title: Infectious disease burden related to child day care in the Netherlands.
abstract: BACKGROUND
  Studying day-care-associated infectious disease dynamics aids in formulating evidence-based guidelines for disease control, thereby supporting day-care centers in their continuous efforts to provide their child population with a safe and hygienic environment. The objective of this study was to estimate the (excess) infectious disease burden related to child day-care attendance in the Netherlands.
  
  
  METHODS
  A Dutch surveillance network of child day-care centers (DCCs) prospectively reported on infectious disease episodes and related use of health care among their child population on a daily basis from March 2010 to March 2012.
  
  
  RESULTS
  Gastroenteritis (387 per 1000 child-years) and influenza-like illness (247 per 1000 child-years) were the most frequently reported infectious diseases. DCCs reported these infectious diseases to occur twice as often among children aged 0-2 years compared with children aged 2-4 years. Antibiotic treatment was required in 6%, a general practitioner visit in 29% and hospitalization in 2% of infectious disease episodes. DCC incidences of gastroenteritis and influenza-like illness requiring children to visit a general practitioner were approximately twice as high as general population estimates for this age group. Part of the DCCs indicated to not always wash the hands of children before eating (34%) or after a toilet visit (15%) or to not always clean the toilet and kitchen areas (17%) on a daily basis.
  
  
  CONCLUSIONS
  The infectious disease risk associated with child day-care attendance is substantial, particularly among the very young attendees, in excess of general population estimates for this age group and potentially partly preventable.
authors.affiliation: Center for Infectious Disease Control-Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment-RIVM, Bilthoven, the Netherlands. remko.enserink@rivm.nl
authors.forename: Remko
authors.initials: R
authors.lastname: Enserink
authors.forename: Rolf
authors.initials: R
authors.lastname: Ypma
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Henriette A
authors.initials: HA
authors.lastname: Smit
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005759:Gastroenteritis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007251:Influenza, Human / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D062486:Public Health Surveillance