.
The Centers for Disease Control and the Advisory Committee on Immunization Practices recommends hepatitis A vaccination only for high-risk groups and in high-risk geographical areas. There is currently no approved vaccination formulation or schedule for children under two years old.
When a vaccine can be used for children under two, the elimination of transmission of HAV will be possible.