title: Prospective study of diarrhoeal outbreaks in child long-daycare centres in western Sydney.
abstract: OBJECTIVE
  To investigate outbreaks of diarrhoeal illness in children attending long-daycare centres (LDCs), to characterise parasitic, bacterial and viral isolates from the children's faeces and to identify individual and LDC risk factors for diarrhoea.
  
  
  METHODS
  Eleven-month prospective case-control study of diarrhoeal outbreaks among children in LDCs.
  
  
  METHODS
  2368 children attending 35 LDCs in the western Sydney area.
  
  
  METHODS
  Frequency of diarrhoeal outbreaks, rate of attack and spread to family members; pathogens isolated from stools; and individual and LDC risk factors.
  
  
  RESULTS
  The overall incidence of diarrhoeal disease was low (0.28 outbreaks per centre per year and 0.056 outbreak-associated cases per child-year). Attack rates during outbreaks varied widely (4%-55%; mean, 15%), as did secondary spread rates to family members (1%-15%; mean, 9%). Pathogens were isolated from 7% of symptomatic children and 7% of controls; no outbreak was shown to be caused by a recognised pathogen. Children with outbreak-associated diarrhoeal illness were more likely to have suffered vomiting, poor appetite, lack of energy, fever and to have taken antibiotics in the previous week than other children. Hygiene practices varied widely among centres.
  
  
  CONCLUSIONS
  We found low incidence and morbidity from diarrhoeal illness in Australian urban LDCs. Diarrhoea in children in LDCs may be caused predominantly by non-infectious factors such as diet and antibiotic exposure. Current hygiene measures in LDCs seem adequate to prevent and contain outbreaks of infectious diarrhoea.
authors.affiliation: Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW.
authors.forename: J K
authors.initials: JK
authors.lastname: Ferguson
authors.forename: L R
authors.initials: LR
authors.lastname: Jorm
authors.forename: C D
authors.initials: CD
authors.lastname: Allen
authors.forename: P K
authors.initials: PK
authors.lastname: Whitehead
authors.forename: G L
authors.initials: GL
authors.lastname: Gilbert
mesh_terms: D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D004196:Disease Outbreaks; D005192:Family Health; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D006801:Humans; D006920:Hygiene; D015994:Incidence; D007223:Infant; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D014504:Urban Health