title: The impact of active intervention on the spread of penicillin-resistant Streptococcus pneumoniae in Swedish day-care centres.
abstract: Policies for handling cases of penicillin-non-susceptible Streptococcus pneumoniae (PNSP) in day-care groups vary between different counties in Sweden. The aim of this study was to evaluate the epidemiological effect of excluding PNSP-carriers from children's day-care centres (DCC). We followed the incidence in 14 DCC groups with ongoing PNSP-spread, by repeated group screens until no further cases could be identified. All identified carriers were excluded from DCC attendance in study area A (Skåne region) while they remained in the group in study area B (Göteborg and örebro), according to local policies. The intervention effect was evaluated by comparing the number of additional cases after the baseline screen (start of the intervention period) between the 2 study areas. All PNSP-isolates were characterized by resistance pattern, serotype and pulse-field gel electrophoresis. The relative risk for children in DCCs without active intervention was 6.4 (95% CI: 2.0-20.7). Each prevented case in area A can be estimated to have demanded the exclusion of 2 other children from day care for approximately 4 weeks each. The total cost-benefit outcome of this action has to be seen in the light of the local situation with regard to the population prevalence and the distribution of other risk factors.
authors.affiliation: Department of Epidemiology, Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Högberg
authors.forename: Birgitta
authors.initials: B
authors.lastname: Henriques Normark
authors.forename: Håkan
authors.initials: H
authors.lastname: Ringberg
authors.forename: Karin
authors.initials: K
authors.lastname: Stenqvist
authors.forename: Hans
authors.initials: H
authors.lastname: Fredlund
authors.forename: Patricia
authors.initials: P
authors.lastname: Geli
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Grabowska
authors.forename: Eva
authors.initials: E
authors.lastname: Melander
authors.forename: Martin
authors.initials: M
authors.lastname: Laurell
authors.forename: Christina
authors.initials: C
authors.lastname: Ahrén
authors.forename: Eva
authors.initials: E
authors.lastname: Törnqvist
authors.forename: Rosmarie
authors.initials: R
authors.lastname: Fält
authors.forename: Dag
authors.initials: D
authors.lastname: Höglund
authors.forename: Gunnel
authors.initials: G
authors.lastname: Möllerberg
authors.forename: Karl
authors.initials: K
authors.lastname: Ekdahl
mesh_terms: D017677:Age Distribution; D002353:Carrier State / Q000382:microbiology*; D002656:Child Day Care Centers; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D015337:Multicenter Studies as Topic; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D017678:Sex Distribution; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013548:Sweden / Q000453:epidemiology