title: High prevalence of Staphylococcus aureus and methicillin-resistant S. aureus colonization among healthy children attending public daycare centers in informal settlements in a large urban center in Brazil.
abstract: BACKGROUND
  In the past decade methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly prevalent in community settings. Attending a daycare center (DCC) is a known risk factor for colonization with MRSA. Brazil operates free, public DCCs for low-income families, some of which are located in census tracts defined by the Brazilian Census Bureau as informal settlements (aglomerados subnormais, AGSN). Physical and demographic characteristics of AGSNs suggest that S. aureus colonization prevalence would be higher, but little is known about the prevalence of MRSA in these settings.
  
  
  METHODS
  We conducted a cross-sectional study to assess risk factors for S. aureus and MRSA colonization among children attending DCCs located in AGSN vs non-AGSN. Nasal swabs were collected from children aged three months to six years in 23 public DCCs in Niterói, Brazil between August 2011 and October 2012.
  
  
  RESULTS
  Of 500 children enrolled in the study, 240 (48%) were colonized with S. aureus and 31 (6.2%) were colonized with MRSA. Children attending DCCs in AGSNs were 2.32 times more likely to be colonized with S. aureus (95% CI: 1.32, 4.08), and 3.27 times more likely to be colonized with MRSA than children attending non-AGSN DCCs (95% CI: 1.52, 7.01), adjusted for confounding variables.
  
  
  CONCLUSIONS
  S. aureus and MRSA colonization prevalence among children attending DCCs in informal settlement census tracts was higher than previously reported in healthy pre-school children in Latin America. Our data suggest that transmission may occur more frequently in DCCs rather than at home, highlighting the importance of DCCs in AGSNs as potential MRSA reservoirs. This finding underscores the importance of local epidemiologic surveillance in vulnerable AGSN communities.
authors.forename: Eneida Dias Vianna
authors.initials: ED
authors.lastname: Braga
authors.affiliation: Laboratório Universitário Rodolpho Albino, Programa de Pós-graduação em Patologia, Fluminense Federal University, Rua: Mário Viana, 523, Santa Rosa - Niterói- RJ CEP, Niterói, Rio de Janeiro 24241-002, Brazil. faalves@vm.uff.br.
authors.forename: Fábio
authors.initials: F
authors.lastname: Aguiar-Alves
authors.forename: Maria de Fátima Nogueira
authors.initials: Mde F
authors.lastname: de Freitas
authors.forename: Monique Oliveira
authors.initials: MO
authors.lastname: de e Silva
authors.forename: Thami Valadares
authors.initials: TV
authors.lastname: Correa
authors.forename: Robert E
authors.initials: RE
authors.lastname: Snyder
authors.forename: Verônica Afonso
authors.initials: VA
authors.lastname: de Araújo
authors.forename: Mariel Asbury
authors.initials: MA
authors.lastname: Marlow
authors.forename: Lee W
authors.initials: LW
authors.lastname: Riley
authors.forename: Sérgio
authors.initials: S
authors.lastname: Setúbal
authors.forename: Licínio Esmeraldo
authors.initials: LE
authors.lastname: Silva
authors.forename: Claudete Aparecida
authors.initials: CA
authors.lastname: Araújo Cardoso
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology; D002656:Child Day Care Centers / Q000706:statistics & numerical data; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D015995:Prevalence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D014504:Urban Health