ContextA growing proportion of young children in the United States participate
in day care, and these children are considered to be at high risk for influenza
infection. Whether vaccinating day care children reduces household transmission
of influenza is not known.ObjectiveTo evaluate the effect of vaccinating day care children on reducing
influenza-related morbidity among their household contacts.DesignSingle-blind, randomized controlled trial conducted during the 1996-1997
influenza season.SettingTen day care centers for children of US Navy personnel in San Diego,
Calif.ParticipantsA total of 149 day care attendees (aged 24-60 months) and their families
were randomized; 127 children and their 328 household contacts received 2
vaccine doses and were included in the analysis.InterventionsInactivated influenza vaccine was administered to 60 children with 162
household contacts, and hepatitis A vaccine as a control was administered
to 67 age-matched children with 166 household contacts.Main Outcome MeasuresInformation regarding febrile respiratory illnesses and related morbidity
for household contacts of influenza-vaccinated vs control children (subgrouped
by influenza-vaccinated and unvaccinated contacts), obtained by telephone
interviews with parents every 2 weeks from November 1996 through April 1997.ResultsInfluenza-unvaccinated household contacts (n = 120) of influenza-vaccinated
day care children had 42% fewer febrile respiratory illnesses (P = .04) compared with unvaccinated household contacts of control children.
Among school-aged household contacts (aged 5-17 years), there was an 80% reduction
among contacts of vaccinated children (n = 28) vs contacts of unvaccinated
children (n = 31) in febrile respiratory illnesses (P
= .01), as well as reductions of more than 70% in school days missed (P = .02), reported earaches (P
= .02), physician visits (P = .007), physician-prescribed
antibiotics (P = .02), and adults who missed work
to take care of ill children (P = .04).ConclusionsThese results indicate that vaccinating day care children against influenza
helps reduce influenza-related morbidity among their household contacts, particularly
among school-aged contacts. Future studies should be conducted in civilian
populations to assess the full effect of vaccinating day care children against
influenza.

https://jamanetwork.com/journals/jama/articlepdf/193137/joc00399.pdf

Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts.

The relationship between respiratory infectious diseases and form of day care was assessed in a retrospective cohort study of 2568 randomly selected children aged 1 through 7 years in Espoo, Finland. Day-care center children had an increased risk for the common cold, acute otitis media, and pneumonia. The risk concentrated in 1-year-old children, for whom the adjusted relative risks (incidence density ratios) for the common cold, otitis media, and pneumonia were 1.69 (95% confidence interval [CI] = 1.43, 2.01), 1.99 (95% CI = 1.57, 2.52), and 9.69 (95% CI = 2.31, 40.55), respectively. Among 1-year-old children, the proportion of infections attributable to care at day-care centers were 41% (95% CI = 30, 50) for colds, 50% (95% CI = 36, 60) for otitis media, and 85% (95% CI = 57, 98) for pneumonia. The results provide evidence that care in day-care centers is a determinant of acute respiratory infections in children under 2, whereas family day care does not essentially increase risk.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.85.8_Pt_1.1109

Form of day care and respiratory infections among Finnish children.

Importance Epidemiological studies support a link between low 25-hydroxyvitamin D levels and a higher risk of viral upper respiratory tract infections. However, whether winter supplementation of vitamin D reduces the risk among children is unknown. Objective To determine whether high-dose vs standard-dose vitamin D supplementation reduces the incidence of wintertime upper respiratory tract infections in young children. Design, Setting, and Participants A randomized clinical trial was conducted during the winter months between September 13, 2011, and June 30, 2015, among children aged 1 through 5 years enrolled in TARGet Kids!, a multisite primary care practice–based research network in Toronto, Ontario, Canada. Interventions Three hundred forty-nine participants were randomized to receive 2000 IU/d of vitamin D oral supplementation (high-dose group) vs 354 participants who were randomized to receive 400 IU/d (standard-dose group) for a minimum of 4 months between September and May. Main Outcome Measures The primary outcome was the number of laboratory-confirmed viral upper respiratory tract infections based on parent-collected nasal swabs over the winter months. Secondary outcomes included the number of influenza infections, noninfluenza infections, parent-reported upper respiratory tract illnesses, time to first upper respiratory tract infection, and serum 25-hydroxyvitamin D levels at study termination. Results Among 703 participants who were randomized (mean age, 2.7 years, 57.7% boys), 699 (99.4%) completed the trial. The mean number of laboratory-confirmed upper respiratory tract infections per child was 1.05 (95% CI, 0.91-1.19) for the high-dose group and 1.03 (95% CI, 0.90-1.16) for the standard-dose group, for a between-group difference of 0.02 (95% CI, −0.17 to 0.21) per child. There was no statistically significant difference in number of laboratory-confirmed infections between groups (incidence rate ratio [RR], 0.97; 95% CI, 0.80-1.16). There was also no significant difference in the median time to the first laboratory-confirmed infection: 3.95 months (95% CI, 3.02-5.95 months) for the high-dose group vs 3.29 months (95% CI, 2.66-4.14 months) for the standard-dose group, or number of parent-reported upper respiratory tract illnesses between groups (625 for high-dose vs 600 for standard-dose groups, incidence RR, 1.01; 95% CI, 0.88-1.16). At study termination, serum 25-hydroxyvitamin D levels were 48.7 ng/mL (95% CI, 46.9-50.5 ng/mL) in the high-dose group and 36.8 ng/mL (95% CI, 35.4-38.2 ng/mL) in the standard-dose group. Conclusions and Relevance Among healthy children aged 1 to 5 years, daily administration of 2000 IU compared with 400 IU of vitamin D supplementation did not reduce overall wintertime upper respiratory tract infections. These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections. Trial Registration clinicaltrials.gov Identifier:NCT01419262

/pdf/effect-of-high-dose-vs-standard-dose-wintertime-vitamin-d-3660r9awzr.pdf

Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children

Objective.Child care outside the home increases children's infections substantially. We have to evaluate the possibilities for reducing the transmission of infections by an infection prevention program.Design and methods.A 15-month randomized controlled trial involving 20 day-care centers was conduc

An open randomized controlled trial of infection prevention in child day-care centers.

The objective of this study was to assess the effectiveness of a hygiene program in reducing the incidence of respiratory and diarrheal diseases in toddlers attending day care centers. A randomized field trial was conducted in 52 day care centers in Quebec, Canada, between September 1, 1996 and November 30, 1997. Absences for any reasons and the daily occurrence of colds and/or diarrhea in toddlers were recorded on calendars by the educators. The number of fecal coliforms on children's hands and on educators' hands was measured during three unannounced visits. Overall, 1,729 children were followed in 47 day care centers for a total of 153,643 child-days. The incidence rate of diarrhea was considerably reduced by the effect of monitoring (IRR = 0.73, 95% CI = 0.54,0.97), and the intervention reduced the incidence rate of upper respiratory tract infections (IRR = 0.80, 95% CI = 0.68,0.93). Monitoring alone also had an important effect in reducing the level of bacterial contamination on children's and educators' hands. The results indicate that both an intervention program and monitoring alone play a role in reducing infections in children attending day care centers.

Effectiveness of a training program in reducing infections in toddlers attending day care centers

We studied 843 children under 36 months of age enrolled in a prepaid health plan from September 1985 through March 1986, to identify characteristics of day care which might be risk factors for infection and to describe the resulting economic costs. Children cared for in their own home had a mean of 2.03 infections diagnosed during the study period. Adjusted rates of excess infection (95 per cent CI) for children cared for in other settings were: -.09 (-.73, .54) in relatives' homes; .10 (-.51, .71) in day care homes; .79 (.13, 1.45) in day care centers; .60 (-.24, 1.46) in mother's day out programs; and .66 (-.01, 1.34) in multiple settings. Children in day care centers were 4.5 times more likely to be hospitalized than those in other settings (95 per cent CI = 1.55, 13.00), primarily due to an increased rate of tympanostomy tube placement (relative risk 3.79, 95 per cent CI = 1.04, 13.36). The strongest predictor of illness risk was the number of other children in the room. The mean monthly cost of medical care was $32.94 for children in the highest risk settings compared with $19.78 for those in other settings. Illness in a child in our study accounted for 40 per cent of parental absenteeism from work; the mean number of days lost per month was 0.52 for parents of children in day care centers compared with 0.37 for those of children in other forms of full time care outside the home.

Illness associated with child day care: a study of incidence and cost.

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Illness associated with child day care: a study of incidence and cost.