The impact of active intervention on the spread of penicillin-resistant Streptococcus pneumoniae in Swedish day-care centres.
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.
Högberg
Liselotte
L
Department of Epidemiology, Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
Henriques Normark
Birgitta
B
Ringberg
Håkan
H
Stenqvist
Karin
K
Fredlund
Hans
H
Geli
Patricia
P
Grabowska
Katarzyna
K
Melander
Eva
E
Laurell
Martin
M
Ahrén
Christina
C
Törnqvist
Eva
E
Fält
Rosmarie
R
Höglund
Dag
D
Möllerberg
Gunnel
G
Ekdahl
Karl
K
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