title: Secondary Haemophilus influenzae type b in day-care facilities. Risk factors and prevention.
abstract: The risk factors for acquisition of secondary day-care-associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle-King County, Washington; Atlanta; and the state of Oklahoma. During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities. In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom. Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old. Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease. Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease. Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%). For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts.
mesh_terms: D000367:Age Factors; D001425:Bacterial Outer Membrane Proteins / Q000032:analysis; D002656:Child Day Care Centers; D002675:Child, Preschool; D005845:Georgia; D006192:Haemophilus Infections / Q000517:prevention & control / Q000635:transmission*; D006193:Haemophilus influenzae / Q000145:classification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008583:Meningitis, Haemophilus / Q000635:transmission; D009825:Oklahoma; D012293:Rifampin / Q000627:therapeutic use; D012306:Risk; D013997:Time Factors; D014861:Washington
chemical_list: D001425:Bacterial Outer Membrane Proteins; D012293:Rifampin