title: Characteristics of child daycare centres associated with clustering of major enteropathogens.
abstract: Insights into transmission dynamics of enteropathogens in children attending daycare are limited. Here we aimed at identifying daycare centre (DCC) characteristics associated with time-clustered occurrence of enteropathogens in DCC-attending children. For this purpose, we used the KIzSS network, which comprises 43 DCCs that participated in infectious disease surveillance in The Netherlands during February 2010-February 2013. Space-time scan statistics were used to identify clusters of rotavirus, norovirus, astrovirus, Giardia lamblia and Cryptosporidium spp. in a two-dimensional DCC characteristic space constructed using canonical correlation analysis. Logistic regression models were then used to further identify DCC characteristics associated with increased or decreased odds for clustering of enteropathogens. Factors associated with increased odds for enteropathogen clustering in DCCs were having indoor/outdoor paddling pools or sandpits, owning animals, high numbers of attending children, and reporting outbreaks to local health authorities. Factors associated with decreased odds for enteropathogen clustering in DCCs were cleaning child potties in designated waste disposal stations, cleaning vomit with chlorine-based products, daily cleaning of toys, extra cleaning of toys during a suspected outbreak, and excluding children with gastroenteritis. These factors provide targets for reducing the burden of gastrointestinal morbidity associated with time-clustered occurrence of major enteropathogens in DCC attendees.
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Pijnacker
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Mughini-Gras
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Vennema
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Enserink
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: C C
authors.initials: CC
authors.lastname: VAN DEN Wijngaard
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Kortbeek
authors.affiliation: Center for Infectious Disease Control,National Institute for Public Health and the Environment (RIVM),The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: VAN Pelt
mesh_terms: D019200:Astroviridae / Q000502:physiology; D019350:Astroviridae Infections / Q000453:epidemiology / Q000821:virology; D017250:Caliciviridae Infections / Q000453:epidemiology / Q000821:virology; D002656:Child Day Care Centers / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016000:Cluster Analysis; D003457:Cryptosporidiosis / Q000453:epidemiology; D003458:Cryptosporidium / Q000502:physiology; D004196:Disease Outbreaks; D005759:Gastroenteritis / Q000453:epidemiology* / Q000469:parasitology / Q000821:virology; D016829:Giardia lamblia / Q000502:physiology; D005873:Giardiasis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D009426:Netherlands / Q000453:epidemiology; D029322:Norovirus / Q000502:physiology; D015995:Prevalence; D012307:Risk Factors; D012401:Rotavirus / Q000502:physiology; D012400:Rotavirus Infections / Q000453:epidemiology / Q000821:virology
keywords: Childhood infection; cluster; daycare; epidemiology; risk factor